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Toyoda H, Kumada T, Tada T, Mizuno K, Kobayashi N, Inukai Y, Takeda A, Sone Y. Discrepant imaging findings of portal vein thrombosis with dynamic computed tomography and computed tomography during arterial portography in hepatocellular carcinoma: possible cause leading to inappropriate treatment selection. Clin J Gastroenterol 2017; 10:163-167. [PMID: 28181172 DOI: 10.1007/s12328-017-0717-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/26/2017] [Indexed: 11/29/2022]
Abstract
We encountered a patient with hepatocellular carcinoma who had discrepant imaging findings on portal vein thrombosis with portal phase dynamic computed tomography (CT) and CT during arterial portography (CTAP). CTAP, via the superior mesenteric artery and via the splenic artery, both showed a portal perfusion defect in the right hepatic lobe, indicating portal vein thrombosis in the main trunk of the right portal vein. Portal phase dynamic CT clearly depicted portal perfusion of the same hepatic area. Transarterial chemoembolization was successfully performed, but it was associated with severe liver injury. Clinicians should be cautious about this possible discrepancy based on imaging technique. The inaccurate evaluation of portal vein thrombosis may result in inappropriate treatment selection, which can worsen patient prognosis.
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Affiliation(s)
- Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan.
| | - Takashi Kumada
- Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan
| | - Toshifumi Tada
- Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan
| | - Kazuyuki Mizuno
- Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan
| | - Natsuko Kobayashi
- Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan
| | - Yosuke Inukai
- Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan
| | - Akira Takeda
- Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan
| | - Yasuhiro Sone
- Department of Radiology, Ogaki Municipal Hospital, Ogaki, Japan
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2
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Fu CJ, Wong YC, Tsang YM, Wang LJ, Chen HW, Ku YK, Wu CH, Chen HW, Kang SC. Computed tomography arterial portography for assessment of portal vein injury after blunt hepatic trauma. Diagn Interv Radiol 2016; 21:361-7. [PMID: 26268303 DOI: 10.5152/dir.2015.14445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Intrahepatic portal vein injuries secondary to blunt abdominal trauma are difficult to diagnose and can result in insidious bleeding. We aimed to compare computed tomography arterial portography (CTAP), reperfusion CTAP (rCTAP), and conventional computed tomography (CT) for diagnosing portal vein injuries after blunt hepatic trauma. METHODS Patients with blunt hepatic trauma, who were eligible for nonoperative management, underwent CTAP, rCTAP, and CT. The number and size of perfusion defects observed using the three methods were compared. RESULTS A total of 13 patients (seven males/six females) with a mean age of 34.5±14.1 years were included in the study. A total of 36 hepatic segments had perfusion defects on rCTAP and CT, while there were 47 hepatic segments with perfusion defects on CTAP. The size of perfusion defects on CT (239 cm3; interquartile range [IQR]: 129.5, 309.5) and rCTAP (238 cm3; IQR: 129.5, 310.5) were significantly smaller compared with CTAP (291 cm3; IQR: 136, 371) (both, P = 0.002). CONCLUSION Perfusion defects measured by CTAP were significantly greater than those determined by either rCTAP or CT in cases of blunt hepatic trauma. This finding suggests that CTAP is superior to rCTAP and CT in evaluating portal vein injuries after blunt liver trauma.
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Affiliation(s)
- Chen Ju Fu
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, TaoYuan, Taiwan.
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3
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Caraiani CN, Dan M, Fenesan DI, Badea R. Description of focal liver lesions with Gd-EOB-DTPA enhanced MRI. Med Pharm Rep 2016; 88:438-48. [PMID: 26733231 PMCID: PMC4689233 DOI: 10.15386/cjmed-414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 07/31/2015] [Indexed: 11/23/2022] Open
Abstract
Imaging procedures play a fundamental role in the therapeutic management of focal liver lesions. The goals of imaging are to detect and correctly characterize focal liver lesions. This review highlights the performances of newer, liver-specific, contrast media in the diagnosis of focal liver lesions, particularly Gd-EOB-DTPA (Primovist), the most frequently used liver specific contrast media. It has been shown, in different papers, that Gd-EOB-DTPA has better performances compared to either triphasic contrast enhanced computed tomography or dynamic MRI in both detection and characterization of hepatocellular carcinoma on the cirrhotic liver. Therefore liver MRI with Primovist is considered, in many centers, the "state-of-the-art" imaging examination of the liver before surgery or liver transplantation. Gd-EOB-DTPA is also useful in the differential diagnosis of benign hypervascular focal liver lesions such as adenomas or focal nodular hyperplasias.
