Hepatic CT Research Articles

Comparison between manual and automated CT liver volumetry in assessment of the liver volume in living donor liver transplantation

Abstract Aim of the work To evaluate the effectiveness and advantages of automated CT volumetry in the assessment of liver volume in living donor liver transplantation and to compare this technique and its results with those calculated from manual volumetry. Materials and Methods This comparative study was conducted on dynamic contrast enhanced hepatic CT scans of 21 potential living liver donors. All potential donors underwent 1st step laboratory investigations to enter the 2nd step investigations for living donor liver transplantation operation. Automated liver volumetry was developed using the Myrian® XP-Liver software. To establish reference standard liver volumes, a radiologist manually traced the contour of the liver on each CT slice. We compared the results obtained with automated with those obtained with the reference standard for this study, manual volumetry. Results The study showed that automated CT liver volumetry achieved excellent agreement with manual volumetry without statistical significance. The average processing times for automated volumetry was 3.09 ± 0.44 min/case, whereas those for manual volumetry were 16.23 ± 0.81 min/case, the difference was statistically significant (p < 0.05). Conclusion Automated CT liver volumetry performed using the Myrian® XP-Liver software can accurately predict the preoperative liver volume and provide acceptable measurements comparable to the gold standard manual volumetry.

Diagnostic performance and image quality of low-tube voltage and low-contrast medium dose protocol with hybrid iterative reconstruction for hepatic dynamic CT.

To evaluate the diagnostic performance and image quality of the low-tube voltage and low-contrast medium dose protocol for hepatic dynamic CT. This retrospective study was conducted between January and May 2018. All patients underwent hepatic dynamic CT using one of the two protocols: tube voltage, 80 kVp and contrast dose, 370 mgI/kg with hybrid iterative reconstruction or tube voltage, 120 kVp and contrast dose, 600 mgI/kg with filtered back projection. Two radiologists independently scored lesion conspicuity and image quality. Another radiologist measured the CT numbers of abdominal organs, muscles, and hepatocellular carcinoma (HCC) in each phase. Lesion detectability, HCC diagnostic ability, and image quality of the arterial phase were compared between the two protocols using the non-inferiority test. CT numbers and HCC-to-liver contrast were compared between the protocols using the Mann-Whitney U test. 424 patients (70.5 ± 10.1 years) were evaluated. The 80-kVp protocol showed non-inferiority in lesion detectability and diagnostic ability for HCC (sensitivity, 85.7-89.3%; specificity, 96.3-98.6%) compared with the 120-kVp protocol (sensitivity, 91.0-93.3%; specificity, 93.6-97.3%) (p < 0.001-0.038). The ratio of fair image quality in the 80-kVp protocol also showed non-inferiority compared with that in the 120-kVp protocol in assessments by both readers (p < 0.001). HCC-to-liver contrast showed no significant differences for all phases (p = 0.309-0.705) between the two protocols. The 80-kVp protocol with hybrid iterative reconstruction for hepatic dynamic CT can decrease iodine doses while maintaining diagnostic performance and image quality compared with the 120-kVp protocol. The 80- and 120-kVp protocols showed equivalent hepatic lesion detectability, diagnostic ability for HCC, image quality, and HCC-to-liver contrast.The 80-kVp protocol showed a 38.3% reduction in iodine dose compared with the 120-kVp protocol.

Advanced CT techniques for assessing hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the sixth-most common cancer in the world, and hepatic dynamic CT studies are routinely performed for its evaluation. Ongoing studies are examining advanced imaging techniques that may yield better findings than are obtained with conventional hepatic dynamic CT scanning. Dual-energy CT-, perfusion CT-, and artificial intelligence-based methods can be used for the precise characterization of liver tumors, the quantification of treatment responses, and for predicting the overall survival rate of patients. In this review, the advantages and disadvantages of conventional hepatic dynamic CT imaging are reviewed and the general principles of dual-energy- and perfusion CT, and the clinical applications and limitations of these technologies are discussed with respect to HCC. Finally, we address the utility of artificial intelligence-based methods for diagnosing HCC.

The correlation between hepatic fat fraction evaluated by dual-energy computed tomography and high-risk coronary plaques in patients with non-alcoholic fatty liver disease.

To determine the relationship between non-alcoholic fatty liver disease (NAFLD) evaluated by a hepatic fat fraction (HFF) using dual-energy computed tomography (DECT) and high-risk coronary plaques (HRP) in NAFLD patients. We conducted a matched case-control study involving 172 NAFLD individuals recruited from August 2019 to September 2020. They underwent dual-energy coronary computed tomographic angiography and were classified as no-plaque, HRP negative and HRP positive groups. HFF values were measured using multimaterial decomposition algorithm of DECT, and the differences among three groups were compared. Multiple logistic regression analysis was performed to determine the independent correlation between HFF and HRP. Spearmanrankcorrelation was used to assess the correlations between HFF and multiple variables. HRP positive group (15.3%) had higher HFF values than no-plaque (6.9%) and HRP negative groups (8.9%) (P < 0.001). After adjusting for confounding variables, the results indicated that HFF was an independent risk factor for HRP (OR 1.93, P < 0.001). Additionally, HFF significantly correlated with coronary artery calcium score, hepatic CT attenuation, epicardial and pericoronary adipose tissue volume, and CT attenuation (all P < 0.001). As a new imaging marker for the quantification of liver fat, HFF was independently associated with HRP.

