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Álvarez MGM, Madhuranthakam AJ, Udayakumar D. Quantitative non-contrast perfusion MRI in the body using arterial spin labeling. MAGMA (NEW YORK, N.Y.) 2024:10.1007/s10334-024-01188-1. [PMID: 39105949 DOI: 10.1007/s10334-024-01188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 05/10/2024] [Accepted: 07/02/2024] [Indexed: 08/07/2024]
Abstract
Arterial spin labeling (ASL) is a non-invasive magnetic resonance imaging (MRI) method that enables the assessment and the quantification of perfusion without the need for an exogenous contrast agent. ASL was originally developed in the early 1990s to measure cerebral blood flow. The utility of ASL has since then broadened to encompass various organ systems, offering insights into physiological and pathological states. In this review article, we present a synopsis of ASL for quantitative non-contrast perfusion MRI, as a contribution to the special issue titled "Quantitative MRI-how to make it work in the body?" The article begins with an introduction to ASL principles, followed by different labeling strategies, such as pulsed, continuous, pseudo-continuous, and velocity-selective approaches, and their role in perfusion quantification. We proceed to address the technical challenges associated with ASL in the body and outline some of the innovative approaches devised to surmount these issues. Subsequently, we summarize potential clinical applications, challenges, and state-of-the-art ASL methods to quantify perfusion in some of the highly perfused organs in the thorax (lungs), abdomen (kidneys, liver, pancreas), and pelvis (placenta) of the human body. The article concludes by discussing future directions for successful translation of quantitative ASL in body imaging.
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Affiliation(s)
| | - Ananth J Madhuranthakam
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9061, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Durga Udayakumar
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9061, USA.
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA.
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Yan C, Xia C, Cao Q, Zhang J, Gao M, Han J, Liang X, Zhang M, Wang L, Zhao L. Predicting High-Risk Esophageal Varices in Cirrhosis: A Multi-Parameter Splenic CT Study. Acad Radiol 2024:S1076-6332(24)00419-7. [PMID: 38997882 DOI: 10.1016/j.acra.2024.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 07/14/2024]
Abstract
RATIONALE AND OBJECTIVES To explore the value of splenic hemodynamic parameters from low-dose one-stop dual-energy and perfusion CT (LD-DE&PCT) in non-invasively predicting high-risk esophageal varices (HREV) in cirrhotic patients. METHODS We retrospectively analyzed cirrhotic patients diagnosed with esophageal varices (EV) through clinical, laboratory, imaging, and endoscopic examinations from September 2021 to December 2023 in our hospital. All patients underwent LD-DE&PCT to acquire splenic iodine concentration and perfusion parameters. Radiation dose was recorded. Patients were classified into non-HREV and HREV groups based on endoscopy. Univariate and multivariate logistic regression analysis were performed, and the prediction model for HREV was constructed. P < 0.05 was considered statistically significant. RESULTS Univariate analysis revealed that significant differences were found in portal iodine concentration (PIC), blood flow (BF), permeability surface (PS), spleen volume (V-S), total iodine concentration (TIC), and total blood volume of the spleen (BV-S) between groups. TIC demonstrated the highest predictive value with an area under the curve (AUC) value of 0.87. Multivariate analysis showed that PIC, PS, and BV-S were independent risk factors for HREV. The logistic regression model for predicting HREV had an AUC of 0.93. The total radiation dose was 20.66 ± 4.07 mSv. CONCLUSION Splenic hemodynamic parameters obtained from LD-DE&PCT can non-invasively and accurately assess the hemodynamic status of the spleen in cirrhotic patients with EV and predict the occurrence of HREV. Despite the retrospective study design and limited sample size of this study, these findings deserve further validation through prospective studies with larger cohorts.
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Affiliation(s)
- Cheng Yan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Chunhua Xia
- Medical Image Center, The Third Affiliated Hospital of Anhui Medical University/ Hefei No1. People's Hospital (Binhu Campus), Hefei 230601, China
| | - Qiuting Cao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jingwen Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Mingzi Gao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jing Han
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Xiaohong Liang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Mingxin Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Lin Wang
- Department of Gastroenterology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Liqin Zhao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
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Criss C, Nagar AM, Makary MS. Hepatocellular carcinoma: State of the art diagnostic imaging. World J Radiol 2023; 15:56-68. [PMID: 37035828 PMCID: PMC10080581 DOI: 10.4329/wjr.v15.i3.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/12/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023] Open
Abstract
Primary liver cancer is the fourth most common malignancy worldwide, with hepatocellular carcinoma (HCC) comprising up to 90% of cases. Imaging is a staple for surveillance and diagnostic criteria for HCC in current guidelines. Because early diagnosis can impact treatment approaches, utilizing new imaging methods and protocols to aid in differentiation and tumor grading provides a unique opportunity to drastically impact patient prognosis. Within this review manuscript, we provide an overview of imaging modalities used to screen and evaluate HCC. We also briefly discuss emerging uses of new imaging techniques that offer the potential for improving current paradigms for HCC characterization, management, and treatment monitoring.
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Affiliation(s)
- Cody Criss
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, United States
| | - Arpit M Nagar
- Department of Radiology, The Ohio State University Medical Center, Columbus, OH 43210, United States
| | - Mina S Makary
- Department of Radiology, The Ohio State University Medical Center, Columbus, OH 43210, United States
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Muacevic A, Adler JR, Pulivadula Mohanarangam VS. The Role of Computed Tomography Perfusion in Various Focal Liver Lesions. Cureus 2022; 14:e32420. [PMID: 36644059 PMCID: PMC9833639 DOI: 10.7759/cureus.32420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 12/14/2022] Open
Abstract
Background This study aims to identify the potential advantages of quantitative determination of various focal liver pathologies, identify lesion hemodynamics, and distinguish benign and malignant pathologies based on CT perfusion (CTP) parameters. Methodology In this study, we examined 36 patients using contrast-enhanced CT (CECT) and proposed inclusion and exclusion criteria. Of the 36 patients, 18 had malignant lesions and 14 had benign lesions. CTP was performed on patients comprising cases of hepatocellular carcinoma (HCC), metastasis, hemangiomas, hepatic cysts, and hepatic abscess. Images were post-processed and analyzed to calculate various perfusion parameters such as blood flow (BF), blood volume (BV), permeability surface (PS), mean transit time (MTT), the hepatic arterial fraction (HAF), and induced residue fraction time of onset (IRFTO). Parameters were compared between benign and malignant lesions, and descriptive analysis was performed for individual lesions. Results Data were analyzed with IBM SPSS Statistics (IBM Corp., Armonk, NY, USA). IRFTO showed the area of the curve (AOC) = 0.659, P-value = 0.040, sensitivity 66.7%, and specificity 64.3%. BV showed AOC = 0.659, P-value = 0.040, with a cutoff value of 1.26, sensitivity of 66.7%, and specificity of 64.3%. BF showed AOC = 0.786 and P-value = 0.006, with a cutoff value of 171.2, sensitivity of 83.3%, and specificity of 78.6%. MTT showed AOC = 0.778 and P-value = 0.008, with a cutoff value of 6.94, sensitivity of 77.8%, and specificity of 78.6%. Statistically significant changes were observed in the perfusion parameters in the BV, BF, MTT, and IRFTO. Conclusions The noninvasive CT liver perfusion technique makes it possible to compare the hemodynamic changes in healthy and sick liver tissues, identify focal liver lesions, and evaluate the effectiveness of tumor therapy.
