Abstract
PurposeThe aim of this study was to assess the image quality and diagnostic performance of reconstructed arterial (A) and portal venous (PV) phases in computed tomography perfusion (CTP) scans compared to the corresponding phases in standard 4-phase CT and to assess the utility for LI-RADS classification using CTP and 4-phase 4CT. MethodsA total of 26 scans with each method (CTP and 4-phase CT) from 19 hepatocellular carcinoma patients were analyzed and compared. Arterial and PV phases reconstructed by advanced modeled iterative reconstruction at strength 4 (ADMIRE 4) from raw CTP data were compared with image sets from arterial and PV phases of 4-phase CT (ADMIRE 3) in the same patient with respect to image quality. ResultsQuantitative image analysis showed that reconstructed CTP datasets were equivalent to 4-phase CT image sets. Qualitative image analysis revealed similar lesion detection rates with the 2 methods for patients with an abdominal diameter ≤36 cm and body weight <90 kg, but lower detection rates with CTP for patients with an abdominal diameter >37 cm. There was no difference in Liver Imaging Reporting and Data System (LI-RADS) classifications between the 2 methods. ConclusionReconstructed CTP images can potentially replace 4-phase CT images in patients weighing <90 kg and with a body diameter <37 cm, as the 2 methods are comparable in terms of quantitative image quality and ability to detect and classify lesions based on LI-RADS criteria.
Highlights
Accurate early detection of hepatocellular carcinoma (HCC) and its differentiation from benign tumors is critical for achieving optimal treatment outcomes
There were no significant differences in image noise between portal venous computed tomography perfusion (PV-computed tomography perfusion (CTP)) and portal venous (PV) 4-phase computed tomography (CT)
The same was true for PV-CTP and PV 4-phase CT datasets for the pancreas and aorta (P > 0.05)
Summary
Accurate early detection of hepatocellular carcinoma (HCC) and its differentiation from benign tumors is critical for achieving optimal treatment outcomes. In 4-phase CT, bolus tracking yields reproducible images of non-contrast, arterial (A), portal venous (PV), and delayed (D)PV phases [5] This method uses a fixed scan delay after contrast enhancement, which can lead to suboptimal arterial phase enhancement because of interpatient variations in age, body weight, cardiac output, and kidney function [6]. Tumors might still not be optimally enhancing in the predefined arterial phase given that arterial phase enhancement and correct phase timing are essential for Liver Imaging Reporting and Data System (LI-RADS) assessment. This may lead to difficulties in the interpretation of CT images where the tumor arterial enhancement pattern shows small variations [7]
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