Liver fibrosis assessment with multiphasic dual-energy CT: diagnostic performance of iodine uptake parameters.

To evaluate the ability of iodine uptake parameters from hepatic multiphasic CT to predict liver fibrosis, and compare absolute contrast enhancement (ΔHU) with dual-energy iodine density (ID) methods. One hundred seventeen patients with pathologically proven liver fibrosis who underwent dual-energy CT during portal-venous phase (PVP) and 3-min delayed phase (DP) between January 2017 and Octotber2019 were retrospectively included. Two radiologists measured the hepatic and blood-pool iodine uptake using ΔHU and ID methods; extracellular volume fraction (ECV) and the iodine washout rate (IWR) calculated with both methods were compared between different fibrosis stages (F0-1 vs. F2-4, F0-2 vs. F3-4, or F0-3 vs. F4). The inter-observer reproducibility (intraclass correlation coefficients [ICCs]) for ECV and IWR was compared between the ΔHU and ID methods. The areas under the receiver operating characteristic curves (AUCs) to predict liver fibrosis severity were calculated for serum and imaging fibrosis markers. To identify independent predictors, multivariable logistic regression analysis was performed, and combined performance was assessed for the ΔHU and ID models. Patients with F ≥ 2 (n = 70), F ≥ 3 (n = 51), and F4 (n = 29) had higher ECV and lower IWR than those with F ≤ 1, F ≤ 2, and F ≤ 3, respectively (all p < 0.001). ICCs were higher in the ID method than in the ΔHU method (ECV: p = 0.045; IWR: p < 0.001). The AUC ranges of ECVΔHU, ECVID, IWRΔHU, and IWRID for predicting liver fibrosis severity were 0.65-0.71, 0.67-0.73, 0.76-0.81, and 0.81-0.85, respectively. IWR and fibrosis-4 index were independent predictors, with combined AUCs of 0.82-0.87 for the ΔHU model and 0.86-0.89 for the ID model. IWR more accurately predicted liver fibrosis than ECV in routine multiphasic CT. The dual-energy ID method yielded higher inter-observer reproducibility and predictive values than the single-energy ΔHU method. • The IWR calculated from hepatic iodine uptake during PVP and 3-min DP predicted liver fibrosis (AUC, 0.76-0.85), while the ECV had a relatively limited predictive value (ACU, 0.65-0.73). • Compared with the conventional ΔHU method, the dual-energy ID method provided superior inter-observer reproducibility for measurement of ECV (p = 0.046) and IWR (p < 0.001). • The IWR and FIB-4 served as independent predictors of liver fibrosis; their combination yielded the high diagnostic performance particularly when using the ID method (combined AUCs of 0.86-0.89).

Abstract PS16-31: SKT11 loss drives rapid cancer progression and fatal pulmonary tumor thrombotic microangiopathy (PTTM) in a breast cancer patient: A case report

