Contrast-enhanced Multislice CT Research Articles

Diagnostic accuracy of abdominal contrast-enhanced multi-slice spiral CT after oral diluted iodide in a time segment for gastrointestinal fistula in patients with severe acute pancreatitis.

To evaluate the diagnostic accuracy of abdominal contrast-enhanced multi-slice spiral CT after oral diluted iodide in a time segment (post-ODI ACE-MSCT) for gastrointestinal fistula (GIF) in severe acute pancreatitis (SAP). Patients with SAP who underwent both post-ODI ACE-MSCT and endoscopy/surgery from 2017 to 2023 were continuously retrospectively involved. Their demographic information and clinical features were recorded prospectively in an in-hospital database. Using endoscopy/surgery results as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of post-ODI ACE-MSCT for diagnosing GIF in SAP were calculated by a four-cell table. The consistency of the two diagnostic methods was evaluated by the Kappa test and McNemar's test. Using endoscopy/surgery as the reference standard, a total of 86 cases were divided into the GIF group (N = 52) and the non-GIF group (N = 34). Among the 52 cases of GIF, 88.5% (46/52) cases had a positive result and 11.5% (5/52) cases had a negative result of post-ODI ACE-MSCT for GIF. Among the 34 cases of non-GIF, 2.9% (1/34) case had a positive result and 97.1% (33/34) cases had a negative result of post-ODI ACE-MSCT for GIF. Post-ODI ACE-MSCT had a sensitivity of 88.5% (95% CI 75.9%-95.2%), a specificity of 97.1% (95% CI 82.9%-99.8%), a positive predictive value of 97.9% (95% CI 87.3%-99.9%), a negative predictive value of 84.6% (95% CI 68.8%-93.6%), and an accuracy of 91.9% (83.4%-96.4%). The kappa value was 0.834, and P < 0.001 by McNemar's test. There were no significant differences in diagnostic test characteristics between the two modalities. Post-ODI ACE-MSCT can diagnose GIF in SAP in a simple, noninvasive, and accurate way, and can provide earlier imaging evidence for clinical diagnosis and treatment.

Comparison of Lumbar Artery and Superior Gluteal Artery Perforator Flaps for Breast Reconstruction: Multislice CT-Based Anatomical Study.

Although the deep inferior epigastric artery perforator flap is the criterion standard for autologous breast reconstruction, lumbar artery perforator (LAP) and superior gluteal artery perforator (SGAP) flaps are recent trends as alternatives. The purpose of our study was to clarify differences of these flaps based on multislice CT findings of the same patient. Retrospective study was conducted on 58 patients who underwent preoperative contrast-enhanced multislice CT for breast reconstruction using deep inferior epigastric artery perforator. Of these, 32 patients' data were evaluated excluding 26 patients' data either for the lumbar or gluteal fat being outside the imaging range or for nondepiction of the vascular pedicle origin of LAP or SGAP flap. Vascular pedicle diameter, pedicle length, and subcutaneous fat thickness were measured for LAP and SGAP flaps. The vascular pedicle diameter, pedicle length, and fat thickness were 2.1 (SD, 0.3) mm, 3.4 (SD, 0.4) cm, and 4.9 (SD, 1.0) cm, respectively, for LAP flaps; and 1.7 (SD, 0.2) mm, 5.6 (SD, 1.1) cm, and 2.7 (SD, 0.7) cm, respectively, for SGAP flaps. The LAP flaps had thicker subcutaneous fat and a larger vascular pedicle diameter, whereas the SGAP flaps had a longer vascular pedicle. As donor material for breast reconstruction, the LAP flap is indicated for cases where absolute volume is needed; otherwise, the SGAP flap is more advantageous as it facilitates vascular anastomosis with its longer vascular pedicle.

Clinical Research of Combined Application of DCEUS and Dynamic Contrast-Enhanced MSCT in Preoperative cT Staging of Gastric Cancer.

