CT Enhancement Patterns Research Articles

Prediction of the benign and malignant nature of masses in COPD background based on Habitat-based enhanced CT radiomics modeling: A preliminary study.

It is difficult to differentiate between chronic obstructive pulmonary disease (COPD)-peripheral bronchogenic carcinoma (COPD-PBC) and inflammatory masses. This study aims to predict COPD-PBC based on clinical data and preoperative Habitat-based enhanced CT radiomics (HECT radiomics) modeling. A retrospective analysis was conducted on clinical imaging data of 232 cases of postoperative pathological confirmed PBC or inflammatory masses. The PBC group consisted of 82 cases, while the non-PBC group consisted of 150 cases. A training set and a testing set were established using a 7:3 ratio and a time cutoff point. In the training set, multiple models were established using clinical data and radiomics texture changes within different enhanced areas of the CT mass (HECT radiomics). The AUC values of each model were compared using Delong's test, and the clinical net benefit of the models was tested using decision curve analysis (DCA). The models were then externally validated in the testing set, and a nomogram of predicting COPD-PBC was created. Univariate analysis confirmed that female gender, tumor morphology, CEA, Cyfra21-1, CT enhancement pattern, and Habitat-Radscore B/C were predictive factors for COPD-PBC (P< 0.05). The combination model based on these factors had significantly higher predictive performance [AUC: 0.894, 95% CI (0.836-0.936)] than the clinical data model [AUC: 0.758, 95% CI (0.685-0.822)] and radiomics model [AUC: 0.828, 95% CI (0.761-0.882)]. DCA also confirmed the higher clinical net benefit of the combination model, which was validated in the testing set. The nomogram developed based on the combination model helped predict COPD-PBC. The combination model based on clinical data and Habitat-based enhanced CT radiomics can help differentiate COPD-PBC, providing a new non-invasive and efficient method for its diagnosis, treatment, and clinical decision-making.

Prognostic Advantages of Individual Additional Interventions After Lenvatinib Therapy in Patients with Advanced Hepatocellular Carcinoma

BackgroundIncreasing number of patients with advanced hepatocellular carcinoma (HCC) has recently achieved salvage interventions after introduction of new biologic agents, while there are insufficient data to determine if such additional intervention(s) after treatment with newer biologic agents are truly advantageous for patients with advanced HCC. MethodsThe clinical records of 107 consecutive patients who underwent lenvatinib treatment for advanced HCC were extensively reviewed and the prognostic advantages of individual additional treatments after lenvatinib treatment were investigated through a regression analysis considering time-dependent covariates. ResultsMultivariate analysis revealed that R0 resection or curative-intent radiofrequency ablation (RFA) (hazard ratio [HR], 0.07; 95% CI, 0.01–0.32), transarterial chemoembolization or transarterial infusion therapy (HR, 0.39; 95% CI, 0.19–0.81), and subsequent line of systemic therapy (HR, 0.25; 95% CI, 0.10–0.63) were associated with improved disease-specific survival (DSS), while R2 resection or palliative-intent RFA showed no correlation with DSS. The best response during lenvatinib therapy, nutritional status, plasma des-gamma-carboxyprothrombin level, a baseline CT enhancement pattern, and BCLC stage were also selected as independent predictors for DSS. Among the various treatments performed after lenvatinib therapy, R0 resection also showed clear prognostic advantage in both progression-free survival (HR, 0.30; 95% CI, 0.16–0.58) and time-to-treatment failure (HR, 0.08; 95% CI, 0.02–0.39), suggesting that successful conversion to surgery may prolong survival outcomes through prolonged cancer-free interval in advanced HCC. ConclusionsAdditional intervention(s)/treatment(s) after lenvatinib therapy for advanced HCC may have prognostic advantage in strictly selected populations. Successful conversion to curative resection may offer survival benefit with acceptable clinical outcomes.

Diagnostic Performance of LI-RADS Treatment Response Algorithm for Hepatocellular Carcinoma: Adding Ancillary Features to MRI Compared with Enhancement Patterns at CT and MRI.