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Affiliation(s)
- Cosmin-Nicolae Caraiani
- Department of Medical Imaging, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marian Dan
- Department of Medical Imaging, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana-Ioana Fenesan
- Department of Medical Imaging, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Badea
- Department of Ultrasonography/Medical Imaging, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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El-Badrawy A, Denewer A, Kandiel T, Roshdy S, El-Etreby S, El-Badrawy ES, Shawky J. 64 Multidetector CT angiography in preoperative evaluation of hepatic artery. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2011. [DOI: 10.1016/j.ejrnm.2011.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 2007; 18:457-67. [PMID: 18058107 DOI: 10.1007/s00330-007-0716-9] [Citation(s) in RCA: 308] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 03/19/2007] [Accepted: 04/17/2007] [Indexed: 12/30/2022]
Abstract
A multicenter study has been employed to evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) using the new liver-specific contrast agent gadoxetic acid (Gd-EOB-DTPA, Primovist), as opposed to contrast-enhanced biphasic spiral computed tomography (CT), in the diagnosis of focal liver lesions, compared with a standard of reference (SOR). One hundred and sixty-nine patients with hepatic lesions eligible for surgery underwent Gd-EOB-DTPA-enhanced MRI as well as CT within 6 weeks. Pathologic evaluation of the liver specimen combined with intraoperative ultrasound established the SOR. Data sets were evaluated on-site (14 investigators) and off-site (three independent blinded readers). Gd-EOB-DTPA was well tolerated. Three hundred and two lesions were detected in 131 patients valid for analysis by SOR. The frequency of correctly detected lesions was significantly higher on Gd-EOB-DTPA-enhanced MRI compared with CT in the clinical evaluation [10.44%; 95% confidence interval (CI): 4.88, 16.0]. In the blinded reading there was a trend towards Gd-EOB-DTPA-enhanced MRI, not reaching statistical significance (2.14%; 95% CI: -4.32, 8.6). However, the highest rate of correctly detected lesions with a diameter below 1 cm was achieved by Gd-EOB-DTPA-enhanced MRI. Differential diagnosis was superior for Gd-EOB-DTPA-enhanced MRI (82.1%) versus CT (71.0%). A change in surgical therapy was documented in 19 of 131 patients (14.5%) post Gd-EOB-DTPA-enhanced MRI. Gd-EOB-DTPA-enhanced MRI was superior in the diagnosis and therapeutic management of focal liver lesions compared with CT.
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Taouli B, Krinsky GA. Diagnostic imaging of hepatocellular carcinoma in patients with cirrhosis before liver transplantation. Liver Transpl 2006; 12:S1-7. [PMID: 17051556 DOI: 10.1002/lt.20935] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
1. The lack of whole-liver explant correlation has led to an overestimation of the sensitivity of imaging tests for the diagnosis of HCC in the radiological literature. 2. Ultrasound is insensitive for the diagnosis of HCC in the cirrhotic liver and should not be used for the detection of focal liver lesions in this setting. 3. Although magnetic resonance (MR) imaging is more sensitive than multidetector 3-phase computed tomography (CT) for the diagnosis of regenerative and dysplastic nodules it is probably no better than CT for detection of HCC and has a lower false-positive rate. 4. Approximately 10-30% of nodules measuring <2 cm seen only on the hepatic arterial phase at CT or MR imaging represent small HCC and vigilant surveillance imaging is required as interval growth is the best indicator of malignancy.
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Affiliation(s)
- Bachir Taouli
- New York University, Department of Radiology, New York, NY 10016, USA.
