Arterial Enhancement Research Articles

Imaging characteristics of hypervascular focal nodular hyperplasia-like lesions in patients with chronic alcoholic liver disease.

Focal nodular hyperplasia (FNH)-like lesions are hyperplastic formations in patients with micronodular cirrhosis and a history of alcohol abuse. Although pathologically similar to hepatocellular carcinoma (HCC) lesions, they are benign. As such, it is important to develop methods to distinguish between FNH-like lesions and HCC. To evaluate diagnostically differential radiological findings between FNH-like lesions and HCC. We studied pathologically confirmed FNH-like lesions in 13 patients with alcoholic cirrhosis [10 men and 3 women; mean age: 54.5 ± 12.5 (33-72) years] who were negative for hepatitis-B surface antigen and hepatitis-C virus antibody and underwent dynamic computed tomography (CT) and magnetic resonance imaging (MRI), including superparamagnetic iron oxide (SPIO) and/or gadoxetic acid-enhanced MRI. Seven patients also underwent angiography-assisted CT. The evaluated lesion features included arterial enhancement pattern, washout appearance (low density compared with that of surrounding liver parenchyma), signal intensity on T1-weighted image (T1WI) and T2-weighted image (T2WI), central scar presence, chemical shift on in- and out-of-phase images, and uptake pattern on gadoxetic acid-enhanced MRI hepatobiliary phase and SPIO-enhanced MRI. Eleven patients had multiple small lesions (< 1.5 cm). Radiological features of FNH-like lesions included hypervascularity despite small lesions, lack of "corona-like" enhancement in the late phase on CT during hepatic angiography (CTHA), high-intensity on T1WI, slightly high- or iso-intensity on T2WI, no signal decrease in out-of-phase images, and complete SPIO uptake or incomplete/partial uptake of gadoxetic acid. Pathologically, similar to HCC, FNH-like lesions showed many unpaired arteries and sinusoidal capillarization. Overall, the present study showed that FNH-like lesions have unique radiological findings useful for differential diagnosis. Specifically, SPIO- and/or gadoxetic acid-enhanced MRI and CTHA features might facilitate differential diagnosis of FNH-like lesions and HCC.

Imaging of unicentric hyaline-vascular variant of Castleman disease: Emphasis on perilesional fat stranding and fatty proliferation.

The hyaline-vascular variant of Castleman disease (HVCD) is relatively uncommon and demonstrates no specific clinical or laboratory findings; therefore, its preoperative diagnosis warrants a radiological evaluation. This study aimed to review imaging findings of HVCD, focusing on perilesional fat stranding and fatty proliferation. Patients with a pathologically confirmed HVCD diagnosis who had undergone CT were recruited from five hospitals from January 2000 to March 2023. Three experienced radiologists assessed CT findings, including lesion location, lesion size, calcification, enhanced pattern, feeding vessel visualization, and arterial enhancement. Perilesional fat stranding, fatty proliferation, neighboring fascial thickening, and surrounding lymphadenopathy were the primary targets of analysis. Moreover, the intensities and apparent diffusion coefficient (ADC) values on MRI and the maximum standardized uptake value (SUVmax) on 18F-fluorodeoxyglucose positron emission tomography (PET) were evaluated. This study enrolled 43 patients (mean age 41.3 years ± 14.6 [standard deviation], 23 women). All lesions were well-defined round masses. Calcification and feeding vessels were detected in 21% (9/43) and 86% (36/43) of the patients, respectively. Perilesional fat stranding and fatty proliferation were observed in 44% (19/43) and 19% (8/43), respectively, with fatty proliferation detected only in retroperitoneal HVCD. Neighboring fascial thickening and surrounding lymphadenopathy were identified in 21% and 60%, respectively. The mean ADC value and SUVmax were 0.884 × 10-3 mm2/s and 5.0, respectively. Retroperitoneal HVCD cases with perilesional fatty proliferation demonstrated a higher visceral fat ratio than those without (p = 0.046). Perilesional fat stranding and fatty proliferation were new characteristics of HVCD, especially in retroperitoneal cases.

Preoperative prediction of microvascular/nerve invasion in locally advanced gastric cancer by differentiation and enhanced CT features.

The purpose of the article is to determine whether differentiation and enhanced CT features can preoperatively predict microvascular/nerve invasion in locally advanced gastric cancer. Retrospective analysis of the CT and pathological data of 325 patients with locally advanced gastric cancer confirmed by pathology in our hospital from July 2011 to August 2023. The patient's age, gender, tumor location, T stage, N stage, TNM stage, differentiation, Lauren classification, as well as tumor thickness, tumor longest diameter, plain CT value, arterial CT value, venous CT value, arterial phase enhancement rate, and venous phase enhancement rate were assessed. This study included a total of 325 patients with locally advanced gastric cancer and 189 patients (58.15%) with microvascular/nerve invasion. The results of the univariate analysis showed that gender, location, T stage, N stage, TNM stage, differentiation, Lauren classification, tumor thickness, and longest diameter of the tumor were associated with microvascular/nerve invasion (P < .05). Multivariate analysis suggested that TNM stage and differentiation were independent risk factors for microvascular/nerve invasion. The receiver operating characteristic analysis showed that the diagnostic efficacy of the combined parameter of TNM stage and differentiation was better than that of the single parameter, in which area under the curve, sensitivity, and specificity were 0.819 (95%CI: 0.770-0.867), 66.7%, and 83.8%, respectively. Differentiation and enhanced CT are helpful in predicting whether microvascular/nerve invasion occurs in locally advanced gastric cancer before operation, especially the combined parameters of TNM stage and differentiation.