Background The Liver Imaging Reporting and Data System Treatment Response (LR-TR) algorithm is used to assess the response of hepatocellular carcinoma (HCC) to local-regional therapy (LRT) based on enhancement patterns. The potential value of adding MRI ancillary features (AFs) needs to be investigated. Purpose To evaluate the potential application of MRI AFs in category adjustment to detect pathologic tumor viability in comparison with the LR-TR algorithm in CT and gadoxetic acid-enhanced MRI. Materials and Methods This retrospective study included patients with HCCs treated with LRT followed by surgical resection or liver transplantation between January 2014 and December 2017 who underwent both post-LRT CT and gadoxetic acid-enhanced MRI. For each treated observation, treatment response (TR) categories were assigned based on a consensus reading of three radiologists according to the LR-TR algorithm in CT and MRI and according to the MRI-modified TR algorithm in which MRI AFs were allowed for category adjustment. The diagnostic performances of CT LR-TR viable, MRI LR-TR viable, and MRI-modified TR viable categories were compared intraindividually with the McNemar test, with pathologic tumor viability used as a reference standard. Results A total of 138 patients (119 men; mean age, 58 years ± 9 [standard deviation]) with 138 treated observations (108 pathologically viable) were evaluated. The sensitivity and specificity of CT LR-TR viable and MRI LR-TR viable categories for predicting tumor viability were 73% (79 of 108 lesions; 95% confidence interval [CI]: 64%, 81%) versus 76% (82 of 108 lesions; 95% CI: 67%, 84%) and 90% (27 of 30 lesions; 95% CI: 74%, 98%) versus 83% (25 of 30 lesions; 95% CI: 65%, 94%), respectively, without differences between CT and MRI (P = .65 and P = .63, respectively). MRI-modified TR viable category had higher sensitivity (84% [91 of 108 lesions; 95% CI: 76%, 91%]) than CT or MRI LR-TR viable category (P = .002 and P = .01, respectively), without difference in specificity (80% [24 of 30 lesions]; 95% CI: 61%, 92%) (P = .38 and P > .99, respectively). Conclusion The application of MRI ancillary features to the Liver Imaging Reporting and Data System Treatment Response algorithm resulted in higher sensitivity and no change in specificity compared with CT or MRI enhancement patterns alone in the prediction of pathologic tumor viability in patients with hepatocellular carcinoma. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Do and Mendiratta-Lala in this issue.

Lenvatinib-Transarterial Chemoembolization Sequential Therapy as an Effective Treatment at Progression during Lenvatinib Therapy for Advanced Hepatocellular Carcinoma

Background: The aims of this study were to evaluate the efficacy of additional treatment, especially lenvatinib-transarterial chemoembolization (TACE) sequential therapy, for unresectable hepatocellular carcinoma (HCC). Methods: Consecutive 56 patients who underwent lenvatinib treatment were reviewed. Oncological aggressiveness of tumor was estimated using a dynamic CT enhancement pattern classification, and clinical impact of subsequent treatment was investigated through analysis of progression-free survival (PFS), post-progression survival (PPS), and multivariate analysis of potential confounders for survival after progression during lenvatinib therapy. Results: Heterogeneous enhancement patterns (Type-3 and -4), which are reportedly associated with higher oncological aggressiveness of HCC, were associated with better objective response to lenvatinib compared to homogeneous enhancement pattern (Type-2) (86 and 85% vs. 53% in modified Response Evaluation Criteria in Solid Tumors), resulting in similar PFS (p = 0.313). Because of significantly worse PPS, overall survival of Type-4 tumor was poor compared to Type-2 or -3 tumors (p = 0.009). However, subgroup of patients who achieved subsequent treatment showed significantly better PPS, regardless of CT enhancement pattern. Multivariate analysis confirmed that use of lenvatinib-TACE sequential treatment after progression during lenvatinib therapy was associated with better PPS (hazard ratio [HR], 0.08; 95% CI, 0.01–0.71; p = 0.023), while Type-4 enhancement pattern was correlated with worse PPS (HR, 2.92; 95% CI, 1.06–8.05; p = 0.039). Conclusion: Oncological aggressiveness of HCC estimated by CT enhancement pattern was predictive of PPS after progression during lenvatinib. Successful subsequent treatment with lenvatinib-TACE sequential therapy may offer survival benefit regardless of CT enhancement pattern of HCC.