Abstract Introduction: Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare cancer-associated respiratory complication characterized by widespread tumor cell emboli in small arteries and arterioles of the lung. Breast cancer is the second most common cancer causing PTTM. The pathogenesis and molecular background of PTTM have not been clarified. Here we present a case of breast cancer that experienced early onset of liver metastasis after surgical resection of the primary tumor and rapid progression leading to death due to severe respiratory distress. Autopsy was performed and it revealed that the main cause of her death was PTTM. Comprehensive next generation sequencing (NGS) analysis of the tissue obtained serially during the clinical course was performed. Case Presentation: A 48-year-old woman was diagnosed with invasive ductal carcinoma of the left breast, which was ER positive, PgR negative, and HER2 negative. FEC followed by docetaxel was administered as preoperative chemotherapy. Her tumor dramatically shrunk with chemotherapy and left partial mastectomy with left axillary lymph node dissection was performed. Histopathological analysis of the resected breast tissue revealed that there were a lot of residual cancer cells, which were ER negative, PgR negative, HER2 negative, and the result indicated that response to preoperative chemotherapy was insufficient. Additional two courses of FEC therapy were performed. Postoperative radiation therapy including the left supraclavicular lymph node area was given and adjuvant endocrine therapy with anastrozole started at the same time. At 3 months of anastrozole administration, she presented hepatic dysfunction and abnormal CT findings in the liver. Liver biopsy revealed multiple liver metastasis of breast cancer. Unresponsive to weekly paclitaxel and bevacizumab, she developed rapid respiratory failure leading to her death in two weeks. Postmortem microscopic analysis revealed an intimal fibrocellular proliferation in the pulmonary arterioles regardless of microscopic tumor emboli and extensive sinusoidal metastasis of the whole liver. NGS Analysis: We analyzed four specimens, breast cancer biopsy specimen at diagnosis, surgical resection specimen, liver needle biopsy specimen, and liver specimen obtained at autopsy, with the Ion AmpliSeq Comprehensive Cancer Panel (Thermo Fisher). The results were compared with NGS analysis of her normal lung tissue to exclude single nucleotide polymorphisms. Deep sequencing revealed that only TP53 R213* was detected as an oncogenic mutation in all four specimens. There were no mutations associated with the development of liver metastasis and her death. Comparison of the samples obtained between before and after liver metastasis revealed that STK11 loss and IKBKE amplification were harbored only in the specimens after liver metastasis. RNA sequencing analysis with the samples of initial biopsy and liver biopsy showed that the RNA expression associated with apoptosis and adhesion molecules was strongly suppressed in the liver sample. Conclusion: STK11 encodes a serine/threonine kinase, which organizes cell polarity and inhibits tumor growth. In the present patient, STK11 loss had occurred during the treatment and could induce rapid progression of her disease and PTTM. Citation Format: Fumie Fujisawa, Kei Kunimasa, Rieko Kano, Hiroki Kusama, Minako Nishio, Saki Matsui, Tetsuhiro Yoshinami, Nobuyoshi Kittaka, Shigenori Nagata, Toshinari Yagi, Takahiro Nakayama, Yasuhiro Tamaki, Fumio Imamura. SKT11 loss drives rapid cancer progression and fatal pulmonary tumor thrombotic microangiopathy (PTTM) in a breast cancer patient: A case report [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS16-31.

Transcatheter CT Hepatic Arteriography Compared with Conventional CT Fluoroscopy Guidance in Percutaneous Thermal Ablation to Treat Colorectal Liver Metastases: A Single-Center Comparative Analysis of 2 Historical Cohorts

PurposeTo evaluate safety and efficacy of CT hepatic arteriography compared with conventional CT fluoroscopy guidance in percutaneous radiofrequency (RF) and microwave (MW) ablation to treat colorectal liver metastases (CRLM). Materials and MethodsThis single-center comparative, retrospective study analyzed data of 108 patients treated with 156 percutaneous ablation procedures (42 CT fluoroscopy guidance [25 RF ablation, 17 MW ablation]; 114 CT hepatic arteriography guidance [18 RF ablation, 96 MW ablation]) for 260 CRLM between January 2009 and May 2019. Local tumor progression-free survival (LTPFS) was assessed using univariate and multivariate Cox proportional hazard regression analyses. LTPFS and overall survival (OS) were estimated using the Kaplan-Meier method. ResultsThere were no complications related to the transarterial catheter procedure. CT hepatic arteriography proved superior to CT fluoroscopy regarding 2-year LTPFS (18/202 [8.9%] vs 19/58 [32.8%]; P < .001, respectively). CT hepatic arteriography versus CT fluoroscopy (hazard ratio = 0.28; 95% confidence interval, 0.15–0.54; P < .001) and MW ablation versus RF ablation (hazard ratio = 0.52; 95% confidence interval, 0.24–1.12; P = .094) were positive predictors for longer LTPFS. Multivariate analysis revealed that CT hepatic arteriography versus CT fluoroscopy (hazard ratio = 0.41; 95% confidence interval, 0.19–0.90; P = .025) was associated with a significantly superior LTPFS. OS was similar between the 2 cohorts (P = .3). ConclusionsWhile adding procedure time and marginal patient burden, transcatheter CT hepatic arteriography–guided ablation was associated with increased local disease control and superior LTPFS compared with conventional CT fluoroscopy. CT hepatic arteriography represents a safe and valid alternative to CT fluoroscopy, as it reduces the number of repeat ablations required without adding risk or detrimental effect on survival.

Significance of liver dysfunction associated with decreased hepatic CT attenuation values in Japanese patients with severe COVID-19.