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7
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Stemmler BJ, Paulson EK, Thornton FJ, Winters SR, Nelson RC, Clary BM. Dual-phase 3D MDCT angiography for evaluation of the liver before hepatic resection. AJR Am J Roentgenol 2005; 183:1551-7. [PMID: 15547190 DOI: 10.2214/ajr.183.6.01831551] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to evaluate the accuracy of dual-phase MDCT angiography for assessing the liver before hepatic resection and to compare 2D and 3D images for quality and arterial branch visualization. MATERIALS AND METHODS Sixty-three patients with colorectal metastases (n = 30), hepatocellular carcinomas (n = 13), giant hemangiomas (n = 5), and other lesions (n = 15) underwent dual-phase MDCT using either a LightSpeed QX/i 4-MDCT (n = 31) or LightSpeed QX/i Ultra 8-MDCT (n = 32) scanner. Contrast material (150 mL of Isovue 370 [iopamidol]) was injected at a rate of 5 mL/sec. The arterial phase images were rendered on a workstation to obtain 3D MDCT angiograms that were assessed by two reviewers who were blinded to the surgical findings. Arterial anatomy was categorized according to the Michels classification. The reviewers assessed the 2D and 3D images for quality, arterial branch visualization, and differences between the 4- and 8-MDCT images. In the 43 patients who underwent resection, imaging findings were correlated with intraoperative findings. RESULTS The anatomy of hepatic arteries in the 63 patients was classified as follows: Michels type I, 51 patients (80.9%); type III, four patients (6.3%); type V, five patients (7.9%); and types VII, VIII, and IX, one patient (1.6%) each. In 40 (93%) of 43 patients, the surgical findings concurred with MDCT findings. Three discrepancies were due to failure to identify small accessory left hepatic arteries. Branch visualization and image quality of the 2D images were superior to those of the 3D images. No significant difference was found between the 4- and 8-MDCT images in branch visualization and image quality. CONCLUSION Three-dimensional MDCT angiography is accurate for classification of hepatic arterial anatomy before hepatic resection. Although 2D data sets show small arteries to better advantage than 3D MDCT angiograms, the 3D MDCT angiograms provide a useful overview of hepatic anatomy.
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Affiliation(s)
- Bertram J Stemmler
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
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8
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Abstract
Hepatocellular carcinoma (HCC) is the fifth most common malignancy in the world, responsible for 500,000 deaths globally every year. Although HCC is a slow-growing tumor, it is often rapidly fatal because it is usually not discovered until the disease is advanced. HCC occurs primarily in individuals with cirrhosis, a condition that increases the risk of performing potentially curative surgical therapy. Over the last 2 decades, however, the safety of surgical resections has greatly improved because of advances in radiologic assessment, patient selection, and perioperative care. As such, the operative mortality rate for hepatectomy has decreased from the 10%-20% level seen in the 1980s to less than 5% today. The ultimate goal of treatment of HCC is to prolong the quality of life by eradicating the malignancy while preserving hepatic function. For treatment with a curative intent, the gold standard remains surgical resection, by either partial hepatectomy or total hepatectomy followed by liver transplantation. Resectability and choice of procedure depend on many factors, including baseline liver function, absence of extrahepatic metastases, size of residual liver, availability of resources including liver graft, and expertise of the surgical team. Patients without cirrhosis can tolerate extensive resections, and partial hepatectomy should be considered first. For Child class B and C patients with a small HCC, liver transplantation offers the best results, whereas partial liver resection is indicated in patients with well-compensated cirrhosis. Living donor liver transplantation should be considered using the same criteria as that used for cadaveric transplantation.
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Affiliation(s)
- Tae-Jin Song
- College of Medicine, Korea University, Seoul, South Korea
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9
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Kim HC, Kim TK, Sung KB, Yoon HK, Kim PN, Ha HK, Kim AY, Kim HJ, Lee MG. CT during hepatic arteriography and portography: an illustrative review. Radiographics 2002; 22:1041-51. [PMID: 12235334 DOI: 10.1148/radiographics.22.5.g02se071041] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The combination of computed tomography (CT) during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) has been used for evaluation of hepatic neoplasms before partial hepatic resection. Focal hepatic lesions that can be demonstrated with CTAP and CTHA include regenerative nodules, dysplastic nodules, dysplastic nodules with malignant foci, hepatocellular carcinoma, cholangiocarcinoma, hemangioma, and metastases. CTAP is considered the most sensitive modality for detection of small hepatic lesions, particularly small hepatic tumors such as hepatocellular carcinoma and metastatic tumors. CTHA can demonstrate not only hypervascular tumors but also hypovascular tumors and can help differentiate malignant from benign lesions. However, various types of nontumorous hemodynamic changes are frequently encountered at CTAP or CTHA and appear as focal lesions that mimic true hepatic lesions. Such hemodynamic changes include several types of arterioportal shunts, liver cirrhosis, Budd-Chiari syndrome, inflammatory changes, pseudolesions due to an aberrant blood supply, and laminar flow in the portal vein. Familiarity with the CTAP and CTHA appearances of various hepatic lesions and nontumorous hemodynamic changes allows the radiologist to improve the diagnostic accuracy.