Computed Tomographic Findings in Dogs with Hepatic Bacterial Parenchymal Infection and Abscessation.

Bacterial liver parenchymal infections in dogs are rarely documented, and their imaging characteristics are scarce in the veterinary literature, especially in Computed Tomography (CT). This retrospective multicentric study aimed to describe the CT characteristics of parenchymal bacterial liver infection and abscessation in dogs and compare them with the human literature. Twenty dogs met the inclusion criteria. All dogs, except one, showed discrete hepatic lesions consistent with pyogenic liver abscess (19/20). A single case showed diffuse liver changes, which was diagnosed with granulomatous bacterial hepatitis (1/20). Multifocal lesions were associated with the presence of abdominal pain (p = 0.023). CT characteristics of pyogenic liver abscesses in our study resemble those described in the human literature, with multifocal (14/19) or single (5/19), round or ovoid (19/19), hypoattenuating hepatic lesions, which are better visualised in post-contrast images. Pyogenic liver abscesses can also show features such as the "cluster sign" (8/19), transient arterial segmental enhancement (6/10), rim enhancement (6/19), and intralesional gas (4/19). Additional CT findings, such as local lymphadenomegaly (18/20), peritoneal fat stranding (14/20), and peritoneal fluid (13/20), are also commonly observed.

High Diagnostic Accuracy of Arterial Phase CT in Differentiating Pheochromocytoma in Good/Poor Washout Adrenal Masses

Abstract Introduction Differentiating pheochromocytomas from other adrenal masses based on computed tomography (CT) characteristics remains challenging, particularly in lipid-poor lesions with variable washout patterns. This study evaluated CT features for distinguishing pheochromocytomas in good and poor washout subcohorts. Methods We prospectively analyzed 72 patients with unilateral lipid-poor adrenal masses. CT protocol included basal, bolus-tracked arterial, early venous (45 seconds postarterial), and delayed (15 minutes postarterial) phases. Masses were categorized into good and poor washout groups. Histopathology provided the final diagnosis. CT characteristics and calculated indices were compared between pheochromocytomas and other masses in each washout category. Results The cohort included pheochromocytomas (n = 35), adrenocortical carcinoma (ACC; n = 15), lipid-poor adenomas (n = 13), and metastatic infiltration/infection (n = 9). In the good washout group, pheochromocytomas (n = 15) showed larger diameters (6.00 vs 3.45 cm, P = .001), higher necrosis frequency (73.3% vs 30%, P = .049), and greater arterial attenuation (173.2 vs 74.5 HU, P &amp;lt; .001) compared to adenomas (n = 9). Arterial attenuation provided a high discriminatory value [area under the curve (AUC): 0.967], with 100% sensitivity at 87.6 Hounsfield unit (HU) and 100% specificity at 139.9 HU. In the poor washout group, pheochromocytomas (n = 20) exhibited higher arterial attenuation (99.2 vs 59.2 HU, P &amp;lt; .001; AUC: 0.844) compared to ACC (n = 14), metastatic infiltration (n = 9), and adenomas (n = 4), with 85% sensitivity and 78% specificity at 73.3 HU. Normetanephrine-secreting/nonsecretory pheochromocytomas showed higher arterial enhancement than metanephrine-secreting ones (132.0 vs 90.5 HU, P = .020) within the poor washout group. Conclusion Arterial phase attenuation on CT has good diagnostic accuracy for differentiating pheochromocytomas from other adrenal masses in both good and poor washout categories, potentially guiding hormonal workup.

Unveiling Tim-3 immune checkpoint expression in hepatocellular carcinoma through abdominal contrast-enhanced CT habitat radiomics.

