Triphasic Computed Tomography Scan Research Articles

Evaluation of liver segmental dose threshold for hepatocyte regeneration following liver stereotactic body radiation therapy.

There is limited evidence studying the relationship of liver segmental dose and segmental volume changes. The segmental dose thresholds could potentially allow for segmental regeneration after liver stereotactic body radiation therapy (SBRT). Given improved survival in hepatocellular cancer (HCC) and liver metastases and more salvage therapy options, this has become an important clinical question to explore. This study assesses the impact of liver segmental dose on segmental volume changes (gain or loss) after SBRT. Liver segmental contours were delineated on baseline and serial follow up triphasic computed tomography scans. The volumes of total liver and doses to total liver, uninvolved liver and individual segments were noted. A correlation was evaluated between liver/segmental volume and dose using Pearson's correlation. Furthermore, receiver operator's curve (ROC) analysis was performed to find the segmental dose, i.e . predictive for liver volume loss. A total of 140 non-tumour liver segments were available for analysis in 21 participants. Overall, 13 participants showed loss of overall liver volume and eight showed gain of overall liver volume. The median dose in segments reporting an increase in volume was 9.1 Gy (7-36 Gy). The median dose in segments losing volume was 15.5 Gy (1-49 Gy). On ROC analysis, segmental dose >11 Gy was associated with volume loss. On univariate analysis, only liver segmental dose contributed to a significant segmental volume loss. We propose from the findings of this study that in SBRT for large hepatocellular cancer or liver metastases, liver segments should be individually delineated. Furthermore, 3-5 liver segments may be preferentially subjected to <9 Gy to facilitate hepatocyte regeneration. Preferential sparing of uninvolved liver segments may improve outcomes in liver stereotaxyas lower segmental doses were associated with liver regeneration. This may have implications on future liver SBRT planning where segmental doses may be as important as the mean dose.

Virtual non-enhanced dual-energy computed tomography reconstruction: a candidate to replace true non-enhanced computed tomography scans in the setting of suspected liver alveolar echinococcosis.

When a suspected hepatic alveolar echinococcosis (AE) lesion is detected on a contrast enhanced computed tomography (CT) scan, an additional triphasic or non-enhanced CT scan is required to determine the presence of calcification and enhancement. As a result, imaging costs and exposure to ionizing radiation will increase. We can create a non-enhanced series from routine contrast-enhanced images using dual-energy CT (DECT) and virtual non-enhanced (VNE) images. This study's objective is to assess virtual non-enhanced DECT reconstruction as a potential diagnostic tool for hepatic AE. Triphasic CT scans and a routine dual energy venous phase were acquired using a third-generation DECT system. A commercially available software package was used to generate VNE images. Individual evaluations were conducted by two radiologists. The study population consisted of 100 patients (30 AE, 70 other solid liver masses). All AE cases were diagnosed [no false positives/negatives, 95% confidence interval (CI) sensitivity: 91.3%-100%; 95% CI specificity: 95.3%-100%]. Interrater agreement was k: 0.79. In total, 33 (33.00%) of the patients had AE, which was detected using both true non-enhanced (TNE) and VNE images. The mean dose-length product of a standard triphasic CT was significantly higher than biphasic dual-energy VNE images. In terms of diagnostic confidence, VNE images are comparable with actual non-enhanced imaging when evaluating hepatic AE. Further, VNE images could replace TNE images with a substantial radiation dose reduction. Advances in knowledge: hepatic cystic echinococcosis and AE are serious and severe diseases with high fatality rates and a poor prognosis if managed incorrectly, especially AE. Moreover, VNE images produce equal diagnostic confidence to TNE images for assessing liver AE, with a significant reduction in radiation dose.