Purpose To investigate the clinical value of double contrast-enhanced ultrasound (DCEUS) combined with dynamic contrast-enhanced multislice CT (MSCT) in preoperative T staging of gastric cancer (GC). Methods 206 patients with GC confirmed by preoperative gastroscopy from February 2019 to February 2021 were collected, all patients were examined by DCEUS and dynamic contrast-enhanced MSCT before operation, and the invasion depth (T staging) of GC was evaluated. The diagnosis results of DCEUS, dynamic contrast-enhanced MSCT, and combined diagnosis of DCEUS and MSCT methods (D&M method) were compared with the pathological staging results (gold standard). Results The correct diagnosis rate of MSCT was 27.27% in T1 staging, 55.56% in T2 staging, 42.11% in T3 staging, 59.29% in T4 staging, and 55.34% in summation. The correct diagnosis rate of DCEUS was 90.91% in T1 staging, 88.89% in T2 staging, 78.95% in T3 staging, 82.86% in T4 staging, and 83.98% in summation. The correct diagnosis rate of the D&M method was 100.00% in T1 staging, 94.44% in T2 staging, 89.47% in T3 staging, 93.57% in T4 staging, and 93.69% in summation. The D&M method had higher correct diagnosis rate than MSCT or DCEUS alone, the correct diagnosis rate of the D&M method in T1, T2, T3, and T4 staging was significantly higher than that of MSCT (P < 0.05). The correct diagnosis rate of the D&M method in T1, T3, and T4 was significantly higher than that of DCEUS (P < 0.05). The Youden index of preoperative T1, T2, T3, and T4 staging of GC by the D&M method was 99.49%, 94.44%, 84.13%, and 90.54%, respectively, and the Kappa values of these were 0.954, 0.966, 0.707, and 0.881, respectively. Conclusions Dynamic contrast-enhanced MSCT combined with DCEUS in the diagnosis of preoperative cT staging of GC has more validity, reliability, and revenue than the using of MSCT or DCEUS alone, which is an image evaluation method worthy of clinical promotion.

Prevalence and prognostic impact of left ventricular outflow tract calcification in patients with severe aortic stenosis undergoing transfemoral TAVI using second-generation devices

Abstract Introduction Left ventricular outflow tract (LVOT) calcification is known to be associated with adverse outcomes after TAVI in patients receiving first-generation transcatheter heart valves (THV). Second-generation THV have been shown to improve outcomes of TAVI patients. Thus, aim of this study is to assess the prevalence of LVOT calcification as well as its impact on procedural and clinical outcomes in patients with severe aortic stenosis undergoing transfemoral TAVI with second-generation THV in a real-world patient cohort. Methods In this retrospective single-center analysis patients receiving transfemoral TAVI with second-generation THV for the treatment of aortic stenosis (AS) between 05/2012 and 06/2018 and with adequate CT data were included (n=836). Amount of LVOT calcification was measured quantitatively from contrast-enhanced multislice CT using a dedicated software. Baseline characteristics and outcomes were compared according to presence of significant LVOT calcification (none/≤10 mm3 vs. &amp;gt;10 mm3). Procedural and clinical outcome were assessed in accordance with VARC-2 criteria. All-cause mortality was assessed by Kaplan-Meier method, median follow-up was 1.4 years. Results Significant LVOT calcification was present in 37.0% of patients. Patients with LVOT calcification were older (all results as follows without (w/o) vs. with (w) LVOT calcification: 81.4 (77.1, 84.8) vs. 82.3 (78.0, 86.3) years, p=0.006), but presented similar STS scores compared to those without LVOT calcification (5.4±4.7 vs. 5.4±3.5%, p=0.94). Moreover, patients with LVOT calcification had higher mean transvalvular gradients at baseline (30.0 (21.0, 41.0) vs. 37.0 (25.7, 47.0) mmHg, p&amp;lt;0.001) and higher aortic valve calcium volume (380.7 (226.8, 632.1) vs. 663.6 (364.5, 1070.3) mm3, p&amp;lt;0.001). There were no significant differences in rate of device success (97.0 vs. 94.2%, p=0.11), renal failure (2.6 vs. 2.3%, p=1.00), myocardial infarction (0.9 vs. 1.2%, p=1.00) or rate of permanent pacemaker implantation at 30 days after TAVI (16.6 vs. 17.2%, p=0.91). However, rate of TIA/stroke was significantly higher in patients with LVOT calcification (2.1 vs. 6.2%, p=0.0098). Furthermore, patients with LVOT calcification had a higher rate of more than mild paravalvular leakage at discharge (3.8 vs. 7.6%, p=0.033). Rate of 1 year all-cause mortality (17.8 vs. 21.2%, p=0.23) was not significantly different between both groups. Conclusions Significant LVOT calcification is present in a substantial proportion of patients receiving TAVI. In such patients, higher rates of cerebrovascular events and more than mild PVL occurred compared to those without significant LVOT calcification even with currently available second-generation THV. Although these findings did not translate into higher mortality rates in the present study, they underline the need for further optimization of THV technology in order to improve outcomes among all TAVI patients. Figure 1. 1-year mortality Funding Acknowledgement Type of funding source: None