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Affiliation(s)
- Hyun Cheol Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-Dong, Songpa-Ku, Seoul 138-736, Korea
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10
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Mortele KJ, McTavish J, Ros PR. Current techniques of computed tomography. Helical CT, multidetector CT, and 3D reconstruction. Clin Liver Dis 2002; 6:29-52. [PMID: 11933594 DOI: 10.1016/s1089-3261(03)00065-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The many recent advances in CT technology have secured its position as the modality of choice in routine liver imaging and have improved its performance in several problem-solving applications. In addition, improvements in postprocessing software (e.g., in speed, efficiency, and automated algorithms) have increased their use in clinical practice. Multiplanar reformations, 3D renderings, and high-quality CT angiographic displays have become extremely valuable both in image interpretation and in communicating information to surgeons and referring physicians.
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Affiliation(s)
- Koenraad J Mortele
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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11
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Boeve WJ, Sluiter WJ, Kamman RL. Optimization of scantiming in abdominal breathhold contrast-enhanced MRA: an empirical guideline. Magn Reson Imaging 2001; 19:193-200. [PMID: 11358657 DOI: 10.1016/s0730-725x(01)00297-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of this study to determine a suitable scan timing scheme in contrast enhanced MRA for the depiction of the arterial, the portal and the systemic venous system in the abdomen with maximum signal intensity in healthy subjects and in patients with cirrhosis. The signal intensity in the aorta, hepatic artery, portal vein, left renal vein and the supra- and infrarenal IVC were measured in 40 consecutive orthotopic liver transplantation candidates with cirrhosis and 20 healthy renal donors in a bolus triggered arterial scan and after 30, 60, 90 and 150 s respectively. The aorta and hepatic artery showed the highest signal intensity on the arterial scan. The portal and left renal vein showed the highest signal intensity after 30 s, the suprarenal IVC after 60 s and the infrarenal IVC after 90 s. No significant differences were found between healthy subjects and patients with cirrhosis. The arterial, portal and systemic venous system in the abdomen can be visualized selectively with maximum signal intensity by proper timing of the scans, hereby reducing redundant scans. Scanning at just the right time to achieve optimal vessel opacification can be promoted by using data from this study. The proposed scan scheme is suitable for subjects with and without cirrhosis.
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Affiliation(s)
- W J Boeve
- Department of Radiology, University Hospital Groningen, Hanzeplein 1, Groningen 9713 GZ, the Netherlands.
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12
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Bluemke DA, Paulson EK, Choti MA, DeSena S, Clavien PA. Detection of hepatic lesions in candidates for surgery: comparison of ferumoxides-enhanced MR imaging and dual-phase helical CT. AJR Am J Roentgenol 2000; 175:1653-8. [PMID: 11090399 DOI: 10.2214/ajr.175.6.1751653] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the use of phased array MR imaging of the liver at 1.5 T with and without ferumoxides with dual-phase helical CT for the detection of hepatic lesions in candidates for hepatic surgery. SUBJECTS AND METHODS Patients with known or suspected hepatic lesions who were eligible for surgery underwent dual-phase helical CT at 20 and 70 sec after the start of contrast material injection and phased array MR imaging using fast spin-echo T2-weighted imaging and gradient-echo T1-weighted imaging before and after ferumoxides infusion of 0.56 mg of iron per kilogram of body weight. Three observers who were unaware of the surgical findings separately reviewed the CT scans and unenhanced and enhanced MR images of 24 patients who completed the protocol. The observers' findings were compared with results obtained at surgery using intraoperative sonography and having histopathologic confirmation. Statistical analysis was performed using a segment-by-segment analysis. RESULTS Eighty-two lesions were found at surgery. The sensitivity of CT, unenhanced MR imaging, and enhanced MR imaging for blinded observers was 60.4%, 62.0%, and 68.2%, respectively. The specificity was 89.2%, 81.9%, and 81.6%, respectively. Five lesions in three patients were not detected preoperatively using any of the techniques. MR imaging found additional lesions not detected on CT in four patients; CT detected one additional lesion not seen on MR imaging. CONCLUSION Ferumoxides-enhanced MR imaging of the liver shows a trend toward increased sensitivity compared with dual-phase helical CT. Specificity of helical CT was superior to that of enhanced MR imaging for most observers.