Arterial enhancement on triphasic computed tomography scan predicts response of colorectal liver metastases to chemoembolization: A case–control study

Objectives: The arterial enhancement fraction (AEF), a simple calculation based on a standard triple-phase computed tomography (CT) scan, has been shown to predict treatment response in radioembolization of colorectal liver metastases (CRLM). The current study aims to determine if arterial enhancement also predicts treatment response in transarterial chemoembolization (TACE) of CRLM, which uses a larger particle size and exerts an ischemic effect. Materials and Methods: A retrospective analysis of our experience with TACE for CRLM between 2013 and 2022 yielded 97 TACE treatments for CRLM. The study included the first TACE treatment patients having a triple-phase CT scan before and after TACE, yielding 62 tumors treated with TACE of irinotecan drug-eluting beads in 36 patients. Tumors with complete response or partial response based on CT-based modified RECIST criteria were considered to be “responders,” whereas tumors that had progressive disease or stable disease were considered to be “non-responders.” Results: The responders differed from the non-responders in terms of arterial phase enhancement (APhE) (9.5 [interquartile range, IQR 6, 17] vs. 2 [IQR 1, 5] Hounsfield units [HUs], P &lt; 0.001) and AEF (0.7 [IQR 0.5, 1] vs. 0.3 [IQR 0.1, 1], P = 0.01), both validated measures of hepatic arterial perfusion. Receiver operating characteristic curve analysis yielded a 5.5 HU cutoff for APhE. Those tumors with APhE &gt;5.5 HU had a response rate of 72%, whereas those &lt;5.5 HU had a response rate of 21%. Median overall survival for patients with tumors having APhE &gt;5.5 HU was 22.4 months (IQR 13, 32) versus 14.5 months (IQR 10, 19) for those with APhE ≤5.5 HU, but this did not achieve statistical significance (P = 0.14). Conclusion: CRLM with greater hepatic arterial blood supply as measured by the APhE and AEF have a higher probability of TACE treatment response.

Perfusion parameters of triphasic computed tomography hold preoperative prediction value for microvascular invasion in hepatocellular carcinoma

The purpose of this study was to evaluate perfusion parameters of triphasic computed tomography (CT) scans in predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC). All patients were pathologically diagnosed as HCC and underwent triple-phase enhanced CT imaging, which was used to calculate the blood perfusion parameters of hepatic arterial supply perfusion (HAP), portal vein blood supply perfusion (PVP), hepatic artery perfusion Index (HPI), and arterial enhancement fraction (AEF). Receiver operating characteristic (ROC) curve was used to evaluate the performance. The mean values of PVP(Min), AEF(Min), the difference in PVP, HPI and AEF related parameters, the relative PVP(Min) and AEF(Min) in MVI negative group were significantly higher than those in MVI positive group, while for the difference in HPI(Max), the relative HPI(Max) and AEF(Max), the value of MVI positive group significantly higher than that of negative group. The combination of PVP, HPI and AEF had the highest diagnostic efficacy. The two parameters related to HPI had the highest sensitivity, while the combination of PVP related parameters had higher specificity. A combination of perfusion parameters in patients with HCC derived from traditional triphasic CT scans can be used as a preoperative biomarker for predicting MVI.

TRIPLE PHASE CT EVALUATION OF LIVER LESIONS WITH FNAC/HPE CORRELATION.