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Non-invasive evaluation of esophageal varices in patients with liver cirrhosis using low-dose splenic perfusion CT. Eur J Radiol 2022; 152:110326. [DOI: 10.1016/j.ejrad.2022.110326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 11/21/2022]
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Sauer TJ, Abadi E, Segars P, Samei E. Anatomically- and physiologically-informed computational model of hepatic contrast perfusion for virtual imaging trials. Med Phys 2022; 49:2938-2951. [PMID: 35195901 PMCID: PMC9547339 DOI: 10.1002/mp.15562] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 12/10/2022] Open
Abstract
PURPOSE Virtual (in silico) imaging trials (VITs), involving computerized phantoms and models of the imaging process, provide a modern alternative to clinical imaging trials. VITs are faster, safer, and enable otherwise-impossible investigations. Current phantoms used in VITs are limited in their ability to model functional behavior such as contrast perfusion which is an important determinant of dose and image quality in CT imaging. In our prior work with the XCAT computational phantoms, we determined and modeled inter-organ (organ to organ) intravenous contrast concentration as a function of time from injection. However, intra-organ concentration, heterogeneous distribution within a given organ, was not pursued. We extend our methods in this work to model intra-organ concentration within the XCAT phantom with a specific focus on the liver. METHODS Intra-organ contrast perfusion depends on the organ's vessel network. We modeled the intricate vascular structures of the liver, informed by empirical and theoretical observations of anatomy and physiology. The developed vessel generation algorithm modeled a dual-input-single-output vascular network as a series of bifurcating surfaces to optimally deliver flow within the bounding surface of a given XCAT liver. Using this network, contrast perfusion was simulated within voxelized versions of the phantom by using knowledge of the blood velocities in each vascular structure, vessel diameters and length, and the time since the contrast entered the hepatic artery. The utility of the enhanced phantom was demonstrated through a simulation study with the phantom voxelized prior to CT simulation with the relevant liver vasculature prepared to represent blood and iodinated contrast media. The spatial extent of the blood-contrast mixture was compared to clinical data. RESULTS The vascular structures of the liver were generated with size and orientation which resulted in minimal energy expenditure required to maintain blood flow. Intravenous contrast was simulated as having known concentration and known total volume in the liver as calibrated from time-concentration curves (TCC). Measurements of simulated CT ROIs were found to agree with clinically-observed values of early arterial phase contrast enhancement of the parenchyma (∼5 HU). Similarly, early enhancement in the hepatic artery was found to agree with average clinical enhancement (180 HU). CONCLUSIONS The computational methods presented here furthered the development of the XCAT phantoms allowing for multi-timepoint contrast perfusion simulations, enabling more anthropomorphic virtual clinical trials intended for optimization of current clinical imaging technologies and applications. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Thomas J Sauer
- Center for Virtual Imaging Trials (CVIT), Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center
| | - Ehsan Abadi
- Center for Virtual Imaging Trials (CVIT), Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center
| | - Paul Segars
- Center for Virtual Imaging Trials (CVIT), Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center
| | - Ehsan Samei
- Center for Virtual Imaging Trials (CVIT), Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center
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Liu W, Du JJ, Li ZH, Zhang XY, Zuo HD. Liver injury associated with acute pancreatitis: The current status of clinical evaluation and involved mechanisms. World J Clin Cases 2021; 9:10418-10429. [PMID: 35004974 PMCID: PMC8686151 DOI: 10.12998/wjcc.v9.i34.10418] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/16/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis (AP) is a very common acute disease, and the mortality rate of severe AP (SAP) is between 15% and 35%. The main causes of death are multiple organ dysfunction syndrome and infections. The mortality rate of patients with SAP related to liver failure is as high as 83%, and approximately 5% of the SAP patients have fulminant liver failure. Liver function is closely related to the progression and prognosis of AP. In this review, we aim to elaborate on the clinical manifestations and mechanism of liver injury in patients with AP.
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Affiliation(s)
- Wei Liu
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Juan-Juan Du
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Zeng-Hui Li
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xin-Yu Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Hou-Dong Zuo
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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CT hepatic arterial perfusion index does not allow stratification of the degree of esophageal varices and bleeding risk in cirrhotic patients in Child-Pugh classes A and B. Abdom Radiol (NY) 2021; 46:5586-5597. [PMID: 34453180 PMCID: PMC8590679 DOI: 10.1007/s00261-021-03259-6] [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: 07/09/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022]
Abstract
Purpose To evaluate if the hepatic arterial perfusion index (HPI) in liver parenchyma of cirrhotic patients can serve as a surrogate parameter for stratifying the degree of esophageal varices and related bleeding risks. Methods CT image data of sixty-six patients (59 men; mean age 68 years ± 10 years) with liver cirrhosis (Child–Pugh class A (35/66, 53%), B (25/66, 38%), and C (6/66, 9%) who underwent perfusion CT (PCT) for hepatocellular carcinoma (HCC) screening between April 2010 and January 2019 were retrospectively identified. HPI, a parameter calculated by a commercially available CT liver perfusion analysis software that is based on the double maximum slope model, using time attenuation curve to determine perfusion, was correlated with the degree of esophageal varices diagnosed at endoscopy and the number of bleeding events. Results Eta correlation coefficient for HPI/presence of esophageal varices was very weak (0.083). Spearman-Rho for HPI/grading of esophageal varices was very weak (0.037 (p = 0.804)). Kendall-Tau-b for HPI/grading of esophageal varices was very weak (0.027 (p = 0.807)). ANOVA and Bonferroni post-hoc-tests showed no significant difference of HPI between different grades of esophageal varices (F (3, 62) = 1.676, p = 0.186). Eta correlation coefficient for HPI/bleeding event was very weak (0.126). Conclusion The stratification of the degree of esophageal varices and the related bleeding risk by correlation with the HPI as a surrogate parameter for portal venous hypertension was not possible for patients with liver cirrhosis in Child–Pugh class A and B. Graphic abstract ![]()
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Chang NW, Wang HK, Liu CS, Loong CC, Lai YC, Chiou HJ, Chou YH. First-Pass Arrival Interval of Ultrasound Contrast Medium in the Hepatic Artery and Portal Vein as a Marker for Assessment of Liver Transplant Recipients. Transplant Proc 2021; 53:2329-2334. [PMID: 34446308 DOI: 10.1016/j.transproceed.2021.07.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study measures the first-pass arrival times in the hepatic artery and portal vein of the transplanted liver using contrast-enhanced ultrasound (CEUS) and assess its correlation with graft performance in the early posttransplant period. METHODS This study evaluated 35 liver transplant recipients who underwent CEUS examination within 1 month of transplant surgery. CEUS under contrast-specific harmonic imaging mode were recorded for 60 seconds immediately after intravenous administration of microbubble ultrasound contrast medium (Sonazoid, GE Healthcare, Oslo, Norway). The recorded video clips were reviewed by 2 readers to determine the first-pass arrival times in the hepatic artery and portal vein, and the difference between the 2 was defined as the arterial-portal arrival interval (APAI). Laboratory data on the same date of CEUS examination were collected as indicators to correlate with APAI. RESULTS The intra- and inter-rater reliability for APAI measurement were excellent, with intraclass correlation coefficients > .95. The mean APAI was 4.5 ± 1.8 seconds (range, 2.0-10.5 seconds). The APAI was positively correlated with the serum total bilirubin level (r = 0.357, P = .035) and negatively correlated with the platelet count (r = -0.354, P = .037). At the 5 second cutoff point, a total serum bilirubin of >8 mg/dL was reported in 5 of 11 patients (45.4%) with APAI of >5 seconds and in only 3 of 24 patients (12.5%) with APAI of <5 seconds (P < .05). CONCLUSIONS The APAI is a quantitative marker that links the hemodynamics and the clinical status of the liver graft.