BackgroundCOVID-19 has emerged as a threat to human health. Liver dysfunction has been reported to occur frequently in patients with COVID-19, although its significance has not yet been elucidated.MethodsThe subjects were 35 patients with COVID-19, and clinical characteristics were retrospectively analyzed. COVID-19 patients requiring ventilator were classified as having severe COVID-19.ResultsAll 35 patients were diagnosed as having mild-to-moderate COVID-19 at admission, but the severity aggravated to severe in 8 patients (22.9%) in hospital. Hepatocellular-type liver injury, defined as elevation of the serum AST and/or ALT levels to ≥ 3 times the ULN, was seen in 2 patients (5.7%), and cholestasis-type liver injury, defined as elevation of the serum ALP, γ-GTP and/or total bilirubin levels to ≥ twice the ULN, was seen in 4 patients (11.4%). A total of 9 patients (25.7%) fulfilled the criteria for liver injury. The percentage of patients with liver injury was higher in patients with severe COVID-19 than in the remaining patients (P = 0.001). Both the hepatic CT attenuation values and the liver-to-spleen attenuation (L/S) ratios at admission were lower in the former patients than in the latter patients (P < 0.001). ROC curve revealed the optimal cut-off value of the L/S ratio of 1.03 for discriminating between patients with severe and non-severe diseases. The hepatic CT attenuation values increased at the remission phase of the disease as compared to the values at admission (P = 0.012).ConclusionLiver dysfunction associated with reduced hepatic CT attenuation values correlated with the disease severity in patients with COVID-19.

Comparative Analysis of Image Quality and Adverse Events between Iopamidol 250 and Ioversol 320 in Hepatic Angiography for Transcatheter Arterial Chemoembolization

목적간세포암의 화학색전술에 사용되는 조영제인 Ioversol 320과 Iopamidol 250을 영상 화질과 유해반응에서 차이가 있는지 비교 분석하고자 하였다.대상과 방법경동맥 화학색전술을 시행 받은 113명의 간세포암 환자를 대상으로 후향적으로 분석하였고, Iopamidol 250은 44명, Ioversol 320은 69명에게 주입하였다. 영상 화질은 혈관 인지도 및 일치도로 평가하였다. 혈관인지도는 두 명의 영상의학과 전문의가 간동맥 혈관조영술에서 간세분엽동맥, 췌십이지장동맥, 우위동맥, 우위대망동맥이 보이는 인지도와 명확도에 따라 3단계로 점수화하였다. 일치도는 혈관조영술과 전산화단층촬영에서 발견된 간세포암 수를 비교하였다. 시술 전후 임상증상을 조사하여 조영제 유해반응을 평가하였다.결과혈관인지도의 평균 점수는 Iopamidol 250은 2.92점, Ioversol 320은 2.94점이었다. 일치도는 Iopamidol 250은 31명(70.5%), Ioversol 320은 46명(66.7%)이 일치했으며, 혈관인지도와 일치도는 통계적 유의한 차이가 없었다(p > 0.05). Iopamidol 250은 1명, Ioversol 320은 6명의 환자가 오심을 호소하였으며, 유해반응 빈도의 유의한 차이는 없었다(p = 0.24).결론간세포암 화학색전술에서 Iopamidol 250은 Ioversol 320과 영상의 화질 및 유해반응에 유의한 차이가 없이 사용될 수 있을 것으로 생각된다.

Hepatic and splenic 18 F-FDG blood clearance rates (Ki) in hepatic steatosis and diabetes mellitus.

The study aim was to investigate the relationships of blood glucose level (BGL) with hepatic and splenic blood FDG clearances (Ki) in patients with diabetes mellitus (DM) and/or hepatic steatosis (HS). This was a retrospective study of 238 patients, including 92 with type 2 DM (DM2) and 11 with type 1 DM (DM1), having routine whole body FDG PET/CT. Patients with lymphoma were excluded. Patients were divided into the following groups: HS-DM-, HS-DM2+, HS+DM-, HS+DM2+ and 2 DM1 groups (hypoglycaemic and hyperglycaemic). ROI were placed over liver and spleen for measurement of SUVmax , and left ventricular cavity (LV) for measurement of SUVmean . Tissue SUVmax was divided by LV SUVmean . This division, giving Z, eliminates bias from the whole body metric used to calculate SUV and renders SUVmax a closer surrogate of Ki. HS was diagnosed when hepatic unenhanced CT was ≤40 HU. In all patients, individual hepatic Z and individual splenic Z correlated significantly with individual BGL. Highest mean hepatic Z and highest mean BGL were recorded in HS+ DM2+ group and lowest in hypoglycaemic DM1 group. Patients with DM1 and hyperglycaemia showed low hepatic Z in relation to BGL. Hepatic and splenic Z correlated inversely with CT density in patients without DM but not in those with DM2. As BGL increases, hepatocyte glucokinase is up-regulated. This includes patients with HS and DM2 but not DM1. We speculate that in HS and DM2, up-regulation results from insulin resistance and hyperinsulinaemia. The data also support a hepato-splenic metabolic axis.

Hepatic CT attenuation differs in three species of freshwater turtles and hepatic Hounsfield units increase with folliculogenesis in wild Blanding's turtles (Emydoidea blandingii).