Immune checkpoint inhibitors (ICIs) are important systemic therapeutic agents for hepatocellular carcinoma (HCC), among which T-cell immunoglobulin and mucin-domain containing protein 3 (Tim-3) is considered an emerging target for ICI therapy. This study aims to evaluate the prognostic value of Tim-3 expression and develop a predictive model for Tim-3 infiltration in HCC. We collected data from 424 HCC patients in The Cancer Genome Atlas (TCGA) and data from 102 pathologically confirmed HCC patients from our center for prognostic analysis. Multivariate Cox regression analyses were performed on both datasets to determine the prognostic significance of Tim-3 expression. In radiomics analysis, we used the K-means algorithm to cluster regions of interest in arterial phase enhancement and venous phase enhancement images from patients at our center. Radiomic features were extracted from three subregions as well as the entire tumor using pyradiomics. Five machine learning methods were employed to construct Habitat models based on habitat features and Rad models based on traditional radiomic features. The predictive performance of the models was compared using ROC curves, DCA curves, and calibration curves. Multivariate Cox analyses from both our center and the TCGA database indicated that high Tim-3 expression is an independent risk factor for poor prognosis in HCC patients. Higher levels of Tim-3 expression were significantly associated with worse prognosis. Among the ten models evaluated, the Habitat model constructed using the LightGBM algorithm showed the best performance in predicting Tim-3 expression status (training set vs. test set AUC 0.866 vs. 0.824). This study confirmed the importance of Tim-3 as a prognostic marker in HCC. The habitat radiomics model we developed effectively predicted intratumoral Tim-3 infiltration, providing valuable insights for the evaluation of ICI therapy in HCC patients.

Gadoxetic acid-enhanced MRI for the detection of liver metastases from melanoma.

We aimed to assess imaging findings and detection sensitivity for melanoma liver metastases on gadoxetic acid-enhanced magnetic resonance imaging (MRI). This retrospective study included patients with melanoma liver metastasis who underwent gadoxetic acid-enhanced MRI. Two abdominal radiologists independently evaluated signal characteristics of liver metastases on morphologic imaging (precontrast T1- and T2-weighted imaging), diffusion-weighted imaging (DWI), dynamic imaging, and hepatobiliary phase (HBP). Imaging findings were compared according to detection on HBP and the primary site of the melanoma using logistic regression with the generalized estimating equation (GEE). Detection sensitivity for metastases was compared among different MR imaging sets using logistic regression with GEE. A total of 67 patients with 254 liver metastases were included (44 women; mean age ± standard deviation, 65.6 ± 13.0 years). On HBP, 76.0% of metastases were detected, and 55.5% (141/254) showed hypointensity. Most of the metastases that were not detected on HBP originated from ocular melanomas (98.4%, 60/61), ≤1 cm (90.2%, 55/61) and showed T1 hyperintensity (98.4%, 60/61). Metastases from non-ocular melanomas more frequently showed T1 hypointensity, T2 hyperintensity, diffusion restriction, arterial enhancement, and HBP hypointensity than those from ocular melanomas (Ps ≤ 0.019). The detection sensitivity of HBP (76.0%) was significantly higher than DWI (65.7%, P = 0.006), but lower than morphologic imaging (98.8%, P < 0.001) and dynamic imaging (97.6%, P < 0.001). The detection sensitivity of HBP for melanoma liver metastasis was 76.0%, which was lower than that of morphologic or dynamic imaging. HBP of gadoxetic acid-enhanced MRI has little advantage in detecting melanoma liver metastases.

The polar vessel sign: insights from CT imaging analysis in Asian Indian primary hyperparathyroidism.

Data on the polar vessel sign (enlarged feeding vessel terminating in parathyroid lesions) on four-dimensional computed tomography (4D-CT) is limited. We performed a retrospective analysis to determine the prevalence, predictors, and adjunctive utility of polar vessel sign in pre-operative 4D-CT of patients with primary hyperparathyroidism (PHPT). One radiologist blinded to the patients' details reported the 4D-CT of eighty-four operated patients with histopathology-proven single-gland PHPT. Two protocols were used to obtain arterial-phase images: timed via bolus tracking (n = 41) or fixed at 20 s after contrast injection (n = 43). Seventy-one patients were symptomatic for PHPT, with median serum calcium 12.1 mg/dL. On the arterial phase of 4D-CT, 88.1% of lesions had the polar vessel sign, including 7/9 asymptomatic patients, 6/6 parathyroid carcinomas, and 3/4 ectopic(1:mediastinum, 2:thyro-thymic ligament). Predictors of polar vessel sign were maximum lesion dimension (2.2 vs. 1.4 cm; P = 0.03), solid-cystic CT morphology (47.3% vs. none; P = 0.004), and bolus tracking-timed arterial phase (55.4% vs. none; P = 0.001). Of these, bolus tracking improved the polar vessel's visualization (100% vs. 76.7%; P = 0.001) independent of lesion dimension and solid-cystic morphology. The latter two predicted polar vessel sign in images obtained at a fixed interval (20 s). A significantly lower proportion of bolus tracking-timed scans had lesion percentage arterial enhancement (PAE) < 128.9% (2/41 vs. 9/43; P = 0.04). Even with suboptimal PAE, the polar vessel helped identify 9/11 lesions. The polar vessel sign demonstrated an additive role to PAE during CT reporting. Bolus tracking is valuable in optimizing vessel and tumor arterial enhancement and is easily incorporated into parathyroid 4D-CT protocol.