Introduction: Detection and characterization of hepatic lesions is crucial due to the high prevalence of both benign and malignant lesions. USG is the most common initial method for evaluation, but in most cases, a definitive diagnosis cannot be made based on it. CT is superior modality because of its ability to detect vascular perfusion in the different phases. Aim: Objectives: To assess the role of Triple phase computed tomography in differentiating various focal hepatic SOLs. To evaluate the characteristics of focal hepatic lesions on a Triphasic Computed Tomography scan performed in patients with suspected focal liver disease and to correlate the CT findings with FNAC/Histopathological examination. Methodology: This prospective study was conducted for a period of one year. 90 patients were included with suspected hepatic lesions clinically or on ultrasound findings with age more than seven years from both genders. Computed tomography (CT) examinations were done and different enhancement patterns were then seen. The final report was made by the radiologist while the FNAC/HPE findings were reviewed. In present study, 56% of patient Results: s were males and 44% were females. Right lobe was involved in 60% and both lobes in 23% of patients. The most common lesion was hemangioma. Abscess was the 2nd most common benign lesion. Sensitivity, specificity, PPV and NPV for HCC detection was 85%, 95%, 81.8% and 92.7% respectively. Sensitivity, specificity, PPV and NPV for metastasis detection was 85%, 84.37%, 77.3% and 90% respectively. Triple phase CT not only diagnosed hepatic lesions wi Conclusion: th high sensitivity and specificity but also helped in planning the management. CT findings very well correlated with the final pathological diagnosis.

Assessment of Liver Diseases Using Triphasic Computed Tomography

The triphasic spiral liver computed tomography (CT) method is a standard way to find and describe a wide range of benign and cancerous liver lesions. This helps bring down the rates of death and illness among people with liver disease. Objective: To evaluate liver diseases in real time using Triphasic imaging procedure. Methods: A cross-sectional study was carried out at Al-Amin Diagnostic Center, Chattha Hospital, and Gondal Hospital. Before Triphasic CT Scan, each patient completed a form of written informed consent. A total of 65 people were examined. All diagnosed with various liver illnesses, as well as their findings were reviewed using Triphasic liver CT Scan. The typical patient was 53.5 years old. Patients' eligibility was determined using inclusion criteria. Results: The majority of data population was male 39 (60%) and female 26 (40%). The majority of the findings included Portal vein thrombosis 6 (9.2%) liver lesion 5 (7.7%), ascitis 3 (4.6%), cirrhosis of liver 6 (9.2% ), Hepatocellular carcinoma 12 (18.46% ), Dilated CBD 4 (6.2% ), cholilithiasis 8 (12.3%), portal hypertension 5 (7.7%), hepatic Mets 6 (9.2%), Hepatic contusion 6 (9.2%), Right lobe nodules 3 (4.6%), segment 8 tumor 1 (1.5%). Conclusions: Computer tomography is a useful modality for identifying liver pathology. sixty-five patients in this study were aged 30-84 years (60%) male and (40%) female and were found to have a greater incidence of hepatic cellular carcinoma in the liver (12) (18.46%) and it is more affected in males than females

Value of perfusion parameters histogram analysis of triphasic CT in differentiating intrahepatic mass forming cholangiocarcinoma from hepatocellular carcinoma

We aim to gain further insight into identifying differential perfusion parameters and corresponding histogram parameters of intrahepatic mass-forming cholangiocarcinoma (IMCC) from hepatocellular carcinomas (HCCs) on triphasic computed tomography (CT) scans. 90 patients with pathologically confirmed HCCs (n = 54) and IMCCs (n = 36) who underwent triple-phase enhanced CT imaging were included. Quantitative analysis of CT images derived from triphasic CT scans were evaluated to generate liver perfusion and histogram parameters. The differential performances, including the area under the receiver operating characteristic curve (AUC), specificity, and sensitivity were assessed. The mean value, and all thepercentiles of the arterial enhancement fraction (AEF) were significantly higher in HCCs than in IMCCs. The difference in hepatic arterial blood supply perfusion (HAP) and AEF (ΔHAP = HAPtumor − HAPliver, ΔAEF = AEFtumor − AEFliver) for the mean perfusion parameters and all percentile parameters between tumor and peripheral normal liver were significantly higher in HCCs than in IMCCs. The relative AEF (rAEF = ΔAEF/AEFliver), including the mean value and all corresponding percentile parameters were statistically significant between HCCs and IMCCs. The 10th percentiles of the ΔAEF and rAEF had the highest AUC of 0.788 for differentiating IMCC from HCC, with sensitivities and specificities of 87.0%, 83.3%, and 61.8%, 64.7%, respectively. Among all parameters, the mean value of ∆AEF, the 75th percentiles of ∆AEF and rAEF, and the 25th percentile of HFtumor exhibited the highest sensitivities of 94.4%, while the 50th percentile of rAEF had the highest specificity of 82.4%. AEF (including ΔAEF and rAEF) and the corresponding histogram parameters derived from triphasic CT scans provided useful value and facilitated the accurate discrimination between IMCCs and HCCs.