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Affiliation(s)
- Nai-Wen Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Kai Wang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Chin-Su Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Che-Chuan Loong
- Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chen Lai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan; Department of Radiology, Yee Zen General Hospital, Taoyuan, Taiwan
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Stella SF, Noel-Lamy M, Rogalla P, Beecroft R, Rajan DK. Hepatic Arterial Blood Flow Modulation in Patients with Hepatocellular Carcinoma: A Pilot Study of the Influence of Intraarterial Norepinephrine Assessed with CT Perfusion. J Vasc Interv Radiol 2020; 32:204-210. [PMID: 33358329 DOI: 10.1016/j.jvir.2020.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE This pilot study aims to evaluate the effect of hepatic intraarterial norepinephrine injection in vasculature modulation for hepatocellular carcinoma (HCC) tumors. MATERIALS AND METHODS This is a single-center prospective study of patients with HCC with proven single-lobe tumors > 3 cm. Eight patients were included, with a mean age of 63 y ± 8. All patients had Barcelona Clinic Liver Cancer stage B HCC and an Eastern Cooperative Oncology Group performance status of 0. Mean tumor size was 6.1 cm ± 1.8; all tumors were hypervascular. Patients underwent CT hepatic perfusion before and after injection of 24 μg of norepinephrine intraarterially (4 μg/mL; total 6 mL injected at a rate of 1 mL/s). Color-coded perfusion maps were used to assess the effects of local therapy on hepatic perfusion values. Tumor-to-liver ratio (TLR) was calculated from the ratio of tumor perfusion to background liver perfusion value. RESULTS Seven of 8 patents had significant (P = .04) absolute increase in tumor perfusion vs background liver, varying from incremental (-2 mL/min/100 mL) to 290 mL/min/100 mL. There was a nonsignificant increase in TLR from 2.7 ± 1.3 to 2.9 ± 1.4 after norepinephrine injection (P = .8). Mean peak time to maximal increase in tumor perfusion after injection was 6.1 s (range, 4.5-9.1 s). Norepinephrine injection was well tolerated without major adverse events. CONCLUSIONS Norepinephrine causes increased blood flow toward HCC tumors, but with a corresponding smaller increase in blood flow to noncancerous liver tissue, with no observed systemic side effects.
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Affiliation(s)
- Steffan F Stella
- Division of Vascular and Interventional Radiology, Department of Radiology, Hamilton Health Sciences, McMaster University Medical Centre, McMaster University, Hamilton, Ontario, Canada
| | - Maxime Noel-Lamy
- Department of Radiology, Division of Interventional Radiology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Patrik Rogalla
- Division of Vascular and Interventional Radiology, Toronto General Hospital-University Health Network/University of Toronto, 1PMB-287, 585 University Ave., Toronto, ON, Canada M5G 2N2
| | - Robert Beecroft
- Division of Vascular and Interventional Radiology, Toronto General Hospital-University Health Network/University of Toronto, 1PMB-287, 585 University Ave., Toronto, ON, Canada M5G 2N2
| | - Dheeraj K Rajan
- Division of Vascular and Interventional Radiology, Toronto General Hospital-University Health Network/University of Toronto, 1PMB-287, 585 University Ave., Toronto, ON, Canada M5G 2N2.
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Xie S, Li Q, Cheng Y, Zhou L, Xia S, Li J, Shen W. Differentiating mild and substantial hepatic fibrosis from healthy controls: a comparison of diffusion kurtosis imaging and conventional diffusion-weighted imaging. Acta Radiol 2020; 61:1012-1020. [PMID: 31825764 DOI: 10.1177/0284185119889566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Early and accurate detection of liver fibrosis are important for clinical treatment. PURPOSE To compare the diagnostic accuracy of liver diffusion kurtosis imaging (DKI) and conventional diffusion-weighted imaging (cDWI) in differentiating patients with mild and substantial fibrosis from normal individuals. MATERIAL AND METHODS Twenty-seven healthy volunteers with no fibrosis (S0) and 45 patients with mild (S1) or substantial (S2) liver fibrosis underwent DWI with multiple b-values. Liver mean apparent diffusion (MD) and mean kurtosis (MK) values derived from DKI and apparent diffusion coefficient (ADC) derived from cDWI were measured and compared. Their discriminative abilities were analyzed and compared by receiver operating characteristic (ROC) curve analysis. RESULTS Significant differences in MD and ADC values were found between groups (P < 0.05). MD value was statistically different between S0 and S1 (P = 0.028) and S0 and S2 (P = 0.005). ADC value was statistically different between S0 and S2 (P = 0.012). MK value was similar between groups (P = 0.646). MD and ADC values significantly correlated with fibrosis stages (rs = -0.668, -0.341; P < 0.01). MK values had no correlation with fibrosis stages (rs = 0.180; P = 0.130). The area under ROC curves (AUC) for MD and ADC was 0.937 and 0.707 for characterization of S1-2 and 0.817 and 0.658 for S2, respectively. MD performed better than ADC for characterization of S1-2 and S2 (P < 0.05). CONCLUSION Differentiating patients with mild or substantial fibrosis from normal individuals is feasible using DKI, which performs better than cDWI.