Enhancements in pancreatic protocol CT as a prognostic indicator in pancreatic cancer.

216 Background: Pancreatic protocol CT (pCT) is widely used to evaluate stage and resectability of pancreatic ductal adenocarcinoma (PDAC). Recent studies show that CT enhancement patterns are related to the patient’s prognosis in several cancers, however it is not well described that pCT enhancement has prognostic effect in resectable PDAC so far. We aimed to show correlaton between pCT enhancements and prognosis in resectable PDAC. Methods: We retrospectively enrolled 159 patients (median age, 67.8 years) who underwent pCT before curative resection in Seoul National University Bundang Hospital between January 2010 and December 2015, with final pathological diagnosis of PDAC. CT enhancement ratio (CTER) of each primary lesion was calculated as proportional difference between maximum Houndsfield Unit (HU) of pancreatic phase (PP) image and maximum HU of non-contrast image; [(max HU of PP) - (max HU of non-contrast)] / (max HU of non-contrast). Patients were classified into two groups, based on CTER. Kaplan–Meier analysis and Cox proportional hazards models were used to correlate CTER with overall survival (OS) and recurrence free survival (RFS). Results: Median overall survival was 22.0 months during a median follow-up period of 18.5 months. Based on CTER with cut-off value of 1.8, higher (CTER ≥ 1.8) group (N = 43) was compared with lower (CTER &lt; 1.8) group (N = 116) in terms of OS and RFS. Lower group showed significantly shorter median OS (18.5 months versus 39.3 months, P &lt; 0.001) and median RFS (9.9 months versus 21.5 months, P = 0.006) than those of higher group. Multivariate regression analysis showed that lower group had shorter OS (HR 1.70; CI 1.01-2.85, P = 0.044) and RFS (HR 1.84; CI 1.10-3.06, P = 0.019). Conclusions: Our study suggests that lower enhancement in pancreatic phase of pCT is related to poor prognosis in PDAC. Therefore, active surveillance would be required in resected PDAC patients with CTER less than 1.8.

Preoperative Prediction of Microvascular Invasion in Hepatocellular Carcinoma Using Quantitative Image Analysis

Microvascular invasion (MVI) is a significant risk factor for early recurrence after resection or transplantation for hepatocellular carcinoma (HCC). Knowledge of MVI status would help guide treatment recommendations, but is generally identified after operation. This study aims to predict MVI preoperatively using quantitative image analysis. One hundred and twenty patients from 2 institutions underwent resection of HCC from 2003 to 2015 were included. The largest tumor from preoperative CT was subjected to quantitative image analysis, which uses an automated computer algorithm to capture regional variation in CT enhancement patterns. Quantitative imaging features by automatic analysis, qualitative radiographic descriptors by 2 radiologists, and preoperative clinical variables were included in multivariate analysis to predict histologic MVI. Histologic MVI was identified in 19 (37%) patients with tumors ≤5 cm and 34 (49%) patients with tumors >5 cm. Among patients with tumors ≤5 cm, none of the clinical findings or radiographic descriptors were associated with MVI; however, quantitative features based on angle co-occurrence matrix predicted MVI with an area under curve of 0.80, positive predictive value of 63%, and negative predictive value of 85%. In patients with tumors >5 cm, higher α-fetoprotein level, larger tumor size, and viral hepatitis history were associated with MVI, and radiographic descriptors were not. However, a multivariate model combining α-fetoprotein, tumor size, hepatitis status, and quantitative feature based on local binary pattern predicted MVI with area under curve of 0.88, positive predictive value of 72%, and negative predictive value of 96%. This study reveals the potential importance of quantitative image analysis as a predictor ofMVI.

Active Surveillance of Nonfatty Renal Masses in Patients With Lymphangioleiomyomatosis: Use of CT Features and Patterns of Growth to Differentiate Angiomyolipoma From Renal Cancer.