Freshwater turtle species are suffering from anthropocentric-caused population declines, making preservation of professionally managed populations increasingly important. Turtles under professional care have an increased risk to develop hepatic lipidosis, potentially resulting in early death. Computed tomography can provide an antemortem screening for increased fatty liver composition. A goal of this prospective analytical cross-sectional study was to assess the hepatic attenuation measured as Hounsfield units (HU) in a wild population of a freshwater turtle species, and then compare hepatic HU to freshwater turtles under professional care. Ninety-five wild Blanding's turtles (BT; Emydoidea blandingii) as well as 10 Vietnamese Pond turtles (VPT; Mauremys annamensis) and six Northern Snake-Necked turtles (NSNT; Chelodina oblonga) under professional care underwent CT with quantification of hepatic HU. Hepatic HU were correlated to serum chemistry findings and the presence of follicles was recorded in BT. The mean (±SD) hepatic attenuation for 95 wild BT was 97.5 HU ±9.6. There were significant differences in hepatic attenuation among VPT, NSNT, and BT, with median HU values (range) of 5.39 HU (-6.45 to 61.50), 71.74 HU (59.44-94.49), and 95.43 HU (74.41-124.56), respectively. Aspartate aminotransferase (AST) values had a weak negative correlation to HU with a coefficient of -0.85 (P<.001). The hepatic attenuation was significantly higher for individuals undergoing folliculogenesis (P=.007). The decreased HU values were significantly negatively correlated with AST values. Findings supported the use of CT as an aid for guiding future management practices in freshwater turtles.

Postablation assessment of hepatocellular carcinoma using dual-energy CT: Comparison of half versus standard iodine contrast medium.

This retrospective study was aimed to evaluate the reduced iodine load on image quality and diagnostic performance in multiphasic hepatic CT using a novel monoenergetic reconstruction algorithm (nMERA) in assessment of local tumor progression after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). Ninety patients who underwent CT 1 month after RFA of HCC. Forty-five patients had multiphasic hepatic dual-energy CT with a half-reduced contrast medium (HRCM) of 277.5 mg I/kg. The nMERA (40–70-keV) images were reconstructed in each phase. Another 45 patients received a standard contrast medium (SCM) of 555 mg I/kg, and the images were reconstructed as a simulated 120-kVp images. Primary outcome was accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) in assessment of local tumor progression. Additional advanced assessments included the image noise, attenuation value, contrast-to-noise ratio (CNR), and subjective image quality between the groups. The accuracy, sensitivity and specificity of nMERA HRCM images were 95.7%, 100% and 93.9% for 40 keV, 95.7%, 85.7% and 100% for 50 keV, 83.0%, 42.8% and 100% for 60 keV, and 83.0%, 42.9% and 100% for 70 keV. The AUROC was 0.99, 0.99, 0.94, and 0.93 for 40–70 keV nMERA HRCM images, respectively. Compared with simulated 120-kVp SCM images, nMERA HRCM images demonstrated comparable noise at 70-keV (P < 0.05), and comparable CNR at 40- and 50-keV (P < 0.05). nMERA DECT enables the contrast medium to be reduced to up to 50% in multiphasic hepatic CT while preserving diagnostic accuracy.

CT-based estimation of liver function using arterial enhancement fraction in liver cirrhosis patients

To explore the feasibility and clinical value of CT-based arterial enhancement fraction (AEF) for evaluating liver function in liver cirrhosis patients. Methods: Fifty-two patients with liver cirrhosis (Child-Pugh A, B, and C group included 13, 20, and 19 patients, respectively) and 17 patients without liver diseases as control were prospectively enrolled, respectively. All individuals underwent three-phase hepatic CT, and the color mapping of AEF were obtained in CT kinetics software, as well as the corresponding parameters, i.e., hepatic AEF (HAEF) and the ratio of HAEF to spleen AEF (H/S). The AEF parameters were compared among different groups, and the area under the receiver operating characteristic curve (AUROC) was calculated. The Spearman correlation analysis was performed between the AEF parameters and model for end-stage liver disease (MELD) score in liver cirrhosis patients. Results: The interobserver agreement of HAEF and H/S were perfect, and the intraclass correlation coefficient (ICC) were 0.918 (95% CI 0.871 to 0.949), 0.946 (95% CI 0.915 to 0.966), respectively. The HAEF and H/S among those groups were significant different (both P<0.001), and they elevated with the increase of Child-Pugh classification in liver cirrhosis patients (all P<0.05, except the H/S between Child-Pugh A and B). In all patients with liver cirrhosis, the AUROC of HAEF and H/S were 0.933 and 0.821 for Child-Pugh A, and were 0.925 and 0.915 for Child-Pugh C, respectively. The HAEF and H/S of patients with liver cirrhosis were significantly correlated with the MELD score (HAEF: r=0.752, P<0.001; H/S: r=0.676, P<0.001). Conclusion: CT-based AEF parameters including HAEF and H/S are closely associated with the severity and prognosis of patients with liver cirrhosis, which have the potential to estimate the liver function in liver cirrhosis patients quantitatively and effectively.

CT-based radiogenomic signature to identify isocitrate dehydrogenase (IDH)1/2 mutations in advanced intrahepatic cholangiocarcinoma.