Perfluorobutane-Enhanced CEUS in Intrahepatic Cholangiocarcinoma: Correlating Imaging Features With Liver Backgrounds and Tumor Sizes

ObjectiveTo investigate Sonazoid contrast-enhanced ultrasound (CEUS) features of intrahepatic cholangiocarcinoma (ICC) based on liver backgrounds and tumor sizes. MethodsA retrospective analysis was conducted on patients with histopathologically diagnosed ICC at two centers. Patients underwent Sonazoid CEUS examination at a dose of 0.0165 mL/kg before surgery or biopsy. Continuous imaging was recorded for the first 70 s, followed by intermittent scanning every 15–20 s for 5 min, with a Kupffer phase captured after an 8-min delay. Patients were categorized by liver backgrounds and tumor sizes. Two ultrasound experts evaluated the enhancement patterns of ICCAs during the arterial, portal, delayed, and Kupffer phases according to current guidelines. ResultsFrom February 2019 to July 2022, a total of 85 ICC lesions were included. ICCs were categorized into normal liver (n = 24), chronic liver disease with fibrosis (n = 40), and cirrhosis (n = 21) groups based on different liver backgrounds, and into groups measuring ≤30 mm (n = 22), 31–50 mm (n = 32), and >50 mm (n = 31) based on tumor sizes. Most ICCs in liver fibrosis or liver cirrhosis tended to show non-rim enhancement in arterial phase (p = 0.022) and relatively later washout (39.9 ± 8.5 s vs. 39.7 ± 13.0 s) compared with those on a normal liver background (28.1 ± 5.6 s) (p < 0.001). Based on CEUS Liver Imaging Reporting and Data System, the diagnostic performance of LR-M criteria showed an accuracy of 100% in our high-risk populations. ICCs of ≤30 mm more commonly showed non-rim enhancement in arterial phase (p = 0.003) and relatively later washout (41.3 ± 12.5 s) compared with larger ICCs (p = 0.046). In the Kupffer phase, all ICCs showed marked washout with sharp margin delineation on Sonazoid CEUS, regardless of liver backgrounds and tumor sizes. ConclusionSonazoid CEUS features of ICCs differ according to different liver backgrounds and tumor sizes. Arterial phase non-rim enhancement and relatively later washout were more commonly observed in ICCs on liver fibrosis or cirrhosis background or smaller ICCs (≤30 mm).

Immunohistochemical Glutamine Synthetase As a Surrogate Marker for Beta Catenin (Exon 3 Deletion) in a Rare Case of Hepatic Adenomatosis with Early Malignant Transformation to Well Differentiated Hepatocellular Carcinoma

Abstract Introduction/Objective Hepatic adenomatosis (HA) is a rare entity defined by ≥ 10 hepatocellular adenomas (HCAs). About half of HA cases are asymptomatic and incidentally found. Compared to individual HCAs, HA carries a higher risk of complications including: tumor rupture, bleeding, and an approximate 4.2% overall frequency of malignant transformation. Methods/Case Report A 29-year-old woman presented to the emergency department (ED) requesting a CT scan. She was seen by a gastroenterologist days prior to her ED visit for ongoing sharp rectal pain for 2-3 months. After a recent rectal exam, she was recommended to have a CT abdomen/pelvis to rule out a potential abscess. CT did not show a perianal or perirectal abscess but instead identified a 9.1 cm right hepatic lobe mass. A liver MRI showed a 6.4 x 8.5 cm mass with arterial enhancement. The patient had a prior history of OCP use. She underwent robotic wedge resection of liver segment 6 with cholecystectomy. Gross examination showed a 6 cm tumor with many smaller nodules ranging in size from 0.5-2.2 cm. Our case was submitted entirely for histologic examination. Microscopy demonstrated well differentiated hepatocellular carcinoma (WDHCC) confirmed with positive immunohistochemical (IHC) staining for HepPar1 and Arginase. Tumor cells showed mild patchy cytological atypia, occasional pseudoglands, and architectural atypia with “nodule in nodule growth.” There was reticulin loss in multiple areas and CD34 showed strong diffuse sinusoidal staining. Glypican 3, CRP, and HAA were negative. Low Ki-67, LFABP retention, and absent nuclear staining of beta catenin (BC) were noted. Glutamine synthetase (GS) was diffuse and homogeneous. The gallbladder was unremarkable. Results (if a Case Study enter NA) NA Conclusion This case emphasizes that, despite negative nuclear BC staining, diffuse homogenous staining of GS is a quality surrogate marker for BC mutations (ex. exon 3 deletions). Thorough gross, microscopic, and molecular examination in HA cases is essential for identifying transformation to WDHCC.