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Affiliation(s)
- D A Bluemke
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA
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13
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Makita O, Yamashita Y, Arakawa A, Nakayama Y, Mitsuzaki K, Ando M, Namimoto T, Oyama Y, Takahashi M. Diffuse perfusion abnormality of the liver parenchyma on angiography-assisted helical CT in relation to cirrhosis and previous treatments: a potential diagnostic pitfall for detecting hepatocellular carcinoma. Clin Imaging 2000; 24:292-7. [PMID: 11331160 DOI: 10.1016/s0899-7071(00)00225-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We evaluated diffuse perfusion abnormality of the liver parenchyma in relation to cirrhosis and previous treatments and estimated its potential limitation in detecting hepatocellular carcinomas (HCCs) on CT arterial portography (CTAP) and CT hepatic arteriography (CTHA). Sixty-one patients of liver cirrhosis with or without HCC received both CTAP and CTHA. Irregular defects of enhancement of the liver parenchyma on CTAP were noted in 37 of 61 patients (60.7%) and compensatory arterial perfusion in these defects on CTHA was noted in 30 of 37 patients (81.1%). Most patients had segmental or mixed patterns of enhancement. In patients with severe cirrhosis, irregular enhancement was often noted. The irregularity was also more often in patients who had had previous treatments. Four of 40 HCC nodules in 18 patients with severe irregular perfusion were not detected on CTAP and CTHA. Diffuse perfusion abnormalities of the liver parenchyma on CTAP and CTHA would decrease the accuracy of tumor detection in HCC patients.
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Affiliation(s)
- O Makita
- Department of Radiology, Kumamoto University School of Medicine, 1-1-1 Honjo, 860-8556, Kumamoto, Japan
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14
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Abstract
Computed tomography (CT) examination of the liver has continually been improving our understanding and assessment of liver disease since its introduction into clinical practice. The hallmark of the advances in CT imaging has undoubtably been helical CT, which made a great impact on body imaging with its many advantages, the most important being optimization of multiphasic enhanced studies, CT hepatic angiography (CTHA), and CT arterial portography (CTAP). Various applications and protocols of CT imaging rendering advantages and drawbacks to the technique are highlighted in this review article.
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Affiliation(s)
- A Poyanli
- Department of Radiology, Istanbul Medical Faculty, Capa, Turkey.
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15
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Abstract
Recent improvements in the treatment of hepatocellular carcinoma (HCC) have resulted in a need to identify the disease at an early stage. The wide range of imaging techniques available reflects the difficulty in demonstrating small HCC, particularly in the cirrhotic liver. This article reviews the current imaging techniques available for the diagnosis of HCC.
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Affiliation(s)
- C Frazer
- Department of Radiology, Sir Charles Gairdner Hospital, QEII Medical Centre, Nedlands, Western Australia, Australia.
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16
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Abstract
Since its inception, CT scan has had a dominant role in hepatic imaging. Recent advances including helical CT scan and bolus-triggered scan initiation software packages have had a significant impact. Issues regarding volume, rate of administration, and type of intravenous contrast are being distilled. Workstations for three-dimensional data reconstructions are producing images that compete with conventional angiography in certain areas, while angiographically assisted CT scan is being refined in others.
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Affiliation(s)
- S R Kemmerer
- Department of Radiology, University of Florida College of Medicine, Gainesville, USA
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17
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Stotland BR, Siegelman ES, Morris JB, Kochman ML. Preoperative and postoperative imaging for colorectal cancer. Hematol Oncol Clin North Am 1997; 11:635-54. [PMID: 9257149 DOI: 10.1016/s0889-8588(05)70454-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Management and survival in colorectal cancer are dictated by the extent of the disease at the initial diagnosis. Technological advances over the past 25 years have improved the ability to accurately preoperatively stage these lesions and detect recurrence. This article reviews the focus on the utility of computerized tomography, magnetic resonance, endoscopic ultrasound, and newer imaging methods including PET scan and monoclonal antibodies in the management of colorectal carcinoma.