4081 Background: IDH1/2 mutations have a high prevalence (20%) in intrahepatic cholangiocarcinoma (iCCA) and can be associated with therapeutic benefit from IDH inhibitors. Radiomics, a developing field within imaging, has shown its ability to discriminate between tumors of distinct genomic profiles and mutational status. Methods: We developed a radiogenomic signature to robustly predict IDH1/2 mutation status (mutated versus wild-type [WT]) in 22 patients with iCCA using the pretreatment CT scans. The triphasic hepatic CT scan was used to segment the lesion. After semiautomatic segmentation of the tumor, the extracted volume of interest (VOI) was imported into our in-house radiomic pipeline and 610 radiomic features were extracted. The least absolute shrinkage and selection operator regression (LASSO) and minimum redundancy and maximum relevance (mRMR) were used for feature selection. Selected features were used to build a classification model for prediction of IDH1/2 mutation status (XGboost). The performance of the radiomics model was assessed using leave-one-out cross-validation (LOOCV). Results: Of 22 patients, 16 patients (male, 6; female, 10; average age, 55.5 years) had IDH1 (N = 14) or IDH2 (N = 2) mutations and 6 patients (male, 4; female, 2; average age = 55.5 years) had IDH1/2 WT.The CT-derived radiomic signature robustly predicted presence of IDH1/2 mutations versus WT with an area under the curve (AUC), sensitivity and specificity of 98.4%, 83.3% and 93.8%, respectively ( P = 0.037) and in a subgroup analysis presence of IDH1 mutation versus WT with an AUC, sensitivity and specificity of 98.2%, 83.3% and 92.8%, respectively ( P = 0.035). Conclusions: To our knowledge, this is the first study investigating the ability of radiogenomics as a potential method to predict the IDH1/2 mutation status in iCCA patients. Our data suggest that radiogenomic signature may correlate with IDH1/2 mutations and represent a promising non-invasive tool to stratify the patients based on molecular alterations.

Revolution CT hepatic perfusion imaging assessment of peripheral infiltration zone of hepatic alveolar echinococcosis

To analyze the blood supply and metabolism in the marginal area of foci of hepatic alveolar echinococcosis by quantitative perfusion parameters. Thirty patients with hepatic alveolar echinococcosis were scanned with the Revolution CT and the images were analyzed. The perfusion parameters, such as the bloodflow (BF), time to peak (TTP), blood volume (BV), mean transit time (MTT) and hepatic arterial fraction (HAF) were compared among different groups. The BF, TTP, BV and MTT values of the peripheral infiltration zone and the values of the surrounding normal liver tissues were significantly different (F = 24.579, 8.343, 20.535 and 21.843, all P<0.05), but the HAF values of the peripheral infiltration zone and the values of the surrounding normal liver tissues were not significantly different in the hepatic alveolar echinococcosis patients (F = 2.621, P> 0.05) . The whole hepatic perfusion Revolution CT can accurately and quantitatively analyze the alveolar echinococcosis foci, especially the peripheral infiltration zone, which has important guiding significance for the formulation of surgical plan.

Opportunistic Screening for Hereditary Hemochromatosis With Unenhanced CT: Determination of an Optimal Liver Attenuation Threshold.

The purpose of this study was to assess whether a specific liver attenuation threshold for unenhanced CT allows both sensitive opportunistic detection of unsuspected hereditary hemochromatosis and low overall screening test-positive rates. We used a standard ROI placement method on unenhanced CT studies of 3357 consecutive adults (mean age, 57.0 years) with no symptoms of liver disease who underwent colorectal screening. Hepatic attenuation (in HU) was measured to assess test-positive rates at various liver attenuation thresholds. To assess sensitivity, unenhanced hepatic CT attenuation was also measured in 12 patients with hereditary hemochromatosis (mean age, 48.3 years), who were homozygous for the HFE C282Y mutation. All scans were obtained at 120 kV. Serum ferritin levels were recorded for the hereditary hemochromatosis cohort. Mean liver attenuation ± SD among screened adults was 59.4 ± 12.7 HU, compared with 78.7 ± 13.1 HU (range, 59-105 HU) in the hereditary hemochromatosis cohort (p < 0.001). Screening test-positive rates were 30.6% (n = 1028) at 65 HU, 8.2% (n = 275) at 70 HU, 1.2% (n = 39) at 75 HU, and 0.2% (n = 7) at 80 HU. Corresponding sensitivities for hereditary hemochromatosis at these thresholds were 83.3% (10/12) at 65, 70, and 75 HU; and 50.0% (6/12) at 80 HU. Serum ferritin levels were elevated in all patients with hereditary hemochromatosis (mean, 1678 ng/mL; range, 477-3991 ng/mL). An unenhanced CT liver attenuation threshold of 75 HU was sensitive (83.3%) for hereditary hemochromatosis while maintaining an acceptably low screening test-positive rate (1.2%). An unexplained liver attenuation of 75 HU or more on unenhanced CT should trigger appropriate laboratory investigation for iron overload; early intervention with phlebotomy can limit or prevent organ damage in patients with hemochromatosis.