Characteristics and prognosis of hepatocellular carcinoma patients after direct-acting antiviral hepatitis C virus therapy in a single medical center in Egypt

Objective: Hepatocellular carcinoma (HCC) incidence has increased dramatically over the previous two decades and is anticipated to rise further in some countries, notably the United States, by 2030. HCC is most widespread in Asia and Africa, where hepatitis B and C are ubiquitous and lead to the development of chronic liver disease and, finally, HCC. In this study, we examined changes in the characteristics and prognosis of HCC patients, as well as the risk of developing HCC after direct-acting antiviral (DAA) medication.Methods: The study enrolled all individuals who attended the Clinical Oncology and Nuclear Medicine Department, Suez Canal University Hospital, Ismailia, Egypt, with a proven diagnosis of HCC in the period between January 2020 and December 2021. HCC is diagnosed based on radiographic appearance (arterial enhancement phase and delayed washout phase) or compatible histology.Results: This retrospective cohort included 254 HCC patients, separated into three groups. Kaplan-Meier curves with log-rank analysis revealed that hepatitis C virus (HCV) treatment therapy considerably reduced the time to HCC development following hepatitis diagnosis (p &lt; .001). HCV therapy had a substantial impact on progression-free survival and overall survival in HCC patients (p &lt; .001).Conclusions: The emergence of DAA medication has greatly altered the management of HCV patients in the context of HCC. DAAs have been shown to be both safe and beneficial in these individuals, particularly in terms of lowering the risk of hepatic decompensation. DAAs have been reported to enhance overall survival in patients with cirrhotic HCV-related HCC, most likely due to decreased hepatic decompensation.

7085 Myoclonus Seizure with Pseudo-Adrenal Insufficiency as the Clinical Manifestations Leading to the Diagnosed Multi-focal Insulinomas that Mimic Multiple Endocrine Neoplasia Type 1 Syndrome

Abstract Disclosure: P. Kiatpanabhikul: None. Background: Insulinoma is a rare disease that presents with varying symptoms and can be sporadic or associated with hereditary syndromes (1). These rare points of views of insulinoma-patient on clinical manifestations, hormonal responses and surgical pathology result for final diagnosis and management. Clinical Case: A 59-year-old woman presented with myoclonic seizure of right arm with consciousness duration 5-10 minutes every midday twice a week for 6 months and generalized convulsion for 20 minutes ago. She had a low FPG level (59 mg/dL; n 70-100) and was admitted to doing 72-hour fasting test that revealed hypoglycemia at 12-hour of fasting with a nadir glucose level of 55 mg/dL, insulin 3.7 uIU/mL (cutoff &amp;gt; 5), C-peptide 0.4 ng/mL (cutoff &amp;gt; 0.6), cortisol 6.22 mcg/dL (n 5-25) and normal morning ACTH level (29.8 pg/mL; n 10-65). These were appropriated response of endogenous insulinemia with inappropriate response of serum cortisol level in hypoglycemic feature. MRI pituitary gland was considered to evaluate secondary hypocortisolism which showed a small less enhancing lesion left anterior lobe 0.3x0.45-cm without any pituitary hormonal abnormalities that were considered non-functioning pituitary microadenoma which could not explain inappropriate response of cortisol level to hypoglycemic period in this patient. Five months later, she presented at the emergency room with myoclonic seizure on her extremities, blurred consciousness and slurred speech after having lunch for 1-2 hour and revealed CPG 30 mg%, severe hypoglycemia (26 mg/dL), hypocortisolism (4.49 mcg/dL), with endogenous hyperinsulinemia (insulin 55.2 uIU/mL, C-peptide 2.5 ng/mL). 250-mcg ACTH stimulation test was done and showed normal response of her HPA-axis function (serum cortisol level at 0, 30, 60 min was 9.12, 17.87, 18.61 mcg/dL). CT pancreatic protocol showed several arterial enhancing nodules scattering at pancreatic tails isoattenuation to pancreatic parenchyma on portovenous phase up to 1.7*1.6 cm. She was operated on to distal pancreatectomy with intraoperative insulin/glucose ratio monitoring. Surgical pathology confirmed 4-well-differentiated pancreatic neuroendocrine tumors with insulin-producing, sizes 0.5-1.7 cm in diameter. Her final diagnosis was multi-focal insulinomas with non-functioning pituitary microadenoma that mimic MEN-1 syndrome without secondary adrenal insufficiency. She underwent successful surgical resection with complete resolution of symptoms during 4 years of followed-up with no recurrence and no having any hypercalcemia and hyperprolactinemia. Conclusion: Multi-focal insulinomas can be presented as sporadic, more severe hypoglycemia and endogenous hyperinsulinemia during period after meal with myoclonic seizure and pseudo-adrenal insufficiency in older-aged, non-diabetes person without recurrence after treatment for 4-year of followed-up. Presentation: 6/2/2024

Novel intravascular tantalum oxide-based contrast agent achieves improved vascular contrast enhancement and conspicuity compared to Iopamidol in an animal multiphase CT protocol