The objective of this study was to report our experience with active surveillance of nonfatty renal masses in a large cohort of patients with lymphangioleiomyomatosis (LAM), correlate their CT features and patterns of growth with histopathology results, and provide guidelines for management. Yearly CT examinations were performed of 367 women (age range, 21-75 years; mean age, 47 years). For the 31 patients with 37 nonfatty renal masses that were biopsied, excised, or followed for ≥ 5 years, CT enhancement characteristics and patterns of growth were compared with the histopathology results. Four of 37 nonfatty renal masses were biopsied without follow-up CT examinations: Two were heterogeneous renal cell carcinomas (RCCs), one was a heterogeneous nonfatty angiomyolipoma (AML), and one was homogeneous nonfatty AML. In the remaining 33 nonfatty renal masses with multiple follow-up CT examinations, two growth patterns were identified. Four showed a continuous increase in size of > 0.5 cm/y in some years, and all four in this first group were heterogeneous and were biopsy-proven RCC. The second group was composed of the remaining 29 masses. These 29 masses showed yearly no change, increase, or decrease in diameter. Eight were heterogeneous, and 21 were homogeneous. Of the masses showing a yearly increase, the increase was < 0.5 cm/y in all except one. In the one exception, the increase followed a decrease. Nine of the 29 masses were biopsied, and all nine were nonfatty renal masses (five homogeneous, four heterogeneous). Our data provide further evidence in a large prospective study with longterm follow-up that active surveillance is an appropriate strategy in the management of nonfatty renal masses in patients with LAM. Our analysis of the growth patterns reveals duration of growth in addition to growth rate as criteria for biopsy or excision. Biopsy should be reserved for nonfatty renal masses that show sustained growth or growth > 0.5 cm/y during follow-up.

Value of multidetector computed tomography in the diagnosis of mucosa-associated lymphoid tissue-lymphomas in the parotid gland: A case report and review of the literature

The present study aimed to review the multidetector computed tomography (MDCT) imaging features of eight mucosa-associated lymphoid tissue (MALT)-lymphoma cases of the parotid gland and to explore the diagnostic value of MDCT. A total of eight patients with pathologically confirmed MALT-lymphomas of the parotid gland underwent pre-operative MDCT plain and dual-phase scans. The changes in the CT values and enhancement patterns of the tumors were assessed. Quantitative analysis was performed to determine the CT value changes of the tumors in the various enhanced phases compared with the plain scan. The MALT-lymphomas of the parotid gland exhibited even density isodense or hyperdense nodules, with occasional calcification and necrosis. The dual-phase scan of the MALT-lymphomas revealed a pattern of lower or moderate enhancement, circumambient enhancement or delayed enhancement. The MALT-lymphomas were closely associated with Sjögre’s syndrome and demonstrated malignant features and isodense or hyperdense nodules and lower or moderate enhancement on the CT scans.

Differentiation of tuberculosis from lymphomas in neck lymph nodes with multidetector-row computed tomography

Tuberculosis (TB) of the cervical lymph nodes may mimic lymphoma. To evaluate multidetector-row computed tomographic (MDCT) imaging criteria for differentiating between the two diseases. We retrospectively reviewed the anatomical distribution and CT enhancement patterns of the nodes in 81 patients, 27 (33%) with untreated TB and 54 (67%) with untreated lymphomas involving cervical lymph nodes. Of the patients with lymphomas, 19 (35%) had Hodgkin's disease and 35 (65%) had non-Hodgkin's lymphoma. TB predominantly involved the upper cervical nodes. The supraclavicula fossa nodes on MDCT were involved more often in Hodgkin's disease (n = 15, 79%) and non-Hodgkin's lymphoma (n = 25, 71%) than in TB (n = 3, 11%). Tuberculous lymphadenopathy commonly showed peripheral enhancement, frequently with a multilocular appearance. Peripheral enhancement was significantly more frequent in TB (n = 19, 70%) than in Hodgkin's disease (n = 1, 5%) and non-Hodgkin's lymphoma (n = 1, 3%), but homogeneous enhancement was less common in the TB group. Our findings indicate that a specific enhancement pattern of lymphadenopathy seen on MDCT was useful in differentiating between untreated TB and lymphomas of the cervical lymph nodes.