Acute necrotizing pancreatitis as a manifestation of Behcet’s Disease: A case report and review of the literature

BackgroundBehçet’s disease (BD) is a chronic, relapsing, multisystemic vasculitis with varying frequency of gastrointestinal manifestations. Pancreatitis is a rare manifestation of BD. Case presentationA 31-year-old man diagnosed with Behçet’s disease with a fiveyear history of recurrent orogenital ulcers, ocular involvement and pseudofolliculitis presented with severe epigastric pain radiating to back that worsens after meals and weight loss (10 kg in 3 months). He denied history of abdominal trauma, drug abuse or alcohol consumption. He was found to be hypertensive. Laboratory investigations revealed presence of leukocytosis, thrombocytosis, high inflammatory markers, low serum albumin, impaired renal functions, hyperglycemia and elevated serum amylase. Post contrast triphasic computed tomography scan showed a picture of necrotizing hemorrhagic pancreatitis. Bile and pancreatic ducts were normal. CT mesenteric angiography showed no evidence of aortic, celiac or superior mesenteric artery aneurysms, also splenic artery and veins were patent with no evidence of occlusion. After exclusion of other causes of acute pancreatitis, the condition has been attributed to BD. High dose of oral corticosteroids was started (60 mg/day) in addition to proper hydration, antihypertensive medications, intravenous antibiotics and insulin to control elevated blood sugar. Cystogastrostomy through endoscopic ultrasound was done to relieve the patient’s pain. Unfortunately, three months after the onset of pain, the patient developed systemic inflammatory response syndrome and passed away. ConclusionAlthough acute pancreatitis is a rare gastrointestinal manifestation of BD, it is a possibly fatal one.

Value of perfusion parameters and histogram analysis of triphasic computed tomography in pre-operative prediction of histological grade of hepatocellular carcinoma.

Background:Pre-operative non-invasive histological evaluation of hepatocellular carcinoma (HCC) remains a challenge. Tumor perfusion is significantly associated with the development and aggressiveness of HCC. The purpose of the study was to evaluate the clinical value of quantitative liver perfusion parameters and corresponding histogram parameters derived from traditional triphasic enhanced computed tomography (CT) scans in predicting histological grade of HCC.Methods:Totally, 52 patients with HCC were enrolled in this retrospective study and underwent triple-phase enhanced CT imaging. The blood perfusion parameters were derived from triple-phase CT scans. The relationship of liver perfusion parameters and corresponding histogram parameters with the histological grade of HCC was analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal ability of the parameters to predict the tumor histological grade.Results:The variance of arterial enhancement fraction (AEF) was significantly higher in HCCs without poorly differentiated components (NP-HCCs) than in HCCs with poorly differentiated components (P-HCCs). The difference in hepatic blood flow (HF) between total tumor and total liver flow (ΔHF = HFtumor − HFliver) and relative flow (rHF = ΔHF/HFliver) were significantly higher in NP-HCCs than in P-HCCs. The difference in portal vein blood supply perfusion (PVP) between tumor and liver tissue (ΔPVP) and the ΔPVP/liver PVP ratio (rPVP) were significantly higher in patients with NP-HCCs than in patients with P-HCCs. The area under ROC (AUC) of ΔPVP and rPVP were both 0.697 with a high sensitivity of 84.2% and specificity of only 56.2%. The ΔHF and rHF had a higher specificity of 87.5% with an AUC of 0.681 and 0.673, respectively. The combination of rHF and rPVP showed the highest AUC of 0.732 with a sensitivity of 57.9% and specificity of 93.8%. The combined parameter of ΔHF and rPVP, rHF and rPVP had the highest positive predictive value of 0.903, and that of rPVP and ΔPVP had the highest negative predictive value of 0.781.Conclusion:Liver perfusion parameters and corresponding histogram parameters (including ΔHF, rHF, ΔPVP, rPVP, and AEFvariance) in patients with HCC derived from traditional triphasic CT scans may be helpful to non-invasively and pre-operatively predict the degree of the differentiation of HCC.