BackgroundTo assess thoracic vascular computed tomography (CT) contrast enhancement of a novel intravenous tantalum oxide nanoparticle contrast agent (carboxybetaine zwitterionic tantalum oxide, TaCZ) compared to a conventional iodinated contrast agent (Iopamidol) in a rabbit multiphase protocol.MethodsFive rabbits were scanned inside a human-torso-sized encasement on a clinical CT system at various scan delays after intravenous injection of 540 mg element (Ta or I) per kg of bodyweight of TaCZ or Iopamidol. Net contrast enhancement of various arteries and veins, as well as image noise, were measured. Randomized scan series were reviewed by three independent readers on a clinical workstation and assessed for vascular conspicuity and image artifacts on 5-point Likert scales.ResultsOverall, net vascular contrast enhancement achieved with TaCZ was superior to Iopamidol (p ≤ 0.036 with the exception of the inferior vena cava at 6 s (p = 0.131). Vascular contrast enhancement achieved with TaCZ at delays of 6 s, 40 s, and 75 s was superior to optimum achieved Iopamidol contrast enhancement at 6 s (p ≤ 0.036. Vascular conspicuity was higher for TaCZ in 269 of 300 (89.7%) arterial and 269 of 300 (89.7%) venous vessel assessments, respectively (p ≤ 0.005), with substantial inter-reader reliability (κ = 0.61; p < 0.001) and strong positive monotonic correlation between conspicuity scores and contrast enhancement measurements (ρ = 0.828; p < 0.001).ConclusionTaCZ provides absolute and relative contrast advantages compared to Iopamidol for improved visualization of thoracic arteries and veins in a multiphase CT protocol.Relevance statementThe tantalum-oxide nanoparticle is an experimental intravenous CT contrast agent with superior cardiovascular and venous contrast capacity per injected elemental mass in an animal model, providing improved maximum contrast enhancement and prolonged contrast conspicuity. Further translational research on promising high-Z and nanoparticle contrast agents is warranted.Key PointsThere have been no major advancements in intravenous CT contrast agents over decades.Iodinated CT contrast agents require optimal timing for angiography and phlebography.Tantalum-oxide demonstrated increased CT attenuation per elemental mass compared to Iopamidol.Nanoparticle contrast agent design facilitates prolonged vascular conspicuity.Graphical

Perfusion Patterns of Peripheral Pulmonary Metastasis Using Contrast-Enhanced Ultrasound (CEUS) and Their Correlation with Immunohistochemically Detected Vascularization Pattern.

Description of the perfusion of pulmonary metastasis by contrast-enhanced ultrasound (CEUS) and their correlation with vascularization patterns represented by immunohistochemical CD34 endothelial staining. The data of 54 patients with histologic proven peripheral pulmonary metastasis, investigated between 2004 and 2023 by CEUS. These CEUS parameters were evaluated: time to enhancement (TE), categorized as early pulmonary-arterial (PA) or delayed bronchial-arterial (BA) patterns; extent of enhancement (EE), either marked or reduced; homogeneity of enhancement (HE), homogeneous or inhomogeneous; and decrease of enhancement (DE), rapid washout (<120 s) or late washout (≥120 s). Additionally, tissue samples in 45 cases (83.3%) were stained with CD34 antibody for immunohistochemical analysis. In total, 4 lesions (7.4 %) exhibited PA enhancement, and 50 lesions (92.6%) demonstrated BA enhancement. Furthermore, 37 lesions (68.5%) showed marked enhancement, while 17 lesions (31.5%) exhibited reduced enhancement. The enhancement was homogeneous in 28 lesions (51.86%) and inhomogeneous in 26 lesions (48.14%). Additionally, 53 lesions (98.1%) displayed a rapid washout. A chaotic vascular pattern indicative of a bronchial arterial blood supply was identified in all cases (45/45, 100%), including all 4 lesions with PA enhancement. Pulmonary metastases in CEUS predominantly reveal bronchial arterial enhancement and a rapid washout. Regarding EE and HE, pulmonary metastases show heterogeneous perfusion patterns. A PA enhancement in CEUS does not exclude BA neoangiogenesis.

Advancing microvascular invasion diagnosis: a multi-center investigation of novel MRI-based models for precise detection and classification in early-stage small hepatocellular carcinoma (≤ 3cm).

This study aimed to develop two preoperative magnetic resonance imaging (MRI) based models for detecting and classifying microvascular invasion (MVI) in early-stage small hepatocellular carcinoma (sHCC) patients. MVI is graded as M0 (no invasion), M1 (invasion of five or fewer vessels located within 1cm of the tumor's peritumoral region), and M2 (invasion of more than five vessels or those located more than 1cm from the tumor's surface). This study enrolled 395 early-stage sHCC (≤ 3cm) patients from three centers who underwent preoperative gadopentetate-enhanced MRI. From the first two centers, 310 patients were randomly divided into training (n = 217) and validation (n = 93) cohorts in a 7:3 ratio to develop the first model for predicting MVI presence. Among these, 153 patients with identified MVI were further divided into training (n = 112) and validation (n = 41) cohorts, using the same ratio, to construct the second model for MVI classification. An independent test cohort of 85 patients from the third center to validate both models. Univariate and multivariate logistic regression analyses identified independent predictors of MVI and its classification in the training cohorts. Based on these predictors, two nomograms were developed and assessed for their discriminative ability, calibration, and clinical usefulness. Besides, considering the two models are supposed applied in a serial fashion in the real clinical setting, we evaluate the performance of the two models together on the test cohorts by applying them simultaneously. Kaplan-Meier survival curve analysis was employed to assess the correlation between predicted MVI status and early recurrence, similar to the association observed with actual MVI status and early recurrence. The MVI detection nomogram, with platelet count (PLT), activated partial thromboplastin time (APTT), rim arterial phase hyperenhancement (Rim APHE) and arterial peritumoral enhancement, achieved area under the curve (AUC) of 0.827, 0.761 and 0.798 in the training, validation, and test cohorts, respectively. The MVI classification nomogram, integrating Total protein (TP), Shape, Arterial peritumoral enhancement and enhancement pattern, achieved AUC of 0.824, 0.772, and 0.807 across the three cohorts. When the two models were applied on the test cohorts in a serial fashion, they both demonstrated good performance, which means the two models had good clinical applicability. Calibration and decision curve analysis (DCA) results affirmed the model's reliability and clinical utility. Notably, early recurrence was more prevalent in the MVI grade 2 (M2) group compared to the MVI-absent and M1 groups, regardless of the actual or predicted MVI status. The nomograms exhibited excellent predictive performance for detecting and classifying MVI in patients with early-stage sHCC, particularly identifying high-risk M2 patients preoperatively.