The use of neoadjuvant radioembolization prior to resection of hepatic malignancies

Introduction: Arterial radioembolization with yttrium-90 (Y-90) has demonstrated efficacy for hepatic malignancies. Little is known about use of Y-90 in a neoadjuvant fashion. We describe our use of unilobar Y-90 therapy for liver directed treatment and hepatic conditioning in preparation for resection. Methods: 14 patients undergoing Y-90 therapy with subsequent surgical resection from 2007 to 2017 were reviewed. Patients underwent mapping angiography with angiosomal analysis via cone beam CT and hepatic arterial Tc-MAA SPECT CT. Dosimetry was accomplished using MIRD and BSA for glass and resin spheres respectively. Results: Patient descriptions are given in Table 1. The mean age was 62.7 and included hepatocellular carcinoma, cholangiocarcinoma, and liver metastasis in 5 (36%), 3 (21%), and 6 (43%) respectively. All patients were non-surgical candidates due to insufficient contralateral volume or high risk biology prior to treatment. Mean contralateral hypertrophy with neoadjuvant Y-90 alone resulted in a 549 ml to 789 ml (30% to 45%) in 9 patients within a median 202 days. Y-90 with PVE in 5 patients resulted in 531 ml to 710 mL (38% to 54%) hypertrophy within a median 190 days. Liver resection included right hepatectomy, left hepatectomy, and trisegmentectomy in 9 (64%), 2 (14%) and 3 (22%) respectively with a mean length of stay of 8.5 days and major morbidity of 14%. No perioperative mortality occurred.FP08-09 TableCharacteristics and post hepatectomy outcomes in patients with previous Y-90 for liver malignancy.PtAge/SexDiagnosisTumor size (cm)/NPVEY-90Dosage (Gy)Y-90 – surgery(days)FLRVPre /post Y-90(ml) (%)Type of SurgeryLOS90-Day Complications (CD-grade)173/MHCC10.0/1Yes101190514(19%)/786(31%)Open TRS6Pleural effusion, (Cl–I)259/MHCC6.3/1No118210517(30%)/875(49%)HA RH22Bile leak, (Cl–IIIb)367/FMCA3.2/multipleNo105217421(33%)/627(56%)Lap. RH7Subcortical infarct (Cl-II)460/MHCC11.0/1No122.7202625(25%)/789(36%)Open RH6Anemia, (Cl-II)566/FHCC13.0/1No106122447(35%)/631(48%)Open TRS6None668/MCCA4.0/1No116.7167310(16%)/535(35%)Open TRS20DVT, PE (Cl-IIIb)727/FMMA6.0/1Yes110126530(34%)/527(43%)Lap. RH4None872/MMCA2.8/multipleYes117153411(43%)/372(53%)Open RH6None970/FMCA3.8/multipleYes113481733(58%)/854(68%)Open LH6Anemia, (Cl-II)1061/FCCA11.0/1No369141598(31%)/1046(47%)Open RH6None1163/MMCA2.0/multipleYes104459469(34%)/1012(73%)Open RH8Ileus, (Cl-II)1244/MCCA8.8/multipleNo2252431008(43%)/934(47%)Lap. LH8Anemia, (Cl-II)1361/MMCA2.3/1No231182469(34%)/808(49%)Open RH5None1487/MHCC9.8/1No412259543(27%)/855(41%)HA RH8N/AAbbreviations: HCC, hepatocellular carcinoma; MCA, metastatic carcinoma; MCA, metastatic melanoma; TRS, trisegmentectomy; HA, hand assisted; RH, right hepatectomy; LH, left hepatectomy; Cl, Clavien-Dindo classification; LOS, length of stay; DVT, deep vein thrombosis; PE, pulmonary embolism; PVE, portal vein embolization; CD, Clavien-Dindo-Score. Open table in a new tab Abbreviations: HCC, hepatocellular carcinoma; MCA, metastatic carcinoma; MCA, metastatic melanoma; TRS, trisegmentectomy; HA, hand assisted; RH, right hepatectomy; LH, left hepatectomy; Cl, Clavien-Dindo classification; LOS, length of stay; DVT, deep vein thrombosis; PE, pulmonary embolism; PVE, portal vein embolization; CD, Clavien-Dindo-Score. Conclusion: Neoadjuvant radioembolization contributes to contralateral hypertrophy and tumor control during surviellance in patients with aggressive biology. Surgical intervention after Y-90 is feasible without adding morbidity.