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Affiliation(s)
- B R Stotland
- Department of Medicine, University of Pennsylvania Health System, Philadelphia, USA
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Young N, Sing T, Wong KP, Hollands M, Tait N. Use of spiral and non-spiral computed tomography arterial portography in the detection of potentially malignant liver masses. J Gastroenterol Hepatol 1997; 12:385-91. [PMID: 9195386 DOI: 10.1111/j.1440-1746.1997.tb00448.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The present study assesses the usefulness of computed tomography (CT) arterial portography (CTAP) in detecting and defining the number and anatomy of potentially malignant liver lesions. One hundred and one adults studied in 1993 and 1994 were retrospectively reviewed, including patients with primary or secondary tumours for possible resection and patients with non-hepatic malignancies in whom the detection of liver metastases would preclude surgery. Twenty-three patients underwent non-spiral CT studies and 78 had studies on a spiral unit, with 22 of these having single phase and 56 having dual phase studies to overcome artefact problems. The relationship between lesion size and detection sensitivity is critical. On non-spiral studies, the overall lesion detection sensitivity and positive predictive value was 69 and 90%, respectively. Detection sensitivity was 100 and 20% for lesions > 1 cm and < 1 cm, respectively. On single phase spiral CTAP the overall detection sensitivity and positive predictive value was 80 and 66%, respectively. Detection sensitivity for lesions > 1 cm and < 1 cm was 100 and 0%, respectively. On dual phase spiral CTAP the overall detection sensitivity and positive predictive value was 76 and 71%, respectively. For lesions > 1 cm and < 1 cm the sensitivity was 81 and 55%, respectively. Eighteen patients with non-hepatic malignancies with unsuspected metastatic spread did not proceed to major surgery because of liver metastases detected on CTAP. Perfusion artefacts occurred in 30 and 64% of non-spiral and of initial portal venous spiral CTAP studies, respectively. By using the double-phase technique, these artefacts were substantially diminished. In conclusion, CTAP is a valuable tool for assessing the presence, site and size of possible liver tumours and confers a benefit even when previous ultrasound and conventional CT have already been used. In addition, CTAP has a lower limit of useful resolution of approximately 1 cm. Perfusion artefacts can be reduced by a dual phase protocol.
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Affiliation(s)
- N Young
- Department of Radiology, Westmead Hospital, New South Wales, Australia
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19
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Affiliation(s)
- R D Redvanly
- Department of Radiology, Emory School of Medicine, Atlanta, GA 30322, USA
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20
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Abstract
Knowledge of the extent of primary colorectal carcinoma at initial diagnosis is critical for proper management of disease. Currently, CT does not have a role in screening for colorectal carcinoma, though promising work on virtual colonoscopy is on the horizon. In patients with proven colorectal carcinoma, accurate prospective noninvasive assessment can identify those who may benefit from preoperative local radiotherapy, hepatic resection or cryoablation, or intra-arterial chemotherapy. CT should be considered complementary to the clinical assessment of colorectal carcinoma and to other modalities, such as barium enema, endorectal ultrasonography, MRI, and immunoscintigraphy. Although limited in evaluation of the primary tumor and local spread, CT has proven useful in assessing patients thought to harbor extensive local or metastatic disease. CT is generally the modality of choice for imaging the postoperative patient. The cross-sectional display of CT clearly depicts the operative bed, particularly after abdominoperineal resection. Baseline examinations should be obtained 2 to 4 months after surgery, with follow-up examinations every 6 to 9 months for 2 years, and yearly studies thereafter. CT-guided biopsies should be performed when findings suggest recurrent carcinoma.