Multi-Detector Computed Tomography in Diagnosis of Esophageal and Fundal Varices in Cirrhotic Patients

Background: Esophageal varices is one of the most common complication of liver cirrhosis, which lead to hematemesis with high morbidity and mortality rates. this study aimed to assess the role of triphasic computed tomography (CT) scan in detection and grading of esophageal varices (EV) and gastric varices (GV) compared to endoscopy. Patients and methods: A cross-sectional study was conducted on 35 patients (26 male & 9 female) who had cirrhosis. All patients were referred to perform triphasic abdominal CT scan then upper gastro-intestinal (UGI) endoscopy. Results: We have noticed that there is only 1 patient had oesophageal varices confirmed by UGI endoscopy not seen in CT. while there were 15 patients confirmed by endoscopy and CT. There is only 1 patient had gastric varix confirmed by UGI endoscopy not seen in CT. while there were 8 patients confirmed by endoscopy and CT. CT has 88.9 sensitivity comparing to endoscopy and 100 specificity with 97.14 accuracy with highly significant p value (p < 0.05). CT detected 8 positive cases of gastric varices and one negative case while EGD detected 9 positive cases. So CT has 88.9 sensitivity comparing to endoscopy and 100 specificity with 97.14 accuracy with highly significant p value (p < 0.05). Conclusion: CT scan could be used as independent method for diagnosis of gastric and esophageal varices.

Percutaneous Argon-Helium Cryoablation for Small Hepatocellular Carcinoma Located Adjacent to a Major Organ or Viscus: A Retrospective Study of 92 Patients at a Single Center.

BackgroundCryoablation of hepatocellular carcinoma (HCC) close to major organs or viscus is challenging because it can cause complications. This retrospective study aimed to investigate the safety and efficacy of percutaneous argon-helium cryoablation of small HCC located adjacent to major organs or viscus.Material/MethodsNinety-two patients who underwent percutaneous argon-helium cryoablation between February 2012 and December 2018 at the Fifth Medical Center of the Chinese People’s Liberation Army General Hospital were included. Treatment efficacy was evaluated by magnetic resonance imaging or triphasic computed tomography scan within 1 week after each cryoablation procedure. Local tumor progression, distant recurrence, and overall survival were analyzed using the Kaplan-Meier method and log-rank test.ResultsA total of 92 patients with small HCC located adjacent to major organs or viscus who underwent cryoablation were retrospectively reviewed. The number of patients with tumors adjacent to the gallbladder, portal or hepatic vein, diaphragm, stomach, heart, and intestine was 22, 1, 39, 6, 8, and 16, respectively. Cumulative local tumor progression rates at 1 and 2 years were 2.8% and 7.3%, respectively. Cumulative distant recurrence rates at 1, 2, and 3 years were 11.1%, 17.6%, and 20.7%, respectively. The overall survival rates at 1, 2, and 4 years were 100%, 93.6%, and 74.9%, respectively. Major complications were observed in 5 (5.4%) patients. Minor complications were observed in 85 (92.4%) patients.ConclusionsThis experience from a single center showed that percutaneous argon-helium cryoablation was safe and effective in the management of small HCC that is located adjacent to major organs or viscus.