Enhancement Patterns of Hepatocellular Carcinoma After Transarterial Chemoembolization Using Drug-Eluting Beads on Arterial Phase CT Images: A Pilot Retrospective Study

The purpose of this article is to assess CT enhancement patterns of hepatocellular carcinoma (HCC) within 1 month after transarterial chemoembolization (TACE) using drug-eluting beads and to determine whether enhancement patterns may be useful for predicting local tumor progression. Forty-one patients with 50 HCCs underwent CT within 1 month after TACE with drug-eluting beads. Two blinded readers independently reviewed the arterial phase images and classified enhancement patterns as follows: no enhancement, peripheral ring enhancement, and peripheral nodulelike enhancement. Enhancement patterns were correlated with time to tumor progression of enhancing tissue by log-rank test. In the group with no enhancement, 92.3% (24/26) had not progressed and 7.7% (2/26) showed progression; for peripheral ring enhancement, 83.3% (10/12) had not progressed and 16.7% (2/12) showed progression; and for peripheral nodulelike enhancement, 16.7% (2/12) had not progressed and 83.3% (10/12) showed progression. The time to progression of enhancing tissue was significantly different between the group with no enhancement plus peripheral ring enhancement and the group with peripheral nodulelike enhancement (p < 0.001). Analysis of enhancement patterns at the arterial phase of the first follow-up CT after TACE with drug-eluting beads is helpful for predicting progression of treated HCC.

Defining vascular signatures of malignant hepatic masses: role of MDCT with 3D rendering

Malignant hepatic masses, both primary and metastatic lesions, have characteristic CT appearances and enhancement patterns. Owing to advances in CT resolution, high-quality vascular maps can be generated with 3D rendering tools to aid hepatic mass evaluation. These renderings enable identification of neovascularity, which is critical for distinguishing malignant from benign lesions, and facilitate identification of small hyperenhancing malignant hepatic tumors. In this review, CT features of malignant hepatic masses are discussed in conjunction with a demonstration of the role for 3D vascular mapping.

Heterogeneous Type 4 Enhancement of Hepatocellular Carcinoma on Dynamic CT Is Associated With Tumor Recurrence After Radiofrequency Ablation

The aim of this study was to predict recurrence of hepatocellular carcinoma (HCC) from baseline dynamic CT images. This retrospective study included 191 consecutive patients who underwent surgical resection or radiofrequency ablation (RFA) between January 2005 and September 2009 for the treatment of HCC. Enhancement on pretreatment arterial and portal phase dynamic CT images was classified into one of the four following enhancement patterns: Types 1 and 2 are homogeneous enhancement patterns without or with increased arterial blood flow, respectively; type 3 is a heterogeneous enhancement pattern with septations; and type 4 is an irregularly shaped ring structure enhancement pattern. Predictive factors for tumor recurrence including dynamic CT enhancement pattern were also evaluated. Moreover, risk factors including recurrence type (i.e., tumor number ≥ 10, portal vein invasion, or both) were evaluated in RFA-treated cases. Among 60 patients who underwent surgical resection, no statistical association was observed between dynamic CT enhancement patterns and recurrence rate. In contrast, in the 131 patients who underwent RFA, cumulative recurrence rates for each enhancement pattern were significantly different: Recurrence rates 2 years after RFA for patients with type 1, 2, 3, and 4 were 26.6%, 46.9%, 38.6%, and 77.8%, respectively (p = 0.042). Recurrence, which was defined as the presence of 10 or more nodules, portal vein invasion, or both occurred in nine of 131 patients (6.9%) in the RFA group. A multivariate Cox proportional hazards analysis revealed that the type 4 dynamic CT enhancement pattern is an independent factor for HCC recurrence (hazard ratio, 27.68; 95% CI, 6.82-112.33; p < 0.001). The pretreatment type 4 dynamic CT enhancement pattern can potentially be used to predict recurrence of HCC after RFA treatment.