Liver metastases in patients with curatively treated colorectal cancer

Background. The problem of the development of liver metastases in colorectal cancer patients previously treated with curative intent surgery remains little studied. Identification of significant factors affecting the occurrence of metachronous metastasis contributes to a more accurate prediction of recurrence in this group of patients. material and methods. In our study we analyzed the incidence of liver metastases and prognostic factors in 116 colorectal cancer patients previously treated with curative intent at Irkutsk Regional Cancer Center between 2006 and 2017. The patients received combined modality treatment including neoadjuvant radiotherapy or chemoradiotherapy for localized and locally advanced rectal cancer, radical surgery and adjuvant chemotherapy. After curative treatment, 96 patients had no evidence of distant liver metastases, and 20 patients developed distant metastases. results. The incidence of liver metastases was 17 %. In most patients, metastases occurred 16.5 months after completion of curative treatment, reaching peak incidence at 12–18 months. Prognostic factors of colorectal liver metastases in colorectal cancer patients previously treated with curative intent surgery were: the stage of the tumor, tumor growth in the parirectal/mesocolic fatty tissue, and no previous preoperative chemoradiotherapy and adjuvant chemotherapy. conclusion. For early detection of liver metastases, the carcinoembryonic antigen (CEA) measurements, contrast-enhanced abdominal multislice CT, and ultrasound-guided liver biopsy were recommended to perform every 3 months in the postoperative period.

Role of MSCT in the evaluation of perforated gall bladder (a retrospective study)

Gall bladder perforation (GBP) is a rare life threatening complication of acute cholecystitis, which has high morbidity and mortality. Aim of the studyThe aim of the study was to evaluate the role of multislice CT (MSCT) in the diagnosis of GBP and detection of its complications. Patients and methodStudy included retrospective evaluation of 23 patients with GBP. All the patients were evaluated with abdominal ultrasonography and contrast-enhanced abdominal MSCT. ResultsTwenty-three patients were reviewed over a period of 18months: 7 patients with type I GBP, 16 patients with type II and no patients with type III GBP. Abdominal US showed gall stones, wall thickening, free intra-peritoneal fluid and pericholecystic fluid collection. GB wall defect could not be detected in US for all patients. Reviewing the MSCT, the most important point was the detection of wall defect, either single or multiple and its site: fundus (19 patients) or body (4 patients). 3 patients were associated with sub-hepatic abscess. ConclusionMSCT was found to be a sensitive modality for the detection of GBP and its complication and we recommended MSCT for all cases suspected to have GBP.

Pathways involved in the spread of buccal carcinoma on contrast-enhanced multislice CT.

To explore how buccal carcinoma spread, using contrast-enhanced multislice CT (CEMSCT). We retrospectively analysed the extent of lesions in 56 patients with primary buccal squamous cell carcinoma (SCCA). Abnormal manifestations on CEMSCT at oral subsites and involved adjacent structures were documented and evaluated, which were compared with the results of surgery and histopathology. Infiltration and spread to oral subsites and/or adjacent structures was confirmed in 33 patients (58.9%). The opening of the Stensen duct was the most commonly invaded oral subsite (72.7%); other sites included the gingivobuccal sulcus (60.6%), pterygomandibular raphe (54.5%), gingiva (24.2%), retromolar trigone (24.2%), orbicularis oris (18.2%) and the floor of mouth (15.2%). Of the involved adjacent structures, the buccal space was the most common site of spread (69.7%), followed by the masticatory muscles and spaces (57.6%), bone (54.5%), skin and subcutaneous fat (39.4%), pharynx (30.3%), investing fascia (15.2%) and the base of the skull (6.1%). CEMSCT manifestations of the involvement in buccal SCCAs had correlations with pathological findings (p < 0.05). The sensitivities, specificities and accuracies of two radiologists' evaluation on buccal carcinoma involvement were 50.00%, 23.21% and 73.21%; and 51.79%, 32.14% and 83.93%, respectively. Buccal SCCAs could superficially and deeply spread to multiple oral subsites and/or adjacent structures. CEMSCT could delineate their spread pathways and extents.