Metastatic Choroidal Melanoma and Liver Metastasis: A Case Report

Metastatic melanoma to liver is rare in adults. Melanoma can arise from the skin and uveal tract of eyes and metastasizes to other organs, including liver. A middleaged an who had right eye enucleation 5 years ago due to choroidal melanoma was presented with nonspecific abdominal symptoms for a 6-month duration. He had mild tenderness in the right hypochondriac region. An abdominal ultrasound examination showed two hypoechoic lesions that are suggestive of metastatic deposits. Triphasic computed tomography scan of the abdomen showed heterogeneously enhancing lesion that is indicative of hepatoma. Magnetic resonance imaging revealed T2 iso- to hyperintense lesion, giving differential diagnoses of focal nodular hyperplasia, hepatic adenoma, and fibrolamellar carcinoma. Immunohistochemistry results showed that the tumor cells derived from liver biopsy contain melanin as they are positive for both S-100 and MART-1, indicating that the tumor is melanoma. The histopathological examination should be performed on tumor cells from patients who have an increased risk for metastatic melanoma in the liver due to choroidal melanoma.

Frequency of Different Types of Focal Hepatic Lesions on Triphasic Computed Tomography Scan in Adult Patients

Out of various pathologies that affect the liver, focal liver lesion form an important group. Triphasic computed tomography is the imaging modality most often used to evaluate focal liver lesions. The purpose of this study was to evaluate the role of computed tomography in the diagnosis of liver lesions and to determine frequency of these lesions. Keywords : Liver, focal lesion, liver parenchyma, enhancement, iso-dense, hypo-dense and hyper-dense DOI : 10.7176/JHMN/77-04 Publication date :July 31st 2020

Prevalence of portal vein thrombosis in patients with chronic liver disease using triphasic computed tomography scan as diagnostic modality: A study in Jos, North-Central, Nigeria

Background: Portal vein thrombosis (PVT) is one of the complications of chronic liver disease (CLD), and the prevalence varies from country to country as well as the method utilized in determining the presence of the thrombosis. Objective: The present study was aimed at determining the prevalence of PVT in patients with CLD in our locality using triphasic computed tomography as a diagnostic modality. Materials and Methods: This was a retrospective study. The triphasic computed tomography scan of the abdomen of 121 patients from January 2019 to April 2020 was retrieved and reviewed for the presence of PVT. Results: The mean age for the study population was 54.4 ± 13.4 years with age range of 22–100 years. Out of the 121 patients, 46 patients had PVT constituting the prevalence of 38.0%. The PVT is more in males (80.4%) than females (19.6). The thrombosis is more in the age group of 41–50 years. Conclusion: There is a high prevalence of PVT in our locality possibly because patients present in the later stage of CLD. PVT is associated with ascites and multiple hepatic masses.

Assessment of the Hallmarks of Wilson Disease in CT Scan Imaging

IntroductionOwing to nonspecific clinical symptoms, Wilson disease (WD) diagnosis is often missed or delayed; hence, many patients reach end-stage liver disease. When cirrhosis takes place, it is difficult to distinguish between WD and other causes of cirrhosis by imaging alone. This study outlines abdominal computed tomography (CT) imaging findings that occur more frequently in patients with WD cirrhosis. Material and MethodsFifty-seven patients with WD who had referred for liver transplantation took part in this study and underwent dynamic liver CT examination before transplantation. Qualitative and quantitative parameters including liver density, contour irregularity, dysmorphia, hypertrophy of caudate lobe, presence of focal parenchymal lesion, thickness of perihepatic fat layer, periportal thickness, lymphadenopathy, and other associated findings were recorded and evaluated. ResultsAmong these patients, 85.9% had contour irregularity, 28% had hepatic dysmorphia, and periportal thickening and cholelithiasis were found in 25.5% and 12.3% of patients, respectively. Splenomegaly, lymphadenopathy, and portosystemic shunting were observed in all patients. Also, hyperdense nodules (>20 mm) and honeycomb pattern were detected in 65.2% and 15.2% of patients, respectively, in the arterial phase. In the portal phase, these findings were detected only in 13% and 4.3% of patients. Hypertrophy of caudate lobe was seen only in 12.2% of patients. ConclusionWD-associated cirrhosis has many CT imaging findings, although most of them are nonspecific. Some findings, such as hyperdense nodules and honeycomb pattern in non–contrast-enhanced CT scan and arterial phase of triphasic CT scan with lack of hypertrophy of caudate lobes, are hallmarks of WD.