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Affiliation(s)
- E S Scharling
- Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1088, USA
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21
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Semelka RC, Schlund JF, Molina PL, Willms AB, Kahlenberg M, Mauro MA, Weeks SM, Cance WG. Malignant liver lesions: comparison of spiral CT arterial portography and MR imaging for diagnostic accuracy, cost, and effect on patient management. J Magn Reson Imaging 1996; 6:39-43. [PMID: 8851401 DOI: 10.1002/jmri.1880060108] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We compared two imaging techniques, spiral CT arterial portography (CTAP) and MR imaging, for diagnostic accuracy, procedural cost, and effect on management of 26 patients referred for hepatic surgery for suspected limited malignant liver disease. CTAP and MR imaging were done within a 1-week period (19 within 24 hours); the results of the studies were interpreted prospectively by separate reviewers. Surgical data were evaluated in conjunction with imaging data in 10 patients. Lesion detection and segmental involvement were determined and sensitivity and specificity were calculated. Procedural cost was determined from hospital billing codes. Effect on patient management was determined by the referring oncologic surgeon. CTAP and MR imaging showed 185 and 176 true-positive malignant lesions, 15 and zero false-positive malignant lesions, zero and 18 true-negative malignant lesions, and 13 and 22 false-negative malignant lesions, respectively. CTAP and MR imaging showed 107 and 105 true-positive segments, 11 and zero false-positive segments, 80 and 91 true-negative segments, and four and six false-negative segments, respectively. There was a significant difference in specificity of segmental involvement between MR imaging (1.0 +/- 0) compared with CTAP (0.88 +/- 0.05), P = .03. Total procedural cost was $3,499 for CTAP and $1,224 for MR imaging. CTAP findings did not change patient management over MR imaging findings in any patient, whereas MR imaging findings resulted in a change in patient management over CTAP findings in seven patients (P = .015). The results of our study suggest that MR imaging has higher diagnostic accuracy and greater effect on patient management than CTAP does and is 64% less expensive.
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Affiliation(s)
- R C Semelka
- Department of Radiology, University of North Carolina, Chapel Hill 27599-7510, USA
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Soyer P, Bluemke DA, Sitzmann JV, Hruban RH, Fishman EK. Hepatocellular carcinoma: findings on spiral CT during arterial portography. ABDOMINAL IMAGING 1995; 20:541-6. [PMID: 8580750 DOI: 10.1007/bf01256708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND To determine characteristic imaging features of hepatocellular carcinoma (HCC) on spiral CT during arterial portography (SCTAP) and to correlate the presence or absence of spontaneous portosystemic shunts with the degree of hepatic parenchymal enhancement during SCTAP in patients with HCC. METHODS SCTAP scans of 20 patients with HCC were retrospectively analyzed for tumor features, degree of hepatic parenchymal enhancement, and presence or absence of spontaneous portosystemic shunts. RESULTS Nineteen tumors (95%) were hypoattenuating masses and one (5%) was isoattenuating compared with the liver on SCTAP. In seven patients (35%), the tumor was homogeneous in attenuation. Tumor margins were smooth and regular in 12 patients (60%). Vascular invasion and encapsulation were depicted in 10 patients (50%). A high degree of hepatic parenchymal enhancement was observed in 14 patients; one of them (7%) had spontaneous portosystemic shunts. Poor or moderate enhancement was observed in six patients; five of them (83%) had spontaneous portosystemic shunts (p < .001). CONCLUSION The presence of a low attenuated homogeneous intrahepatic mass with associated vascular invasion on SCTAP scans should raise the possibility of HCC. The presence of spontaneous portosystemic shunts is associated with poor or moderate parenchymal enhancement.
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Affiliation(s)
- P Soyer
- Department of Radiology, Johns Hopkins Hospital, Baltimore, MD 21287-2180, USA
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Tarver DS, Plant GR. Case report: the effect of contrast density on computed tomographic arterial portography. Br J Radiol 1995; 68:200-2. [PMID: 7735752 DOI: 10.1259/0007-1285-68-806-200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Artifacts associated with computed tomographic arterial tomography (CTAP) are well documented. We report a patient undergoing CTAP in whom laminar flow artifact occurred using Iopamidol 370 mg ml-1 but not when using Iopamidol 300 mg ml-1 under identical conditions. The denser Iopamidol 370 mg ml-1 mixed inadequately with unopacified blood in the portal vein. This was not a problem with the less dense Iopamidol 300 mg ml-1 which is likely to be a more reliable contrast agent for CTAP.