727P - Safety and Efficacy of Transcatheter Arterial Chemoembolization (Tace) in Unresectable Biliary Cancer

ABSTRACT Aim: Many patients (pts) with biliary cancer present advanced and unresectable disease. TACE has been effective in prolonging survival of pts with hepatocellular carcinoma; the aim of this analysis is to assess its safety and efficacy in biliary cancer. Methods: We retrospectively collected data on pts with histologically-proven unresectable biliary cancer consecutively treated with TACE at our Institution. TACE was performed with infusion of 2 ml of microspheres preloaded with doxorubicin (50 mg) into the tumor-supplying vessels. The treatment was repeated at a minimum of 4-weeks interval. Follow-up investigations after 4 weeks included contrast-enhanced multislice spiral CT and laboratory control. Results: From January 2011 to December 2013 52 TACE (range 1-7 per pts) were performed in 23 pts with the following characteristics: M/F 10/13; median age 64 (range 32-78); intrahepatic cholangiocarcinoma: 18, extrahepatic cholangiocarcinoma: 3 and gallbladder cancer: 2; unifocal/multifocal disease 10/13; 14 pts presented a minimal extrahepatic disease. According to RECIST criteria, best hepatic response to treatment was complete response in 1 pts, partial response in 5 pts and stable disease in 17 pts. 2 pts became resectable and underwent liver resection after TACE. No hepatic progression was observed within 4 weeks after procedure, while 4 pts progressed in extrahepatic sites (17%). The treatment was well tolerated with no deaths and no acute liver failure. Only 1 pts had an hepatic abscess as major complication; all other pts experienced mild side effects as fever, nausea, general malaise, loss of appetite and abdominal pain (PES, Post Embolization Syndrome). This syndrome occurred in the first 72 hours after procedure and resolved with conservative therapy alone. At the time of analysis 12 pts are alive and 4 of them have not progressed yet. Data are still immature for survival analysis. Conclusions: TACE is an effective and safe procedure with a high local disease control rate in unresectable biliary tract cancer and might be able to improve the outcome in this setting. Further studies are needed to confirm these preliminary data and to set the better timing for TACE integration with systemic chemotherapy. Disclosure: All authors have declared no conflicts of interest.

Diagnostic efficacy of perfusion scans interpreted by PISA-PED criteria for pulmonary embolism:comparison with CTPA

Objective To compare the diagnostic efficiency of lung perfusion scans in PE interpreted by prospective investigative study of PE diagnosis (PISA-PED) criteria with contrast-enhanced multislice spiral CT pulmonary angiography ( CTPA ).Methods One hundred and four consecutive patients with suspected PE were enrolled. All patients underwent lung perfusion scans,CTPA and chest radiography.Lung perfusion scans were interpreted by PISA-PED criteria.Final diagnosis was confirmed using a composite reference test.Kappa test was used to analyze the degree of agreement between the multimodality images.The differences between the multimodality images were tested for significance using nonparametric test or x2-test.Results PE was finally diagnosed in 55 of the 104 patients.After excluding three patients ( 2.9％ )with non-diagnostic CTPA from analysis,the sensitivity,specificity,positive predictive value and negative predictive value were 92.6％ ( 50/54),83.0％ ( 39/47 ),86.2％ ( 50/58 ),90.7％ ( 39/43 ) respectively for lung perfusion scans,and 96.3％ ( 52/54 ),93.6％ ( 44/47 ),94.5％ ( 52/55 ),95.7％ ( 44/46 ) respectively for CTPA.The agreement rate between the two modalities was 89.1％ (90/101 ; Kappa =0.78,P ＜0.05).In the segment-based analysis,a total of 1664 segments were evaluated.The agreement rate between lung perfusion scans and CTPA was 79.7％ ( 1327/1664; Kappa =0.58,P ＜0.05 ).Conclusions Lung perfusion scans interpreted by PISA-PED criteria can provide diagnostic accuracy comparable to CTPA,and the two modalities both show high efficacy in diagnosing PE.The agreement between lung perfusion scans and CTPA was intermediate on a segment-by-segment basis. Key words: Plumonary embolism; Radionuclide imaging; Tomography, X-ray computed; MAA

Sorafenib in combination with local microtherapy guided by gadolinium-EOB-DTPA enhanced MRI in patients with inoperable hepatocellular carcinoma (HCC) (SORAMIC).