Non‐invasive diagnostic criteria for hepatocellular carcinoma: The value of contrast washout at imaging and the death of alpha‐fetoprotein

Non‐invasive diagnostic criteria for hepatocellular carcinoma: The value of contrast washout at imaging and the death of alpha‐fetoprotein

Incidental breast lesions detected on CT: what is their significance?

An increasing number of breast lesions are being detected incidentally on CT. The aim of this study was to investigate the rate of referrals to the breast unit for assessment of lesions identified on CT and the resulting yield of previously undiagnosed breast malignancies from this pathway. A retrospective review was undertaken of CT examinations conducted over a period of 14 years. All patients (with no previous history of breast cancer) whose report contained the keyword "breast" and who were referred to a specialist breast unit for assessment were reviewed. CT lesion morphology and enhancement pattern were identified and compared with the final diagnostic outcome. 70 patients were identified by retrospective analysis, yielding 78 incidental breast lesions, of which 22 (28.2%) were malignant (category B5). This gave a positive predictive value (PPV) for malignancy of 28.2%. The best morphological predictor of malignancy was spiculation (PPV, 76%) and irregularity (PPV, 58%), whereas calcification patterns (PPV, 36%) were diagnostically unhelpful. Malignant lesions were likely to be larger (mean, 28.5 mm) than benign lesions (mean, 20.2 mm; p<0.05). In conclusion, 30% of incidental breast lesions in this large series of patients proved to be unsuspected breast cancers, particularly irregular spiculated masses. Referral for formal triple assessment of CT-diagnosed breast lesions is worthwhile, and careful examination of the breast should be a routine part of CT examinations.

Radiologic Diagnosis of Interstitial Lung Diseases

Diffuse interstitial lung diseases (DILD) are a group of chronic disorders showing varying degrees of active inflammation and established fibrosis mainly involving the interstitium of the lungs. DILD can be classified into two groups in an etiologic aspect; idiopathic and DILD with known-cause, such as connective tissue diseases associated with DILD. Although there had been complexity and variability in the classification of idiopathic interstitial pneumonia (IIP), an international standard was established for the classification of IIPs including seven clinical-radiologic-pathologic entities; idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), cryptogenic organizing pneumonia (COP), acute interstitial pneumonia (AIP), respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), desquamative interstitial pneumonia (DIP), and lymphoid interstitial pneumonia (LIP). The prognosis of fibrotic NSIP and IPF is much poorer compared to those of other spectrum of IIPs, such as COP, RB-ILD, DIP, and LIP. Therefore, fibrotic NSIP and IPF can be considered separately as a group of fibrotic IIPs. Trying to predict the prognosis of IIPs, there has been an effort to differentiate inflammation-predominant lesions from fibrosis-predominant lesions in patients with fibrotic IIPs. Radiologic features of low fibrotic scores at high-resolution CT and early enhancement patterns at dynamic enhancement of MRI can be useful prognostic determinants for the prediction of disease improvement in patients with fibrotic IIPs.

Enhancement characteristics of cholangiocarcinomas on mutiphasic helical CT: emphasis on morphologic subtypes

The purpose of this study was to characterize the differences in CT enhancement pattern among the morphologic subtypes of cholangiocarcinomas. Unenhanced, hepatic arterial (HAP), and portal venous phase (PVP) CT images of 84 patients with pathologically proven cholangiocarcinoma were retrospectively reviewed. Tumors were of the following types: 27 mass-forming, 39 periductal-infiltrating, and 18 intraductal. The CT attenuation values of tumors were measured at each phase. The tumor enhancement ratio (ER) on HAP and PVP was calculated. Each cholangiocarcinoma subtype produced characteristic enhancement relative to liver on HAP and PVP images: mass-forming tumors demonstrated hyperenhancing periphery and hyopenhancing centers; periductal-infiltrating tumors, hyperenhancing; and intraductal tumors, hypoenhancing. The ER of the tumor types was significantly different (P<.001, HAP, PVP): periductal-infiltrating tumors showed the highest ER (2.5; 3.8); the centers of mass-forming tumors, lowest (1.5; 2.2); the peripheries of mass-forming tumors, high (2.1; 3.0); intraductal tumors, low (1.9; 2.6). Cholangiocarcinoma subtypes tended to exhibit distinct enhancement characteristics. Knowledge of these enhancement patterns may aid diagnosis and surgical planning.