Predicting angiogenesis in adrenal pheochromocytoma: the role of modified parameters from contrast-enhanced CT

ObjectiveThe aim of this study is to investigate the value of modified parameters derived from dual-phase contrast-enhanced computed tomography (CT) in predicting angiogenesis within pheochromocytoma.MethodA total of 31 patients with pathologically confirmed pheochromocytoma underwent preoperative dual-phase contrast-enhanced CT scanning, wherein modified CT enhancement parameters, namely maximum enhancement difference (∆H) and maximum enhancement velocity (V), were quantified. Subsequently, postoperative specimens were evaluated by pathological section, while microvessel density (MVD) and vascular endothelial growth factor (VEGF) levels were counted. We conducted comparative analyses to assess disparities in maximum enhancement difference and enhancement velocity between groups characterized by high and low VEGF expression. Furthermore, correlations between maximum enhancement difference, enhancement velocity, and MVD were examined, along with an assessment of the association between maximum enhancement difference, VEGF expression, and MVD at the point of maximal enhancement difference occurrence.ResultsIn the study group, unilateral pheochromocytoma was observed in 31 cases, with 19 cases of arterial phase enhancement and 12 cases displaying venous phase enhancement. The range of maximum enhancement difference (ΔH) spanned from 24 to 102 HU, while the range of maximum enhancement velocity (V) extended from 0.40 HU/s to 4.08 HU/s. Analysis revealed a significant elevation in MVD value within the arterial phase enhancement group compared to the venous phase enhancement group. Additionally, a positive correlation was discerned between the maximum enhancement difference, V, and MVD. Notably, both ∆H and V exhibited statistically significant elevations in the high VEGF expression group relative to the low VEGF expression group. Furthermore, a positive correlation was observed between both ΔH and V and VEGF expression levels.ConclusionIncreased values of ∆H and V are indicative of heightened MVD and VEGF expression. Consequently, the modified parameters derived from dual-phase contrast-enhanced CT scanning serve as predictive markers for angiogenesis in adrenal pheochromocytoma.

Comparison between pancreatoblastoma (PB) and solid pseudopapillary neoplasm (SPN) in pediatric patients with enhanced CT

Rationale and objectivesTo investigate whether computed tomography features can differentiate pancreatoblastoma (PB) from solid pseudopapillary tumor (SPN) in children. Materials and methodsClinical and imaging data of 18 cases of PB and 61 cases of SPN confirmed by surgery or biopsy were retrospectively analyzed. All enrolled patients underwent 3 phases (non-contrast, arterial, and portal venous phases) of CT scanning. Qualitative CT analysis (location, margin, solid/cystic component proportion, calcification, hemorrhage, peritumoral vascularity, bile duct dilatation, pancreatic duct dilatation, pancreatic atrophy, vascular invasion, peripancreatic invasion, and distant metastases) and quantitative analysis (maximum tumor diameter, interface between tumor and parenchyma [delta], arterial enhancement ratio [AER], and portal enhancement ratio [PER]) were performed. The general CT morphologic features, age and tumor markers were compared also compared between the groups. Univariate analysis and the F test were conducted to identify features of PB. Then logistic Regression classifier was trained using the top five features with the highest F-value. Moreover, we used 5-fold cross-validation techniques for the validation of our model. ResultsPB exhibited a significantly higher frequency of location in the body/tail, larger tumor size, poorly defined margins, calcification, peritumoral vascularity, pancreatic atrophy, and less hemorrhage. In addition, PB had higher AER, PER and lower delta relative to SPN (p < 0.05). PB presented a younger age and higher levels of AFP. Results of the F test indicated that AFP, AER, Age, calcification and pancreatic atrophy were the top five features included in the model that could differentiate pediatric PB from SPN. The combined model of CT and clinical features performed well in differentiating PB from SPN, with an AUC of 0.981 in the training cohort and 0.953 in the validation cohort. ConclusionsAFP, AER, age, calcification and pancreatic atrophy are robust CT and clinical features for differentiating pediatric PB from SPN. A combination of qualitative and quantitative CT features may provide good diagnostic accuracy in differentiating PB from SPN in children.