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Affiliation(s)
- Shuangshuang Xie
- Department of Radiology, Tianjin First Central Hospital, Tianjin Imaging Medical Institute, Nankai District, Tianjin, PR China
| | - Qing Li
- Department of Radiology, Tianjin First Central Hospital, Tianjin Imaging Medical Institute, Nankai District, Tianjin, PR China
| | - Yue Cheng
- Department of Radiology, Tianjin First Central Hospital, Tianjin Imaging Medical Institute, Nankai District, Tianjin, PR China
| | - Li Zhou
- Department of Hepatology, Tianjin Second People’s Hospital, Nankai District, Tianjin, PR China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Tianjin Imaging Medical Institute, Nankai District, Tianjin, PR China
| | - Jia Li
- Department of Hepatology, Tianjin Second People’s Hospital, Nankai District, Tianjin, PR China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, Tianjin Imaging Medical Institute, Nankai District, Tianjin, PR China
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Woisetschläger M, Henriksson L, Bartholomae W, Gasslander T, Björnsson B, Sandström P. Iterative reconstruction algorithm improves the image quality without affecting quantitative measurements of computed tomography perfusion in the upper abdomen. Eur J Radiol Open 2020; 7:100243. [PMID: 32642503 PMCID: PMC7334814 DOI: 10.1016/j.ejro.2020.100243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/26/2022] Open
Abstract
Iterative image-reconstruction algorithm (ADMIRE) did not affect the quantitative measurements in CT perfusion. Iterative image-reconstruction algorithm (ADMIRE) did not affect the time attenuation curves in CT perfusion. Image noise was lower, but the SNR was higher, for iterative reconstructions in CT perfusion examinations with higher strength of noise reduction.
Objective To investigate differences between reconstruction algorithms in quantitative perfusion values and time-attenuation curves in computed tomography perfusion (CTP) examinations of the upper abdomen. Methods Twenty-six CTP examinations were reconstructed with filtered back projection and an iterative reconstruction algorithm, advanced modeled iterative reconstruction (ADMIRE), with different levels of noise-reduction strength. Using the maximum-slope model, quantitative measurements were obtained: blood flow (mL/min/100 mL), blood volume (mL/100 mL), time to peak (s), arterial liver perfusion (mL/100 mL/min), portal venous liver perfusion (mL/100 mL/min), hepatic perfusion index (%), temporal maximum intensity projection (Hounsfield units (HU)) and temporal average HU. Time-attenuation curves for seven sites (left liver lobe, right liver lobe, hepatocellular carcinoma, spleen, gastric wall, pancreas, portal vein) were obtained. Mixed-model analysis was used for statistical evaluation. Image noise and the signal:noise ratio (SNR) were compared between four reconstructions, and statistical analysis of these reconstructions was made with a related-samples Friedman’s two-way analysis of variance by ranks test. Results There were no significant differences for quantitative measurements between the four reconstructions for all tissues. There were no significant differences between the AUC values of the time-attenuation curves between the four reconstructions for all tissues, including three automatic measurements (portal vein, aorta, spleen). There was a significant difference in image noise and SNR between the four reconstructions. Conclusions ADMIRE did not affect the quantitative measurements or time-attenuation curves of tissues in the upper abdomen. The image noise was lower, and the SNR higher, for iterative reconstructions with higher noise-reduction strengths.
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Key Words
- 4D computed tomography
- ADMIRE, advanced modelled iterative reconstruction
- ALP, arterial liver perfusion
- AUC, area under the curve
- Abdomen
- BF, blood flow
- BMI, body mass index
- BV, blood volume
- CTP, computed tomography perfusion
- FBP, filtered back projection
- GFR, glomerular filtration rate
- HCC, hepatocellular carcinoma
- HPI, hepatic perfusion index
- Image reconstruction
- LI-RADS-5, liver imaging reporting and data system
- Liver
- PVP, portal venous liver perfusion
- Perfusion
- Radiation dosage
- SNR, signal to noise ratio
- TAC, time attenuation curve
- TACE, transarterial chemoembolization
- TTP, time to peak
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Affiliation(s)
- Mischa Woisetschläger
- Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Lilian Henriksson
- Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Wolf Bartholomae
- Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Thomas Gasslander
- Department of Surgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Bergthor Björnsson
- Department of Surgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Sandström
- Department of Surgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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13
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Can Disturbed Liver Perfusion Revealed in p-CT on the First Day of Acute Pancreatitis Provide Information about the Expected Severity of the Disease? Gastroenterol Res Pract 2019; 2019:6590729. [PMID: 31485219 PMCID: PMC6710743 DOI: 10.1155/2019/6590729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/24/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
Background The aim of the study was to evaluate the prognostic properties of perfusion parameters of liver parenchyma based on computed tomography (CT) of patients with acute pancreatitis (AP) made on the first day of onset of symptoms, to assess their usefulness in identifying patients with increased risk of the development of severe AP. Methods 79 patients with clinical symptoms and biochemical criteria indicative of AP underwent perfusion computed tomography (p-CT) within 24 hours after onset of the symptoms. Perfusion parameters in 41 people who developed a severe form of AP were compared with parameters in 38 patients in whom the course of AP was mild. Results Statistical differences in the liver perfusion parameters between the group of patients with mild and severe AP were shown. The permeability-surface area product was significantly lower, and the hepatic arterial fraction was significantly higher in the group of patients with progression of AP. Conclusions Based on the results, it seems that p-CT performed on the first day from the onset of AP is a method that, by revealing disturbances in hepatic perfusion, can help in identifying patients with increased risk of the development of severe AP.