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Affiliation(s)
- D S Tarver
- Department of Radiology, North Hampshire Hospital, Basingstoke, UK
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Affiliation(s)
- R L Baron
- Department of Radiology, University of Pittsburgh Medical Center, PA 15213
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Semelka RC, Shoenut JP, Ascher SM, Kroeker MA, Greenberg HM, Yaffe CS, Micflikier AB. Solitary hepatic metastasis: comparison of dynamic contrast-enhanced CT and MR imaging with fat-suppressed T2-weighted, breath-hold T1-weighted FLASH, and dynamic gadolinium-enhanced FLASH sequences. J Magn Reson Imaging 1994; 4:319-23. [PMID: 8061428 DOI: 10.1002/jmri.1880040316] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Twenty consecutive cancer patients with a solitary hepatic metastasis detected with dynamic contrast-material-enhanced computed tomography (CT) who were considered for hepatic resection underwent magnetic resonance (MR) imaging within 18 days after CT. Histologic confirmation was obtained in all lesions. CT depicted 20 solitary lesions. MR imaging showed a solitary lesion in 14 patients, two lesions in three patients, and more than two lesions in three patients, for a total of 37 lesions. Twenty-three lesions less than 2 cm in diameter were missed with CT, and six lesions less than 1.3 cm in diameter were missed with MR imaging. MR imaging was superior to CT in the detection of hepatic metastases on a patient-by-patient basis (P < .01). The results suggest that MR imaging is superior to dynamic contrast-enhanced CT for the detection of hepatic metastases.
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Affiliation(s)
- R C Semelka
- Department of Radiology-MRI, University of North Carolina, Chapel Hill 27599
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Vogel SB, Drane WE, Ros PR, Kerns SR, Bland KI. Prediction of surgical resectability in patients with hepatic colorectal metastases. Ann Surg 1994; 219:508-14; discussion 514-6. [PMID: 8185401 PMCID: PMC1243180 DOI: 10.1097/00000658-199405000-00009] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the efficacy of two distinct imaging techniques to predict, before operation, unresectability compared with standard computed tomographic scan (CT). SUMMARY BACKGROUND Accurate preoperative identification of the number, size, and location of hepatic lesions is crucial in planning hepatic resection for colorectal hepatic metastases. Although infusion-enhanced CT is the standard, its limitations are the imaging of relatively isodense and/or small (< 1 cm) lesions. The increased sensitivity of CT arterial portography (CTAP) may be offset by false-positive results caused by benign lesions and flow artifacts. METHODS Fifty-eight selected patients considered to be eligible for resection by standard CT had laparotomy. Before operation and in addition to CT, all patients had CT arterial portography and hepatic artery perfusion scintigraphy (HAPS) using radiolabeled macroaggregated albumin. Early studies showed an increased sensitivity for detecting small lesions using the invasive CTAP. Similarly, the HAPS study has detected malignant lesions not observed by standard CT. RESULTS Of 58 patients having laparotomy, 40 were resectable by either lobectomy (22) or trisegmentectomy (1) and the rest by single or multiple wedge resections. Eighteen patients could not be resected because of combined intra- and extrahepatic disease or the number and location of metastases. Standard CT detected 64% of all lesions (12% of lesions less than 1 cm). Unresectability was accurately predicted by CTAP and HAPS in 16 (88%) and 15 (83%), respectively, of the 18 patients considered ineligible for resection at laparotomy. Of the 40 patients who had resection for possible cure, CTAP and HAPS falsely predicted unresectability in 6 of 40 patients (15%) and in 10 of 40 patients (25%), respectively. The positive predictive value for unresectability of CTAP and HAPS was 73% and 60%, respectively. False-positive lesions after CTAP included hemangiomas, cysts, granulomas, and flow artifacts. False-positive HAPS lesions included patients in whom no tumor was found at surgery but with some identified by intraoperative ultrasound, blind biopsy, and blind resection. CONCLUSIONS False-positive results by HAPS and CTAP may limit the ability of these tests to accurately predict unresectability before operation and may deny patients the chance for surgical resection. The HAPS study does, however, detect small lesions not seen by CT or CTAP. Standard CT, although less sensitive, followed by surgery and intraoperative ultrasound, does not necessarily preclude patients who could be resected.
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Affiliation(s)
- S B Vogel
- Department of Surgery, University of Florida College of Medicine, Gainesville
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Trenkner SW, Thompson WM. IMAGING OF RECURRENT CARCINOMA OF THE GASTROINTESTINAL TRACT. Radiol Clin North Am 1993. [DOI: 10.1016/s0033-8389(22)00319-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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