TPS4148 Background: HCC is a leading cause of cancer-related mortality in both men and women. It represents the fifth most common cancer worldwide with an increasing incidence. For the individual patient tumor stage at diagnosis (number and size of nodules, presence or absence of vascular invasion, presence or absence of extrahepatic spread), liver function and general health status are the principal prognostic factors. The clinical management of HCC requires a comprehensive, multidisciplinary approach. In early HCC curative treatment can be achieved by local ablation, resection or liver transplantation. In intermediate stages patients (pts) are offered locoregional treatment with palliative intent (transarterial chemoembolisation (TACE), Yttrium-90-radioembolisation (SIRT)). In advanced disease systemic therapy with sorafenib (sor) has the potential to prolong survival of pts and is standard of care in pts with preserved liver function. Studies on the combined use of locoregional and systemic therapy with their potential of a beneficial synergism are few and conducted in a small number of pts. Methods: This phase II-study is composed of three substudies with the following primary objectives: 1. In pts in whom local ablation is appropriate to determine if sor in combination with RFA prolongs the time-to-recurrence in comparison with RFA plus placebo. Primary endpoint (PEP): time to recurrence, n = 290 pts 2. In pts in whom RFA is not appropriate (palliative treatment group) to determine if the combination of SIRT and sor improves the overall survival in comparison to sor alone. PEP: overall survival, n = 375 pts 3. To confirm in a 2-step procedure that Gd-EOB-DTPA enhanced MRI is non-inferior or superior compared with contrast-enhanced multislice CT for stratification of pts to a palliative or a local ablation treatment strategy. PEP: correct stratification of pts to a palliative versus local ablation treatment strategy; n = 830 pts The trial has started in December 2010 as a multinational and multicentric study. 90 pts have been enrolled until January 31st 2012 with 51 pts randomized in the palliative arm and 14 pts treated in the curative arm.

Detection and classification of focal liver lesions in patients with colorectal cancer: Retrospective comparison of diffusion-weighted MR imaging and multi-slice CT

To compare the diagnostic performance of diffusion-weighted MR imaging (DWI) with multi-slice CT (MS-CT) in the detection and classification of focal liver lesions in patients with colorectal cancer. In a retrospective study 68 patients who underwent DWI at 1.5 T (b-values of 50, 300 and 600s/mm(2)) and contrast-enhanced MS-CT were analysed by two radiologists blinded to the clinical results. Imaging results were correlated with intraoperative surgical and ultrasound findings (n=24), imaging follow-up or PET (n=44). Sensitivity of DWI and MS-CT in detection of focal liver lesions was compared on a per-lesion and a per-segment basis. Receiver operator-characteristic (ROC) curves to determine the diagnostic performance and the sensitivities of correctly identifying liver metastases on a segmental base were calculated. For lesion detection, DWI was significantly superior to MS-CT both on a per-lesion (difference in sensitivities for reader 1 and 2 22.65% and 19.06%, p<0.0001) and a per-segment basis (16.86% and 11.76%, p<0.0001). Especially lesions smaller than 10mm were better detected with DWI compared to MS-CT (difference 41.10% and 29.45%, p<0.0001). ROC-analysis showed superiority for lesions classification (p<0.0001) of DWI (AUC: 0.949 and 0.951) as compared to MS-CT (AUC: 0.879 and 0.892, p<0.0001 and p=0.005). DWI was able to filter out metastatic segments with a higher sensitivity (88.2 and 86.5%) compared to MS-CT (68.0 and 67.4%, p<0.0001 and p=0.005, respectively). Compared to MS-CT DWI is both more sensitive in the detection of liver lesions and more accurate in determining the extent of metastatic disease in patients with colorectal cancer and therefore might help to optimize therapeutic management in those patients.

Angiogenesis of renal cell carcinoma: perfusion CT findings

To observe the perfusion CT findings of renal cell carcinoma (RCC) and prospectively correlate perfusion CT parameters with tumor MVD and VEGF expression. Dynamic contrast-enhanced multislice spiral CT was performed prospectively in 73 cases with histologically proven RCC (65 clear cell, 3 papillary, and 5 chromophobe). Blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface-area product (PS) of RCC and normal renal cortex were measured, respectively. The tumor MVD count and VEGF expression level were determined by immunohistochemistry with specific monoclonal antibodies. There was significant difference between BF, BV, MTT, and PS of normal renal cortex (454.32 ± 110.90 mL/min/100 g, 23.53 ± 5.71 mL/100 g, 3.62 ± 1.38 s, 63.95 ± 18.85 mL/min/100 g) and RCC (261.96 ± 175.86 mL/min/100 g, 17.17 ± 8.34 mL/100 g, 7.08 ± 3.42 s, 25.07 ± 13.20 mL/min/100 g) (P < 0.01). BF and BV among RCC histologic subtypes were significantly different (P < 0.05), MTT and PS were not (P > 0.05). MVD (42.29 ± 21.00) of RCC is positively correlated with BF, BV, and PS (P < 0.01), not with MTT (P > 0.05). No relationship was found between the expression levels of VEGF and any perfusion CT parameter. Perfusion CT is a feasible technique to assess tissue perfusion in patients with RCC. BV, BF, and PS correlate positively with MVD and may reflect angiogenesis of RCC.