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14
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Instant Outcome Evaluation of Microwave Ablation With Subtraction CT in an In Vivo Porcine Model. Invest Radiol 2019; 54:333-339. [DOI: 10.1097/rli.0000000000000545] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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15
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Bevilacqua A, Malavasi S, Vilgrain V. Liver CT perfusion: which is the relevant delay that reduces radiation dose and maintains diagnostic accuracy? Eur Radiol 2019; 29:6550-6558. [PMID: 31115620 DOI: 10.1007/s00330-019-06259-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/20/2019] [Accepted: 04/30/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES High radiation dose during CT perfusion (CTp) studies contributes to prevent CTp application in daily clinical practice. This work evaluates the consequences of scan delay on perfusion parameters and provides guidelines to help reducing the radiation dose by choosing the most appropriate delay. METHODS Fifty-nine patients (34 men, 25 women; mean age 68 ± 12) with colorectal cancer, without underlying liver disease, underwent liver CTp, with the acquisition starting simultaneously with iodinated contrast agent injection. Blood flow (BF) and hepatic perfusion index (HPI) were computed on the acquired examinations and compared with those of the same examinations when a variable scan delay (τ) is introduced. Dose length product, CT dose index, and effective dose were also computed on original and delayed examinations. RESULTS Altogether, three groups of delays (τ ≤ 4 s, 5 s ≤ τ ≤ 9 s, τ ≥ 10 s) were identified, yielding increasing radiation dose saving (RDS) (RDS ≤ 9.5%, 11.9% ≤ RDS ≤ 21.4%, RDS ≥ 23.8%) and decreasing perfusion accuracy (high (τ ≤ 4 s), medium (5 s ≤ τ ≤ 9 s), low (τ ≥ 10 s)). In particular, single-input and arterial BF and HPI were more insensitive to delay as regards the absolute variations (only 1 ml/min/100 g and 1%, respectively, for τ ≤ 9 s), than portal and total BF. CONCLUSION Using delays lower than 4 s does not change perfusion accuracy and conveys unnecessary dose to patients. Conversely, starting the acquisition 9 s after contrast agent injection yields a RDS of about 21%, with no significant losses in perfusion accuracy. KEY POINTS • Scan delays lower than 4 s do not alter perfusion accuracy and deliver an unnecessary radiation dose to patients. • Radiation dose delivered to patients can be reduced by 21.4% by introducing a 9-s scan delay, while keeping accurate perfusion values. • Using scan delays higher than 10 s, some perfusion parameters (portal and total BF) were inaccurate.
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Affiliation(s)
- Alessandro Bevilacqua
- DISI (Department of Computer Science and Engineering), University of Bologna, Viale Risorgimento, 2, I-40136, Bologna, Italy.,ARCES (Advanced Research Center on Electronic Systems), University of Bologna, Via Toffano 2/2, I-40125, Bologna, Italy
| | - Silvia Malavasi
- ARCES (Advanced Research Center on Electronic Systems), University of Bologna, Via Toffano 2/2, I-40125, Bologna, Italy.,CIG (Interdepartmental Centre "L. Galvani" for integrated studies of Bioinformatics, Biophysics and Biocomplexity), University of Bologna, Via Petroni 26, I-40126, Bologna, Italy
| | - Valérie Vilgrain
- Department of Radiology, Assistance-Publique Hôpitaux de Paris, APHP, HUPNVS, Hôpital Beaujon, 100 bd du Général Leclerc, 92110, Clichy, France. .,Sorbonne Paris Cité, INSERM CRI, Université Paris Diderot, 75018, Paris, France.
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16
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Hatzidakis A, Perisinakis K, Kalarakis G, Papadakis A, Savva E, Ippolito D, Karantanas A. Perfusion-CT analysis for assessment of hepatocellular carcinoma lesions: diagnostic value of different perfusion maps. Acta Radiol 2019; 60:561-568. [PMID: 30114926 DOI: 10.1177/0284185118791200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Computed tomography liver perfusion (CTLP) has been improved in recent years, offering a variety of perfusion-parametric maps. A map that better discriminates hepatocellular carcinoma (HCC) is still to be found. PURPOSE To compare different CTLP maps, regarding their ability to differentiate cirrhotic or non-cirrhotic parenchyma from malignant HCC. MATERIAL AND METHODS Twenty-six patients (11 cirrhotic) with 50 diagnosed HCC lesions, underwent CTLP on a 128-row dual-energy CT system. Nine different maps were generated. Regions of interest (ROIs) were positioned on non-tumorous parenchyma and on HCCs found on previous magnetic resonance imaging. Perfusion parameters for non-cirrhotic and cirrhotic livers were compared. Receiver operating characteristic (ROC) analysis was employed to evaluate each map's ability to discriminate HCCs from non-tumorous livers. Comparison of ROC curves was performed to evaluate statistical significance of differences in the discriminating efficiency of derived perfusion maps. RESULTS Perfusion parameters for non-tumorous liver and HCCs recorded in cirrhotic patients did not significantly differ from corresponding values recorded in non-cirrhotic patients ( P > 0.05). The highest power for HCC discrimination was found for the maximum-slope-of-increase (MSI) parametric map, with estimated the area under ROC curve of 0.997. An MSI cut-off criterion of 2.2 HU/s was found to provide 96% sensitivity and 100% specificity. Time to peak, blood flow, and transit time to peak were also found to have high discriminating power. CONCLUSION Among available CTLP-derived perfusion parameters, MSI was found to provide the highest diagnostic accuracy in discriminating HCCs from non-tumorous parenchyma. Perfusion parameters for non-tumorous livers and HCCs were not found to significantly differ between cirrhotic and non-cirrhotic patients.
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Affiliation(s)
- Adam Hatzidakis
- 1 University Hospital of Heraklion, Department of Medical Imaging, Heraklion, Greece
| | - Kostas Perisinakis
- 2 University Hospital of Heraklion, Department of Medical Physics, Heraklion, Greece
| | - Georgios Kalarakis
- 1 University Hospital of Heraklion, Department of Medical Imaging, Heraklion, Greece
| | - Antonis Papadakis
- 2 University Hospital of Heraklion, Department of Medical Physics, Heraklion, Greece
| | - Eirini Savva
- 3 University Hospital of Heraklion, Department of Internal Medicine, Heraklion, Greece
| | - Davide Ippolito
- 4 Azienda Ospedaliera San Gerardo, Department of Diagnostic Radiology, Monza, Lombardia, Italy
| | - Apostolos Karantanas
- 1 University Hospital of Heraklion, Department of Medical Imaging, Heraklion, Greece
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17
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Lee D, Park S, Ang MJC, Park JG, Yoon S, Kim C, Lee SK, Cho KO, Choi J. Evaluation of liver lesions by use of shear wave elastography and computed tomography perfusion imaging after radiofrequency ablation in clinically normal dogs. Am J Vet Res 2019; 79:1140-1149. [PMID: 30372151 DOI: 10.2460/ajvr.79.11.1140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate acute changes of the liver by use of shear wave elastography (SWE) and CT perfusion after radiofrequency ablation (RFA). ANIMALS 7 healthy Beagles. PROCEDURES RFA was performed on the liver (day 0). Stiffness of the ablation lesion, transitional zone, and normal parenchyma were evaluated by use of SWE, and blood flow, blood volume, and arterial liver perfusion of those regions were evaluated by use of CT perfusion on days 0 and 4. All RFA lesions were histologically examined on day 4. RESULTS Examination of the SWE color-coded map distinctly revealed stiffness of the liver tissue, which increased from the normal parenchyma to the transitional zone and then to the ablation zone. For CT perfusion, blood flow, blood volume, and arterial liver perfusion decreased from the transitional zone to the normal parenchyma and then to the ablation zone. Tissue stiffness and CT perfusion variables did not differ significantly between days 0 and 4. Histologic examination revealed central diffuse necrosis and peripheral hyperemia with infiltration of lymphoid cells and macrophages. CONCLUSIONS AND CLINICAL RELEVANCE Coagulation necrosis induced a loss of blood perfusion and caused tissue hardening (stiffness) in the ablation zone. Hyperemic and inflammatory changes of the transitional zone resulted in increased blood perfusion. Acute changes in stiffness and perfusion of liver tissue after RFA could be determined by use of SWE and CT perfusion. These results can be used to predict the clinical efficacy of RFA and to support further studies, including those involving hepatic neoplasia.