Dual input computed tomography perfusion in evaluating the therapeutic response of transarterial chemoembolization for hepatocellular carcinoma

ObjectiveTo assess diagnostic role of multi-detector computed tomographic perfusion in evaluating the therapeutic response of trans-arterial chemo-embolization in hepatocellular carcinoma. Patients & methodsPost trans-arterial chemoembolization HCC patients underwent follow up by hepatic CT perfusion, CT attenuation value and perfusion parameters {arterial flow perfusion (AFP), portal venous perfusion (PVP) & hepatic perfusion index (HPI)} were measured in hypervascular area of treated lesion at perfusion color map suspected as residual disease and adjacent hepatic parenchyma to assess therapeutic efficacy. Parameters distribution were described by their quartile values and statistically analyzed. ResultsThis study included 31(86%) male and 5(14%) female HCC patients with mean age (54 years). The residual lesion was observed in 25 patients of the 36 patients with increased CT attenuation value(HU), AFP (ml/min/100 ml), HPI (%) and decreased PVP (ml/min/100 ml) in the residual disease compared to surrounding cirrhotic liver parenchyma with P value < 0.05. The calculated parameters in the residual disease: CT attenuation value was 145.50 ± 25.26, AFP was 124.68 ± 19.69, PVP was 30.89 ± 11.52 & HPI was 78.07 ± 6.25. The calculated parameters in surrounding liver parenchyma: CT attenuation value was 99.53 ± 25.09, AFP was 37.12 ± 8.99, PVP was 56.38 ± 15.60 & HPI was 32.78 ± 8.55. ConclusionCT perfusion evaluates treatment response in TACE treated HCC patients by providing a quantitative assessment of vascularization of residual tumour.

A noise-optimized virtual monoenergetic reconstruction algorithm improves the diagnostic accuracy of late hepatic arterial phase dual-energy CT for the detection of hypervascular liver lesions.

To assess the image quality and diagnostic accuracy of a noise-optimized virtual monoenergetic imaging (VMI+) algorithm compared with standard virtual monoenergetic imaging (VMI) and linearly-blended (M_0.6) reconstructions for the detection of hypervascular liver lesions in dual-energy CT (DECT). Thirty patients who underwent clinical liver MRI were prospectively enrolled. Within 60 days of MRI, arterial phase DECT images were acquired on a third-generation dual-source CT and reconstructed with M_0.6, VMI and VMI+ algorithms from 40 to 100 keV in 5-keV intervals. Liver parenchyma and lesion contrast-to-noise-ratios (CNR) were calculated. Two radiologists assessed image quality. Lesion sensitivity, specificity and area under the receiver operating characteristic curves (AUCs) were calculated for the three algorithms with MRI as the reference standard. VMI+ datasets from 40 to 60 keV provided the highest liver parenchyma and lesion CNR (p ≤0.021); 50 keV VMI+ provided the highest subjective image quality (4.40±0.54), significantly higher compared to VMI and M_0.6 (all p <0.001), and the best diagnostic accuracy in < 1-cm diameter lesions (AUC=0.833 vs. 0.777 and 0.749, respectively; p ≤0.003). 50-keV VMI+ provides superior image quality and diagnostic accuracy for the detection of hypervascular liver lesions with a diameter < 1cm compared to VMI or M_0.6 reconstructions. • Low-keV VMI+ are characterized by higher contrast resulting from maximum iodine attenuation. • VMI+ provides superior image quality compared with VMI or M_0.6. • 50-keV_VMI+ provides higher accuracy for the detection of hypervascular liver lesions < 1cm.

Arms Down Cone Beam CT Hepatic Angiography Performance Assessment: Vascular Imaging Quality and Imaging Artifacts

The practice of positioning patients' arms above the head during catheter-injected hepatic arterial phase cone beam CT (A-CBCT) imaging has been inherited from standard CT imaging due to image quality concerns, but interrupts workflow and extends procedure time. We sought to assess A-CBCT image quality and artifacts with arms extended above the head versus down by the side. We performed an IRB approved retrospective evaluation of reformatted and 3D-volume rendered images from 91 consecutive A-CBCTs (43 arms up, 48 arms down) acquired during hepatic tumor arterial embolization procedures. Two interventional radiologists reviewed all A-CBCT imaging and assigned vessel visualization scores (VVS) from 1 to 5, ranging from non-diagnostic to optimal visualization. Streak artifacts across axial images were rated from 1 to 3 based on resulting image quality (none to significant). Presence of respiratory or cardiac motion during acquisition, body mass index and radiation dose area product (DAP) were also recorded and analyzed. Univariate and multivariate analyses were used to assess the impact of arm position on VVS and imaging artifacts. VVS were not significantly associated with arm position during A-CBCT imaging. One reader reported more streak artifacts across axial images in the arms down group (p=0.005). DAP was not statistically different between the groups (23.9Gycm2 [6.1-73.4] arms up, 26.1Gycm2 [4.2-102.6] arms down, p=0.54). A-CBCT angiography performed with the arms above the head is not superior for clinically relevant hepatic vascular visualization compared to imaging performed with the arms by the patient's side.