Comparison of Lung Scintigraphy With Multi-Slice Spiral Computed Tomography in the Diagnosis of Pulmonary Embolism

To compare the diagnostic efficacy of lung perfusion scans combined with ventilation (V/Q) scans and/or chest radiography (CR) with contrast-enhanced multislice spiral CT pulmonary angiography (CTPA) in diagnosing pulmonary embolism (PE). Eighty-two consecutive patients with suspected PE underwent CTPA, lung perfusion scan, and CR. Of them, 28 patients underwent V/Q scans. The final diagnosis was made using a composite reference test. The overall sensitivity and specificity were 89.2% and 92.1% for V/Q scan or perfusion scan combined with CR, and 97.3% and 97.4% for CTPA. For the 28 patients with V/Q scan, the sensitivity and specificity were 91.7% and 92.9% for V/Q scan, and 91.7% and 100.0% for CTPA. The segmental agreement rate between perfusion scan and CTPA was 69.5% (kappa = 0.30, P < 0.05). The perfusion scan revealed significantly more subsegmental abnormalities than CTPA (59 vs. 10, chi2 test, P < 0.05). V/Q scan, perfusion scan combined with CR and CTPA all show high efficacy in diagnosing PE. V/Q scan or perfusion scan combined with CR is as accurate as CTPA.

Correlation of perfusion CT findings with microvessel density and vascular endothelial growth factor expression in renal cell cancer

Objective To study the perfusion imaging features of renal cell cancer(RCC) and their correlation with microvessel density(MVD) and vascular endothelial growth factor(VEGF) ex-pression status. Methods Dynamic contrast-enhanced multislice spiral CT was performed preopera-tively in 73 cases with histologically proven RCC (65 cases of clear cell carcinoma, 3 of papillary ade-nocarcinoma, and 5 of chromophobic carcinoma). Blood volume (BV), blood flow (BF), mean transit time (MTT), and permeability surface area product (PS) of tumors were recorded. MVD and VEGF expression status were studied by immunohistochemial staining. Results The mean BV, BF, MTT negative in 35 (47.9 %) cases, slightly positive in 24 (32.9 %) cases, moderate positive in 10 (13.7 %) cases, and intensively positive in 4 (5.5 %) cases. MVD of RCC was positively correlated with BV, BF and PS (P<0.01),and negatively correlated with MTT (P<0.05). No relationship was found be-tween the expression of VEGF and perfusion CT parameters. Conclusion Perfusion CT scan is use-ful to evaluate the angiogenesis status of RCC. Key words: Kidney neoplasms; Carcinoma; Tomography, spiral computed; Microvessel density; Vascular endothelial growth factor

Correlation of Multislice CT and Histomorphology in HCC Following TACE: Predictors of Outcome