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18
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Enjilela E, Lee TY, Hsieh J, Murjoomdar A, Stewart E, Dekaban M, Su F, So A. Ultra-Low-Dose Sparse-View Quantitative CT Liver Perfusion Imaging. ACTA ACUST UNITED AC 2018; 3:175-179. [PMID: 30042980 PMCID: PMC6024390 DOI: 10.18383/j.tom.2017.00018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Radiation dose of computed tomography liver perfusion imaging can be reduced by collecting fewer x-ray projections in each gantry rotation, but the resulting aliasing artifacts could affect the hepatic perfusion measurement. We investigated the effect of projection undersampling on the assessment of hepatic arterial blood flow (HABF) in hepatocellular carcinoma (HCC) when dynamic contrast-enhanced (DCE) liver images were reconstructed with filtered backprojection (FBP) and compressed sensing (CS). DCE liver images of a patient with HCC acquired with a 64-row CT scanner were reconstructed from all the measured projections (984-view) with the standard FBP and from one-third (328-view) and one-fourth (246-view) of all available projections with FBP and CS. Each of the 5 sets of DCE liver images was analyzed with a model-based deconvolution algorithm from which HABF maps were generated and compared. Mean HABF in the tumor and normal tissue measured by the 328-view CS and FBP protocols was within 5% differences from that assessed by the reference full-view FBP protocol. In addition, the tumor size measured by using the 328-view CS and FBP average images was identical to that determined by using the full-view FBP average image. By contrast, both the 246-view CS and FBP protocols exhibited larger differences (>20%) in anatomical and functional assessments compared with the full-view FBP protocol. The preliminary results suggested that computed tomography perfusion imaging in HCC could be performed with 3 times less projection measurement than the current full-view protocol (67% reduction in radiation dose) when either FBP or CS was used for image reconstruction.
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Affiliation(s)
- Esmaeil Enjilela
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada
| | - Ting-Yim Lee
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada.,Imaging Program, Lawson Health Research Institute, London, ON, Canada
| | | | - Amol Murjoomdar
- Department of Medical Imaging, Western University, London, ON, Canada; and
| | - Errol Stewart
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada
| | - Mark Dekaban
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada
| | - Feng Su
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada
| | - Aaron So
- Imaging Program, Lawson Health Research Institute, London, ON, Canada
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19
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Seyyedi S, Liapi E, Lasser T, Ivkov R, Hatwar R, Stayman JW. Low-Dose CT Perfusion of the Liver using Reconstruction of Difference. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2018; 2:205-214. [PMID: 29785411 DOI: 10.1109/trpms.2018.2812360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Liver CT perfusion (CTP) is used in the detection, staging, and treatment response analysis of hepatic diseases. Unfortunately, CTP radiation exposures is significant, limiting more widespread use. Traditional CTP data processing reconstructs individual temporal samples, ignoring a large amount of shared anatomical information between temporal samples, suggesting opportunities for improved data processing. We adopt a prior-image-based reconstruction approach called Reconstruction of Difference (RoD) to enable low-exposure CTP acquisition. RoD differs from many algorithms by directly estimating the attenuation changes between the current patient state and a prior CT volume. We propose to use a high-fidelity unenhanced baseline CT image to integrate prior anatomical knowledge into subsequent data reconstructions. Using simulation studies based on a 4D digital anthropomorphic phantom with realistic time-attenuation curves, we compare RoD with conventional filtered-backprojection, penalized-likelihood estimation, and prior image penalized-likelihood estimation. We evaluate each method in comparisons of reconstructions at individual time points, accuracy of estimated time-attenuation curves, and in an analysis of common perfusion metric maps including hepatic arterial perfusion, hepatic portal perfusion, perfusion index, and time-to-peak. Results suggest that RoD enables significant exposure reductions, outperforming standard and more sophisticated model-based reconstruction, making RoD a potentially important tool to enable low-dose liver CTP.
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Affiliation(s)
- Saeed Seyyedi
- Computer Aided Medical Procedures and Chair of Biomedical Physics, Technical University of Munich, Munich, 85748 Germany
| | - Eleni Liapi
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21205 USA
| | - Tobias Lasser
- Computer Aided Medical Procedures, Technical University of Munich, Munich, 85748 Germany
| | - Robert Ivkov
- Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD 21205 USA
| | - Rajeev Hatwar
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21205 USA
| | - J Webster Stayman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205 USA
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20
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Sade R, Kantarci M, Genc B, Ogul H, Gundogdu B, Yilmaz O. Computed Tomography Perfusion Imaging for the Diagnosis of Hepatic Alveolar Echinococcosis. Eurasian J Med 2017. [PMID: 29531482 DOI: 10.5152/eurasianjmed.2017.17321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective Alveolar echinococcosis (AE) is a rare life-threatening parasitic infection. Computed tomography perfusion (CTP) imaging has the potential to provide both quantitative and qualitative information about the tissue perfusion characteristics. The purpose of this study was the examination of the characteristic features and feasibility of CTP in AE liver lesions. Material and Methods CTP scanning was performed in 25 patients who had a total of 35 lesions identified as AE of the liver. Blood flow (BF), blood volume (BV), portal venous perfusion (PVP), arterial liver perfusion (ALP), and hepatic perfusion indexes (HPI) were computed for background liver parenchyma and each AE lesion. Results Significant differences were detected between perfusion values of the AE lesions and background liver tissue. The BV, BF, ALP, and PVP values for all components of the AE liver lesions were significantly lower than the normal liver parenchyma (p<0.01). Conclusions We suggest that perfusion imaging can be used in AE of the liver. Thus, the quantitative knowledge of perfusion parameters are obtained via CT perfusion imaging.