Bladder Cancer: Analysis of Multi-Detector Row Helical CT Enhancement Pattern and Accuracy in Tumor Detection and Perivesical Staging

No AccessJournal of UrologyUrological Survey: Imaging1 Oct 2005Bladder Cancer: Analysis of Multi-Detector Row Helical CT Enhancement Pattern and Accuracy in Tumor Detection and Perivesical Staging Cary SiegelM.D. Cary SiegelCary Siegel More articles by this author View All Author Informationhttps://doi.org/10.1097/S0022-5347(01)68587-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Bladder Cancer: Analysis of Multi-Detector Row Helical CT Enhancement Pattern and Accuracy in Tumor Detection and Perivesical Staging." The Journal of Urology, 174(4 Part 1), pp. 1250–1251 © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 4 Part 1October 2005Page: 1250-1251 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information Cary Siegel More articles by this author Expand All Advertisement Loading ...

Bladder Cancer: Analysis of Multi-Detector Row Helical CT Enhancement Pattern and Accuracy in Tumor Detection and Perivesical Staging

Bladder Cancer: Analysis of Multi-Detector Row Helical CT Enhancement Pattern and Accuracy in Tumor Detection and Perivesical Staging

Differentiation of Renal Clear Cell Carcinoma and Renal Papillary Carcinoma Using Quantitative CT Enhancement Parameters

The purpose of our study was to evaluate quantitative multiphasic CT enhancement patterns of malignant renal neoplasms to enable lesion differentiation by their enhancement characteristics. We used a new method to standardize enhancement measurement in lesions on multiphasic CT not being influenced by intrinsic factors like cardiac output. The new correction method is a simple tool for excluding intrinsic influences on the enhancement of lesions. Quantitative enhancement evaluation with this method of the influence of intrinsic factors enables accurate differentiation between renal clear cell carcinoma and renal papillary carcinoma.

Tuberculosis versus lymphomas in the abdominal lymph nodes: evaluation with contrast-enhanced CT.

Tuberculosis in the abdominal lymph nodes may be difficult to distinguish from lymphomas. This study evaluated specific CT imaging criteria for differentiating these entities. We retrospectively reviewed the anatomic distribution and CT enhancement patterns of disease in 69 patients, 26 (38%) with tuberculosis and 43 (62%) with untreated lymphomas involving abdominal lymph nodes. Of the patients with tuberculosis, five (19%) had disseminated disease and 21 (81%) had nondisseminated disease. Of the patients with lymphomas, 16 (37%) had Hodgkin's disease and 27 (63%) had non-Hodgkin's lymphoma. Disseminated and nondisseminated tuberculosis involved predominantly lesser omental, mesenteric, anterior pararenal, and upper paraaortic lymph nodes. Lower paraaortic lymph nodes were involved more often in Hodgkin's disease (15 patients [94%]), non-Hodgkin's lymphoma (24 patients [89%]), and disseminated tuberculosis (five patients [100%]) than in nondisseminated tuberculosis (one patient [5%]). Mesenteric lymph nodes were involved more often in disseminated tuberculosis (four patients [80%]) and nondisseminated tuberculosis (11 patients [52%]) than in Hodgkin's disease (one patient [6%]) (p < .01). Anatomic distribution was not different between disseminated tuberculosis and non-Hodgkin's lymphoma. Tuberculous lymphadenopathy commonly showed peripheral enhancement, frequently with a multilocular appearance, whereas lymphomatous adenopathy characteristically showed homogeneous attenuation (14 patients [87.5%] with Hodgkin's disease and 19 patients [70%] with non-Hodgkin's lymphoma [p < .01]). Our findings indicate that the anatomic distribution and specific enhancement patterns of lymphadenopathy seen on contrast-enhanced CT can be useful in differentiating between tuberculosis and untreated lymphomas of the abdominal lymph nodes.