Diagnostic value of serum Dickkopf-1 as a predictor of hepatocellular carcinoma in patients with liver cirrhosis

Objective The aim of this study was to evaluate the significance of Dickkopf-1 (DKK-1) as a tumor marker for the diagnosis of hepatocellular carcinoma (HCC) in cirrhotic patients. Background HCC is a major health problem and its prognosis still remains dismal. Patients and methods This cross-sectional study included 50 cirrhotic patients with HCC, 50 cirrhotic patients without HCC, and 20 healthy age-matched and sex-matched participants as controls. All patients and controls were subjected to the following: full history taking, full clinical examination, and investigations as complete blood count, kidney function tests, liver function tests, serum α-fetoprotein (AFP), serum DKK-1, abdominal ultrasound, and triphasic computed tomography scan were done. Results DKK-1 level was significantly higher in the HCC group than in cirrhotic and control groups (P = 0.002). DKK-1 was significantly higher in multiple focal lesions (P = 0.010) and large focal lesions greater than 5 cm (P = 0.014). The best cut-off value of DKK-1 was 1.122 with a sensitivity of 80%, specificity of 77.1% with an area under curve of 0.810 and P value of less than 0.001. The validity of combined serum AFP and DKK-1 in the diagnosis of HCC showed an increased sensitivity of 92%, specificity of 77.1% with an area under curve of 0.882 and P value of less than 0.001. Conclusion DKK-1 was more sensitive and specific than AFP in the early diagnosis of HCC in cirrhotics. Combined use of DKK-1 and AFP increased the sensitivity and specificity for the diagnosis of HCC than serum AFP or DKK-1 alone.

Postlaparoscopic hepatic resection of hepatocellular carcinoma: Port‐site metastasis

Hepatocellular carcinoma (HCC), the most common primary liver cancer, occurs in 90 per cent of the cases in patients with chronic liver disease. Pure laparoscopic liver resection is a less invasive procedure than conventional liver resection for hepatic lesions. Port‐site metastasis of HCC is rare. We present a case of port‐site metastasis postlaparoscopic resection of HCC. The patient had laparoscopic nonanatomical resection for HCC 3 cm in diameter at segment III. Eleven months postoperative, the patient presented to our Department of Hepato‐Pancreatico‐Biliary with an anterior abdominal wall hard lump where the laparoscopic port had been used for the extraction of HCC and was associated with an elevated α‐fetoprotein level. Triphasic computed tomography scan showed HCC. Local excision was performed, and histopathology confirmed HCC. We recommend that examination of port sites after laparoscopic resection of HCC be included in the follow‐up protocol.

Diagnostic Performance of Quadruple Phase Multidetector Row Computed Tomography in Hepatoma: Comparison with Histopathological Diagnosis

Objective: To determine diagnostic accuracy of quadruple phase helical computed tomography scan in detection of hepatocellular carcinoma in individuals with hepatitis B and C, keeping histopathology as the gold standard. Methods: A cross-sectional study was performed in the Radiology and Imaging department of a tertiary care university hospital during 2014 to 2016. All serologically positive patients were included. Quadruple phase computed tomography scan was done and results were interrelated with histological diagnosis. Results: Hepatocellular carcinoma was accurately diagnosed in 76 out of 80 patients using Quadruple phase computed tomography scan (sensitivity, 95%). It was correctly excluded in 70 of 72 patients (specificity, 97.2%). The overall diagnostic accuracy of Quadruple phase computed tomography scan for diagnosing hepatocellular carcinoma was 96.05%. The positive and negative predictive values were 97.4% and 94.59% respectively. Conclusion: Quadruple phase computed tomography is more effective in evaluating hepatocellular carcinoma than conventional biphasic and triphasic computed tomography scans. We propose it as the technique of first preference for imaging workup in patients with Hepatitis B and C.