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Affiliation(s)
- Recep Sade
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mecit Kantarci
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Berhan Genc
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey.,Department of Radiology, Karataş Hospital, İzmir, Turkey
| | - Hayri Ogul
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Betul Gundogdu
- Department of Pathology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Omer Yilmaz
- Department of Gastroenterology, Atatürk University School of Medicine, Erzurum, Turkey
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21
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Xie S, Li Q, Cheng Y, Zhang Y, Zhuo Z, Zhao G, Shen W. Impact of Liver Fibrosis and Fatty Liver on T1rho Measurements: A Prospective Study. Korean J Radiol 2017; 18:898-905. [PMID: 29089822 PMCID: PMC5639155 DOI: 10.3348/kjr.2017.18.6.898] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 04/15/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the liver T1rho values for detecting fibrosis, and the potential impact of fatty liver on T1rho measurements. MATERIALS AND METHODS This study included 18 healthy subjects, 18 patients with fatty liver, and 18 patients with liver fibrosis, who underwent T1rho MRI and mDIXON collections. Liver T1rho, proton density fat fraction (PDFF) and T2* values were measured and compared among the three groups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the T1rho values for detecting liver fibrosis. Liver T1rho values were correlated with PDFF, T2* values and clinical data. RESULTS Liver T1rho and PDFF values were significantly different (p < 0.001), whereas the T2* (p = 0.766) values were similar, among the three groups. Mean liver T1rho values in the fibrotic group (52.6 ± 6.8 ms) were significantly higher than those of healthy subjects (44.9 ± 2.8 ms, p < 0.001) and fatty liver group (45.0 ± 3.5 ms, p < 0.001). Mean liver T1rho values were similar between healthy subjects and fatty liver group (p = 0.999). PDFF values in the fatty liver group (16.07 ± 10.59%) were significantly higher than those of healthy subjects (1.43 ± 1.36%, p < 0.001) and fibrosis group (1.07 ± 1.06%, p < 0.001). PDFF values were similar in healthy subjects and fibrosis group (p = 0.984). Mean T1rho values performed well to detect fibrosis at a threshold of 49.5 ms (area under the ROC curve, 0.855), had a moderate correlation with liver stiffness (r = 0.671, p = 0.012), and no correlation with PDFF, T2* values, subject age, or body mass index (p > 0.05). CONCLUSION T1rho MRI is useful for noninvasive detection of liver fibrosis, and may not be affected with the presence of fatty liver.
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Affiliation(s)
- Shuangshuang Xie
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China
| | - Qing Li
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China
| | - Yue Cheng
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China
| | - Yu Zhang
- Clinical Science, Philips Healthcare, Beijing 100600, China
| | - Zhizheng Zhuo
- Clinical Science, Philips Healthcare, Beijing 100600, China
| | - Guiming Zhao
- Department of Hepatology, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Wen Shen
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China
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22
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Topcuoğlu OM, Karçaaltıncaba M, Akata D, Özmen MN. Reproducibility and variability of very low dose hepatic perfusion CT in metastatic liver disease. Diagn Interv Radiol 2017; 22:495-500. [PMID: 27759566 DOI: 10.5152/dir.2016.16612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE We aimed to determine the intra- and interobserver agreement on the software analysis of very low dose hepatic perfusion CT (pCT). METHODS A total of 53 pCT examinations were obtained from 21 patients (16 men, 5 women; mean age, 60.4 years) with proven liver metastasis from various primary cancers. The pCT examinations were analyzed by two readers independently and perfusion parameters were noted for whole liver, whole metastasis, metastasis wall, and normal-looking liver (liver tissue without metastasis) in regions of interest (ROIs). Readers repeated the analysis after an interval of one month. Intra- and interobserver agreements were assessed with intraclass correlation coefficients (ICC) and Bland-Altman statistics. RESULTS The mean ICCs of all ROIs between readers were 0.91, 0.93, 0.86, 0.45, 0.53, and 0.66 for blood flow (BF), blood volume (BV), permeability, arterial liver perfusion (ALP), portal venous perfusion (PVP) and hepatic perfusion index (HPI), respectively. The mean ICCs of all ROIs between readings were 0.86, 0.91, 0.81, 0.53, 0.56, and 0.71 for BF, BV, permeability, ALP, PVP, and HPI, respectively. There was greater agreement on the parameters measured for the whole metastasis than on the parameters measured for the metastasis wall. The effective dose of all perfusion CT studies was 2.9 mSv. CONCLUSION There is greater intra- and interobserver agreement for BF and BV than for permeability, ALP, PVP, and HPI at very low dose hepatic pCT. Permeability, ALP, PVP, and HPI parameters cannot be used in clinical practice for hepatic pCT with an effective dose of 2.9 mSv.
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23
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Bulakçı M, Kartal MG, Yılmaz S, Yılmaz E, Yılmaz R, Şahin D, Aşık M, Erol OB. Multimodality imaging in diagnosis and management of alveolar echinococcosis: an update. Diagn Interv Radiol 2017; 22:247-56. [PMID: 27082120 DOI: 10.5152/dir.2015.15456] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Alveolar echinococcosis is a parasitic disease limited to the northern hemisphere. The disease occurs primarily in the liver and shows a profile mimicking slow-growing malignant tumors. Echinococcus multilocularis infection is fatal if left untreated. It can cause several complications by infiltrating the vascular structures, biliary tracts, and the hilum of the liver. As it can invade the adjacent organs or can spread to distant organs, alveolar echinococcosis can easily be confused with malignancies. We provide a brief review of epidemiologic and pathophysiologic profile of alveolar echinococcosis and clinical features of the disease. This article focuses primarily on the imaging features of alveolar echinococcosis on ultrasonogra-phy, computed tomography, magnetic resonance imaging, diffusion-weighted imaging and positron emission tomography-computed tomography. We also reviewed the role of radiology in diagnosis, management, and follow-up of the disease.
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Affiliation(s)
- Mesut Bulakçı
- Department of Radiology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey.
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24
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Peynircioğlu B, Hızal M, Çil B, Deuerling-Zheng Y, Von Roden M, Hazırolan T, Akata D, Özmen M, Balkancı F. Quantitative liver tumor blood volume measurements by a C-arm CT post-processing software before and after hepatic arterial embolization therapy: comparison with MDCT perfusion. Diagn Interv Radiol 2016; 21:71-7. [PMID: 25538037 DOI: 10.5152/dir.2014.13290] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE We aimed to determine whether the C-arm computed tomography (CT) blood volume (BV) imaging of hepatic tumors performed with a new prototype software is capable of measuring the BV changes in response to hepatic arterial treatments and to validate these quantitative measurements with commercially available multidetector computed tomography (MDCT) perfusion software. METHODS A total of 34 patients with hepatic tumors who underwent either radioembolization (RE, n=21) or transarterial chemoembolization (TACE, n=13) were included in the study. Using a prototype software by Siemens Healthcare, 74 C-arm CT BV measurements were obtained in both pre- and postembolization settings (three patients had additional BV measurements before and after work-up angiography for RE). Ten of 34 patients underwent MDCT perfusion study before embolization, enabling comparison of BV measurements using C-arm CT versus MDCT methods. RESULTS The mean BV of 14 tumor lesions in 10 patients on MDCT perfusion was highly correlated with the BV values on C-arm CT (r=0.97, P < 0.01). The BV values obtained by C-arm CT decreased from 140.6±28.3 mL/1000 mL to 45.9±23.5 mL/1000 mL after TACE (66.37% reduction) and from 175.6±29.4 mL/1000 mL to 84.1±22.5 mL/1000 mL after RE (53.75% reduction). DISCUSSION Quantitative BV measurement with C-arm CT is well-correlated with MDCT BV measurements, and it is a promising tool to monitor perfusion changes during hepatic arterial embolization.