Efficiency evaluation of dual-energy CT to predict the postoperative early recurrence of pancreatic ductal adenocarcinoma

ObjectivesTo evaluate the efficacy of quantitative parameters from dual-energy CT (DECT) and basic CT features in predicting the postoperative early recurrence (ER) of pancreatic ductal adenocarcinoma (PDAC). MethodsIn this study, patients with PDAC who underwent radical resection and DECT from 2018 to 2022 were enrolled and categorised into ER and non-ER groups. The clinical data, basic CT features and DECT parameters of all patients were analyzed. Independent predictors of ER were identified with Logistic regression analyses. Three models (model A: basic CT features; model B: DECT parameters; model C: basic CT features + DECT parameters) were established. Receiver operating characteristic curve analysis was utilized to evaluate predictive performance. ResultsA total of 150 patients were enrolled (ER group: n = 63; non-ER group: n = 87). Rim enhancement (odds ratio [OR], 3.32), peripancreatic strands appearance (OR, 2.68), electron density in the pancreatic parenchymal phase (P-Rho; OR, 0.90), arterial enhancement fraction (AEF; OR, 0.05) and pancreatic parenchyma fat fraction in the delayed phase (OR, 1.25) were identified as independent predictors of ER. Model C showed the highest area under the curve of 0.898. In addition, the corresponding ER risk factors were identified separately for resectable and borderline resectable PDAC subgroups. ConclusionsDECT quantitative parameters allow for the noninvasive prediction of postoperative ER in patients with PDAC, and the combination of DECT parameters and basic CT features shows a high prediction efficiency. Our model can help to identify patients with high-risk factors to guide preoperative decision making.

The value of predicting the invasiveness and degree of infiltration of pulmonary ground-glass nodules based on computed tomography features and enhanced quantitative analysis.

The incidence and mortality rate of lung cancer are the highest in the world among all malignant tumors. Accurate assessment of ground-glass nodules (GGNs) is crucial in reducing lung cancer mortality. This study aimed to explore the value of computed tomography (CT) features and quantitative parameters in predicting the invasiveness and degree of infiltration of GGNs. Lesions were classified into three groups based on pathological types: the precursor glandular lesion (PGL) group, including atypical adenomatoid hyperplasia and adenocarcinoma in situ; the minimally invasive adenocarcinoma group; and the invasive adenocarcinoma group. Quantitative and qualitative data of the nodules were compared, and receiver operating characteristic (ROC) curve analysis was performed for each quantitative parameter. Binary logistic regression analysis was used to evaluate independent predictors of GGN invasiveness. There were significant differences in lesion size, morphology, nodule type, bronchial abnormality, internal vascular sign and pleural retraction among the three groups (P<0.05). There were significant differences in all CT quantitative parameters (CT attenuation value in the plain phase, CT attenuation value in the arterial phase, CT attenuation value in the venous phase, arterial phase enhancement difference, venous phase enhancement difference, arterial phase enhancement index and venous phase enhancement index) among the three groups (P<0.001). The ROC curve analysis showed that the CT attenuation value in the plain phase, CT attenuation value in each enhanced phase, enhancement difference and enhancement index had good discriminatory power. Binary logistic regression analysis revealed that nodule type and internal vascular sign were independent risk factors for GGN invasiveness. CT features combined with enhanced scanning and quantitative analysis have important value in predicting the invasiveness of GGNs. The type of pulmonary nodule detected on CT (pure GGN or mixed GGN) and the presence of internal vascular signs are independent risk factors for GGN invasiveness.

Predictive Value of the Nomogram Model Based on Multimodal Ultrasound Features for Benign and Malignant Thyroid Nodules of C-TIRADS Category 4.

To explore the predictive value of the nomogram model based on multimodal ultrasound features for benign and malignant thyroid nodules of C-TIRADS category 4. A retrospective analysis was conducted on the general conditions and ultrasound features of patients who underwent thyroid ultrasound examination and fine needle aspiration biopsy (FNA) or thyroidectomy at the Affiliated Hospital of Zunyi Medical University from April 2020 to April 2023. Predictive signs for benign and malignant nodules of thyroid C-TIRADS category 4 were screened through LASSO regression and multivariate logistic regression analysis to construct a nomogram prediction model. The predictive efficiency and accuracy of the model were assessed through ROC curves and calibration curves. Seven independent risk factors in the predictive model for benign and malignant thyroid nodules of C-TIRADS category 4 were growth pattern, morphology, microcalcifications, SR, arterial phase enhancement intensity, initial perfusion time, and PE [%]. Based on these features, the area under the curve (AUC) of the constructed prediction model was 0.971 (p ＜ .001, 95% CI: 0.952-0.989), with a prediction accuracy of 93.1%. Internal validation showed that the nomogram calibration curve was consistent with reality, and the decision curve analysis indicated that the model has high clinical application value. The nomogram prediction model constructed based on the multimodal ultrasound features of thyroid nodules of C-TIRADS category 4 has high clinical application value.