The purpose of this study was to correlate histopathological with CT findings in patients suffering from hepatocellular carcinoma (HCC) eligible for orthotopic liver transplantation (OLT), with a special focus on the antitumoral effect of transarterial chemoembolization (TACE) therapy. A total of 42 consecutive patients suffering from HCC had been treated prior to OLT by means of TACE. TACE was carried out with a mixture of Lipiodol (10-20 ml) and mitomycin C (max. dosage, 10 mg). TACE was performed at 6- to 8-week intervals. Follow-up investigation included contrast-enhanced multislice CT controls and laboratory control. Liver explants were evaluated macroscopically and microscopically to determine the number and size of the tumor lesions as well as the degree of tumor necrosis. Necrosis was investigated in H&E-stained sections. The degree of necrosis was classified as follows: 0-25%, 26-50%, 51-75%, 75-99%, and complete necrosis. Two hundred thirty-one TACE procedures (5.5 +/- 2.9; range, 1-14) were performed. Mean tumor size in CT before and after TACE was 4.1 +/- 2.4 (range, 1.0-12.0 cm) and 2.7 +/- 1.2 (range, 1.0-6.0 cm; p < 0.001). Mean tumor number before and after TACE in CT was 2.5 +/- 1.5 (n = 105; range, 1-8) and 2.4 +/- 2.0 (n = 103; range, 1-6; p = 0.99). In the surgical specimen tumor size and tumor number were 2.8 +/- 1.6 (range, 1.0-7.0 cm; p = 0.78) and 1.9 +/- 1.2 (range, 1-7; p = 0.003). Mean tumor necrosis was 67.8% +/- 28.1%. Tumor necrosis was subtotal or complete in 17 of 42 (40.5%) patients. Tumor necrosis correlated significantly with the degree of arterial devascularization in CT (p = 0.001), the amount of Lipiodol washout (p = 0.002), and the number of tumor lesions (i.e., unifocal vs. multifocal). Furthermore, elevated serum levels of bilirubin (p = 0.005) and decreased albumin (p = 0.004) affected the local antitumoral effect. A poor necrosis rate (< 25%) significantly correlated with the number of TACE procedures accomplished (p = 0.023). In conclusion, TACE provided an acceptable local antitumoral effect in patients scheduled for liver transplantation. Tumor necrosis depended significantly on the degree of arterial devascularization and the accumulation of Lipiodol within the HCC lesions. Unifocal tumors and preserved liver function were positive predictors for a more favorable local antitumoral effect. Poor necrosis rates were found in patients with significant Lipiodol washout and who received a limited number of TACE procedures.

Role of three-phase contrast-enhanced multislice helical CT in evaluating resectability of pancreatic carcinoma

Role of three-phase contrast-enhanced multislice helical CT in evaluating resectability of pancreatic carcinoma

Contrast-enhanced multislice pneumo-CT-cystography in the evaluation of urinary bladder neoplasms

Purpose To evaluate the accuracy of contrast-enhanced multislice CT (MSCT) in the study of urothelial tumors after distension of the bladder with air. Materials and methods We evaluated 43 consecutive patients with endoscopically proven bladder lesions. After air distension of the bladder, unenhanced pelvic and enhanced abdomino-pelvic scans were obtained with the following protocol: thickness 2.5 mm × 4 mm, increment 1 mm, scan delay 40″ and 7–10 min. For each patient we considered the number, size, aspect (papillary or sessile) and contrast enhancement of lesions. Ureteral involvement and the presence of synchronous lesions in the excretory scan were also evaluated. MPR and virtual endoscopy images were reviewed in all cases. Results Bladder lesions were visualized in 39/43 cases. Compared to conventional cystoscopy, MSCT recognized single lesions in 31/33 patients, two lesions in 4/6, three in 2/2 and more than five foci in 2/2 patients. A papillary aspect was described in 44 cases while 11 lesions were sessile. Conventional Cystoscopy recognized six more lesions as compared with MSCT (four flat and two small papillary lesions). The detection rate for protruding lesions was 100% (52/52) for lesions > 5 mm and 60% (3/5%) for lesions < 5 mm. In four patients hydronephrosis was present, while in one case a synchronous lesion was evident in the renal pelvis. Conclusion Contrast-enhanced MSCT with air distension of the urinary bladder is a safe and complete investigation to evaluate the local stage of bladder cancer and to evaluate the ureteral extension of the tumor, as well as the presence of synchronous lesions.

Transarterial Chemoembolization (TACE) for Inoperable Intrahepatic Cholangiocarcinoma

The aim of this retrospective study was to determine the safety and efficacy of chemoembolization (TACE) as palliative treatment for patients with unresectable intrahepatic cholangiocarcinoma (CCA) and to compare the results with those in the literature. Fifteen patients with histology-proven CCA (5 men, 10 women) had received palliative treatment with TACE over a 6-year period. The treatment protocol comprised repeated TACE at a minimum of 8-week intervals. TACE was performed with a mixture of 10 ml Lipiodol and 10 mg mitomycin C injected into the tumor-supplying vessels. Follow-up investigations after 8-10 weeks comprised contrast-enhanced multislice spiral CT and laboratory control. Statistical evaluation included survival analysis using the Kaplan-Meier method. During the investigation period 58 TACEs (3.9 +/- 3.8; 1-15) were performed in 15 patients. Mean tumor size was 10.8 +/- 4.6 cm (range, 2.0-18.0 cm). Unifocal tumor disease was diagnosed in eight patients, and multifocal disease in seven. Mean survival was 21.1 months (95% CI, 9.4-32.5 months). At the end of the investigation period 3 patients are still alive, and 12 patients have died. The 1-, 2-, and 3-year survival rate was 51.3%, 27.5%, and 27.5% respectively. According to RECIST criteria interim best response to therapy was stable disease in 9 of 15 patients, a partial response in 1 of 15 patients, and tumor progression in 4 of 15 patients. No deaths and no acute liver failure occurred under TACE therapy. Major complications were observed in two patients, comprising anaphylactic shock owing to contrast medium administration in one and gastric ulceration due to lipiodol displacement in the second patient. These results demonstrate that TACE is a safe procedure with a moderate number of complications for patients suffering from inoperable CCA. According to recently published data on i.v. chemotherapy we suggest that TACE might be able to prolong survival in selected patients who would succumb under other palliative treatment modalities.