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Affiliation(s)
- Bora Peynircioğlu
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
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Olthof SC, Othman A, Clasen S, Schraml C, Nikolaou K, Bongers M. Imaging of Cholangiocarcinoma. Visc Med 2016; 32:402-410. [PMID: 28229074 DOI: 10.1159/000453009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cholangiocarcinoma (CC) is the second most common primary hepatobiliary tumour, and it is increasing in incidence. Imaging characteristics, behaviour, and therapeutic strategies in CC differ significantly, depending on the morphology and location of the tumour. In cross-sectional imaging, CCs can be classified according to the growth pattern (mass-forming, periductal infiltrating, intraductal) and the location (intrahepatic, perihilar, extrahepatic/distal). The prognosis of CC is unfavourable and surgical resection is the only curative treatment option; thus, early diagnosis (also in recurrent disease) and accurate staging including the evaluation of lymph node involvement and vascular infiltration is crucial. However, the diagnostic evaluation of CC is challenging due to the heterogeneous nature of the tumour. Diagnostic modalities used in the imaging of CC include transabdominal ultrasound, endosonography, computed tomography, magnetic resonance imaging with cholangiopancreatography, and hybrid imaging such as positron emission tomography/computed tomography. In this review, the potential of cross-sectional imaging modalities in primary staging, treatment monitoring, and detection of recurrent disease will be discussed.
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Affiliation(s)
- Susann-Cathrin Olthof
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Ahmed Othman
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Christina Schraml
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Malte Bongers
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
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Sonnemans LJP, Köster N, Prokop M, van der Laak JAWM, Klein WM. Liver parenchyma at the site of hypodense parafissural pseudolesion contains increased collagen. ACTA ACUST UNITED AC 2016; 40:2306-12. [PMID: 25952576 DOI: 10.1007/s00261-015-0442-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify a histological substrate explaining the hypodense pseudolesion in the liver at the right side of the falciform ligament and the correlation with CT radiodensity. MATERIALS AND METHODS Tissue specimens were obtained from the right (pseudolesion) and left (control) side of the falciform ligament at the level of the left portal vein, in deceased adults during autopsy. Radiodensity was measured at the same locations at CT. Digital image analysis determined the amount of collagen and fat in histological sections, and the number of portal triads and central veins were counted. Glycogen content was visually assessed by the area percentage of the histological section. RESULTS Specimens from 17 patients showed a 39% increase in collagen for the site of the pseudolesion compared to the contralateral side (p = 0.08). No significant differences were found for the amount of fat, glycogen, portal triads, or central veins. In one patient a pseudolesion was visible on CT, and this contained 52% more collagen than the control side. CONCLUSION The pseudolesion at the right parafissural side in the liver contains more collagen compared to the control left side, while there is no difference in fat or glycogen content or number of portal and hepatic veins. Collagen may be the cause of the pseudolesion.
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Affiliation(s)
- Lianne J P Sonnemans
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nils Köster
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Willemijn M Klein
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Fischer MA, Marquez HP, Gordic S, Leidner B, Klotz E, Aspelin P, Alkadhi H, Brismar TB. Arterio-portal shunts in the cirrhotic liver: perfusion computed tomography for distinction of arterialized pseudolesions from hepatocellular carcinoma. Eur Radiol 2016; 27:1074-1080. [PMID: 27368924 DOI: 10.1007/s00330-016-4432-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/24/2016] [Accepted: 05/20/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To determine perfusion computed tomography (P-CT) findings for distinction of arterial pseudolesions (APL) from hepatocellular carcinoma (HCC) in the cirrhotic liver. METHODS 32 APL and 21 HCC in 20 cirrhotic patients (15 men; 65 ± 10 years), who underwent P-CT for evaluation of HCC pre- (N = 9) or post- (N = 11) transarterial chemoembolization, were retrospectively included using CT follow-up as the standard of reference. All 53 lesions were qualitatively (visual) and quantitatively (perfusion parameters) analysed according to their shape (wedge, irregular, nodular), location (not-/adjunct to a fistula), arterial liver perfusion (ALP), portal venous liver perfusion (PLP), hepatic perfusion index (HPI). Accuracy for diagnosis of HCC was determined using receiver operating characteristics. RESULTS 18/32 (56 %) APL were wedge shaped, 10/32 (31 %) irregular and 4/32 (12 %) nodular, while 11/21 (52 %) HCC were nodular or 10/21 (48 %) irregular, but never wedge shaped. Significant difference between APL and HCC was seen for lesion shape in pretreated lesions (P < 0.001), and for PLP and HPI in both pre- and post-treated lesions (all, P < 0.001). Diagnostic accuracy for HCC was best for combined assessment of lesion configuration and PLP showing an area under the curve of 0.901. CONCLUSION Combined assessment of lesion configuration and portal venous perfusion derived from P-CT allows best to discriminate APL from HCC with high diagnostic accuracy. KEY POINTS • Arterio-portal shunting is common in the cirrhotic liver, especially after local treatment. • Arterial pseudolesions (APL) due to shunting might mimic hepatocellular carcinoma (HCC). • Perfusion-CT allows for qualitative and quantitative assessment of liver lesions. • Lesion configuration fails to discriminate APL from HCC in locally treated patients. • Integration of quantitative perfusion analysis improves accuracy for diagnosis of HCC.
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Affiliation(s)
- Michael A Fischer
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, CH-8091, Zurich, Switzerland. .,Division of Medical Imaging and Technology. Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden.
| | - Herman P Marquez
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Sonja Gordic
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Bertil Leidner
- Division of Medical Imaging and Technology. Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden
| | - Ernst Klotz
- Siemens Healthcare, Computed Tomography and Radiation Oncology, DE-91301, Forchheim, Germany
| | - Peter Aspelin
- Division of Medical Imaging and Technology. Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden
| | - Hatem Alkadhi
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Torkel B Brismar
- Division of Medical Imaging and Technology. Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden
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CT Liver Imaging: What is New? CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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