The importance of a multidisciplinary approach to hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. The rising incidence, genetic heterogeneity, multiple etiologies, and concurrent chronic liver diseases make diagnosis, staging, and selection of treatment options challenging in patients with HCC. The best approach to optimize the management of HCC is one that utilizes a core multidisciplinary liver tumor board, consisting of hepatologists, pathologists, interventional radiologists, oncologists, hepatobiliary and transplant surgeons, nurses, and general practitioners. In most cases, HCC is diagnosed by abdominal imaging studies, preferably with a triphasic computed tomography scan of the abdomen or magnetic resonance imaging of the abdomen. Histopathological diagnosis using a guided liver biopsy may be needed in noncirrhotic patients or when radiological diagnostic criteria are not fulfilled in the setting of cirrhosis. The Barcelona Clinic Liver Cancer staging system facilitates a standardized therapeutic strategy based on the tumor burden, extent of metastasis, severity of hepatic decompensation, comorbid medical illnesses, functional status of patient, HCC-related symptoms, and preference of the patient. Treatment options include curative surgery (hepatic resection and liver transplantation) and palliative measures (radiofrequency ablation, transarterial chemoembolization, and chemotherapy with sorafenib). The role of the multidisciplinary team is crucial in promptly reconfirming the diagnosis, staging the HCC, and formulating an individualized treatment plan. In potential liver transplant candidates, timely liver transplant evaluation and coordinating bridging/downsizing treatment modalities, such as radiofrequency ablation and transarterial chemoembolization, can be time-consuming. In summary, a multidisciplinary team approach provides a timely, individualized treatment plan, which can vary from curative surgery in patients with early-stage HCC to palliative/hospice care in patients with metastatic HCC. In most tertiary care centers in the US, a multidisciplinary liver tumor board has become the standard of care and a key component of best practice protocol for patients with HCC.

Are the unenhanced and excretory CT phases necessary for the evaluation of acute pyelonephritis?

Background The most widely accepted computed tomography (CT) protocol for diagnosis of acute pyelonephritis (APN) includes at least a pre- and post-contrast scan, which may expose patients to higher doses of ionizing radiation. Purpose To establish the accuracy, reproducibility, and degree of confidence in CT diagnosis of acute pyelonephritis (APN) and urolithiasis using only images obtained during the nephrographic phase. Material and Methods A retrospective study of 100 consecutive patients (88 women; age range, 19-70 years) with clinical and laboratory suspicion of APN and who underwent triphasic abdominal CT scans (non-contrast, nephrographic, and excretory phases) was performed. Two readers first evaluated independently only the nephrographic phase of scans, and, in a second session, the entire study. The diagnostic reference standard was settled by a third experienced radiologist who reviewed all triphasic scans and clinical data. Results The accuracy of only nephrographic phase for diagnosis of APN and urolithiasis was in the range of 90.3-91.78% and 96.27-99.25%, respectively. There was no significant difference in comparison with the triphasic reading (z: -0.4 - 0.2; P = 0.34-0.83). The average degree of confidence for APN also showed no significant variation for both readers ( P = 0.4 and 0.08). Almost perfect inter-observer agreements for the diagnosis of APN (k = 0.86, P < 0.001) and for urolithiasis (k = 0.84, P < 0.001) were observed when considering only the nephrographic phase. Conclusion CT assessment of APN and urolithiasis can be accurately performed using only the late nephrographic phase, with consequent dose reduction.