Sequentielle transarterielle Chemoembolisation (TACE) des hepatozellulären Karzinoms (HCC) - Erfahrungsbericht eines einzelnen Zentrums über 5 Jahre

To analyze the course of disease of patients treated with sequential TACE and to evaluate the dependent and independent prognostic factors for patient survival using the Cox Proportional Hazard Model. 94 patients palliatively treated with TACE. Patients were selected if they had been treated at least 3 times. The TACE procedure was carried out at 8-week intervals using a suspension consisting of a fixed dosage of Mitomycin C (10 mg) and 10 ml Lipiodol. Follow-up investigations included contrast-enhanced multislice CT before and after TACE and assessment of the laboratory test results (i. e., blood count, liver enzymes, and coagulation). In 66.7 % of the patients, multifocal tumors were found. In 16.0 % of the patients, the tumor load represented more then 50 % of the liver volume. In 23.4 % of the cases, a portal vein thrombosis was found in the initial CT scan. The mean survival for the total cohort was 24.1 months (95 %-CI 20.1 - 28.2). During the investigation period, 72/94 of the patients died. The cumulative 1-year, 2-year, and 3-year survival rates are 71.6 %, 33.9 %, und 17.2 %, respectively. A median of 6.0 +/- 3.1 (range 14, n total = 612 TACE) was performed in each patient. A total of 62.5 % patients died because of tumor progression whereas 18.1 % died due to progressive liver failure. Patients in whom the tumor responded to the TACE treatment and who did not develop ascites or those with Okuda stage I or unifocal tumor growth showed a survival benefit whereas the presence of portal vein thrombosis was associated with a significantly poor outcome (p < 0.05). The Child-Pugh stage was not statistically significant for the disease course; the occurrence of new tumor lesions had no influence with regard to 1-year and 2-year survival but had a significant influence on long-term survival (p < 0.05). Independent prognostic factors are (multivariate analysis; p < 0.05): number of TACE performed, tumor type (i. e., unifocal vs. multifocal), response to TACE (response vs. progression), and Okuda stage. Our results emphasize the value of TACE in the palliative treatment of HCC. Under sequential TACE therapy the course of disease in patients suffering from portal vein thrombosis was not significantly worse. Crucial prognostic factors for the course of the HCC are tumor type and extension, response to TACE, and liver function at the beginning of TACE.

Feasibility and measurement precision of 3D quantitative blood flow mapping of the prostate using dynamic contrast-enhanced multi-slice CT

We have developed a 3D dynamic contrast-enhanced (DCE) multislice CT protocol that covers the complete prostate. The DCE-CT data are subsequently analysed using the adiabatic approximation of the tissue homogeneity model resulting in five 3D quantitative maps of blood flow, mean transit time, extraction fraction, extracellular extravascular space and delay time. The purpose of this study was to establish the feasibility of determining these parameters in the prostate with a spatial resolution as high as ∼0.1 cc as well as a good measurement precision. The precision of the parameter estimation as a function of noise level is determined by a Monte Carlo-based method that simulates the effect of noise present in the data. We find that the precision depends on the value of the flow and transit time, where a higher value is favourable. At a noise level of 4 HU in combination with a peak enhancement in the iliac arteries of ∼300 HU the 95% confidence intervals are sufficiently small to discriminate whether a parameter value is above or below a given threshold. We have collected and analysed the noise level in the DCE-data of five patients. A noise level of 3.8 HU on average can be obtained by averaging to a voxel volume of 4.5 × 4.5 × 5 mm3 = 0.1 cc. Analysis of the parameter maps shows that it is feasible to detect both small and large lesions, as well as irregularly shaped lesions.