Triphasic Computed Tomography Research Articles

Opportunistic screening for osteoporosis using enhanced images based on dual-energy computed tomography material decomposition: a comparison with quantitative computed tomography.

Many patients with malignant tumors require chemotherapy and radiation therapy, which can result in a decline in physical function and potentially influence bone mineral density (BMD). Furthermore, these treatments necessitate enhanced computed tomography (CT) scans for determining disease staging or treatment outcomes, and opportunistic screening with available imaging data is beneficial for patients at high risk for osteoporosis if existing imaging data can be used. The study aimed to investigate the feasibility of opportunistic screening for osteoporosis using enhanced CT based on a dual-energy CT (DECT) material decomposition technique. We prospectively enrolled 346 consecutive patients who underwent abdominal unenhanced and triphasic contrast-enhanced CT (arterial, portal venous, and delayed phases) between June 2021 and June 2022. The BMD, and the density of hydroxyapatite (HAP) on HAP-iodine images and calcium (Ca) on Ca-iodine images were measured on the L1-L3 vertebral bodies. The iodine intake was recorded. Pearson analysis was conducted to assess the correlation between iodine intake and the density values in three phases and the correlation between BMD and the densities of HAP and Ca. Furthermore, linear regression was employed for quantitative evaluation. Bland-Altman analysis was used to evaluate the agreement between calculated BMD derived from DECT (BMD-DECT) and reference BMD derived from quantitative CT (BMD-QCT). Receiver operating characteristic (ROC) analysis was applied to assess the diagnostic efficacy. The HAP and Ca density of the L1-L3 vertebral bodies did not differ significantly among the three phases of contrast-enhanced CT (F=0.001-0.049; P>0.05). Significant positive correlations were found between HAP, Ca densities, and BMD (HAP-BMD: r=0.9472, R2=0.8973; Ca-BMD: r=0.9470, R2=0.8968; all P<0.001). Bland-Altman plots showed high agreement between BMD-DECT and BMD-QCT. The area under the curve (AUC) using HAP and Ca measurements was 0.963 [95% confidence interval (CI): 0.937-0.980] and 0.964 (95% CI: 0.939-0.981), respectively, for diagnosing osteoporosis and was 0.951 (95% CI: 0.917-0.973) and 0.950 (95% CI: 0.916-0.973), respectively, for diagnosing osteopenia. The HAP and Ca density measurements generated through the material decomposition technique in DECT have good diagnostic performances in assessing BMD, which offers a new perspective for opportunistic screening of osteoporosis on contrast-enhanced CT.

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.

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.

Relationship of the Presence of the Inferior Right Hepatic Vein with the Right Hepatic Vein Diameter and CT Liver Volumetry.

Background Right hepatic venous anatomy, right lobe volume, and percentage of remnant liver are issues to be considered in preoperative planning especially transplantation. Objectives The aim of this study was to investigate the relationship of the presence of the inferior right hepatic vein (IRHV) with the right hepatic vein (RHV) diameter, right lobe volume, and percentage of remnant liver. Materials and Methods In t his cross-sectional study, the computed tomography (CT) images of 90 patients who underwent triphasic CT for being living liver donation were evaluated retrospectively. The number and diameter of IRHVs and the diameter of main RHV were recorded. For the liver volume analysis, a deep learning-based automatic liver segmentation (Hepatic VCAR) program was used. A virtual hepatectomy plane was drawn, where the right and left liver volumes were found and the percentage of the left lobe to the total liver volume was calculated. Pearson's correlation analysis was used for correlation analysis and Student's t -test was used to compare parameters. Results A total of 74 IRHVs were detected in 53 (58.88%) of 90 patients. There were no differences in the percentage of remnant left lobe volume, right lobe volume, and RHV diameter between the IRHV (+) and (-) groups. The RHV diameter had a weak negative correlation with the IRHV diameter, and a weak positive correlation with the right lobe volume. Conclusions The percentage of remnant left lobe volume, right lobe volume, and RHV diameter did not differ in liver donors with and without an IRHV. The RHV diameter had a weak negative correlation with the IRHV diameter and a weak positive correlation with the right lobe volume.

The value of enhanced CT features and texture-signatures in assessing the inflammatory infiltration of pancreatic ductal adenocarcinoma.

To explore the predictive value of computed tomography (CT) imaging features and CT-based texture analysis in assessing inflammatory infiltration in pancreatic ductal adenocarcinoma (PDAC). A total of 43 patients with PDAC confirmed by surgical pathology were included in the study. The clinical, radiological, surgical, and pathological features of the patients were analyzed retrospectively using the chi-square test or Spearman's correlation. Receiver operating characteristic (ROC) curves were utilized to assess the overall predictive ability of the tumor enhancement degree on triphasic contrast-enhanced CT images for the inflammatory infiltration degree in PDAC. Furthermore, all CT data were uploaded to the RadCloud platform for region of interest (ROI) delineation and feature extraction. Then, the Variance Threshold and SelectKBest algorithms were used to find the optimal CT features. Binary logistic regression was employed to analyze the selected features in all three contrast-enhanced CT phases, and regression equations were formulated. ROC analysis was performed to evaluate the predictive effectiveness of each equation. The analysis revealed a statistically significant correlation between the degree of differentiation and radiological findings such as necrosis and cystic degeneration, vascular invasion, and the presence of ascites (P < 0.05). The enhancement degree of the tumor in both the arterial and venous phases was significantly correlated with the inflammatory infiltration degree (P < 0.05); however, the areas under the ROC curve (AUCs) of arterial and venous enhancement were 0.570 and 0.542, respectively. Regression equations based on the texture features of triphasic contrast-enhanced tumors were formulated, and their AUCs were 0.982, 0.643, and 0.849. Conventional radiological features are not significantly correlated with the degree of inflammatory infiltration in PDAC. The enhancement degrees in both the arterial phase and venous phase were statistically correlated with the inflammatory infiltration level but had poor predictive value. The texture features of PDAC on contrast-enhanced CT may show a better assessment value, especially in the arterial phase.

Adrenal incidentaloma: A case report of Pheochromocytoma (PCC) with atypical radiological features

Abstract Introduction Adrenal incidentaloma (AI) is an adrenal lesion ≥ 1 cm discovered accidentally during an imaging technique not aimed to assess the adrenal gland (1). Most AIs are benign and nonfunctioning, about 20% are functioning in form of hypercortisolism, hyperaldosteronism, pheochromocytoma (PCC) or sex steroid overproduction (2). Computed Tomography (CT) scan is vital in differentiating adenoma from non-adenoma. Triphasic CT adrenal protocol (TCTAP) with absolute percentage washout (APW) has good sensitivity and specificity in diagnosis of AI. Here we present a case of PCC with atypical CT features. Clinical Case A 45 years old male patient presented with abdominal pain, abdominal US revealed a right suprarenal mass of 55 mm and referred to endocrinologist for further management. During assessment, the patient had attacks of hypertension, no cushingoid features, BMI was 35 kg/m2 and his blood pressure 180/120 mmHg. Normetanephrine was very high (1016.9 pg/mL), cortisol (10.1 μg/dL), suppressible serum cortisol (1.7 μg/dL), normal DHEA-S (110 μg/dL) and ACTH was 13 pg/mL. Aldosterone, renin, aldosterone/renin ratio (ARR), Metanephrine, K+ are normal. TCTAP showed a homogenous 51×46 mm right adrenal mass of a native Hounsfield units (HU) of 25, portal phase HU of 86, delayed phase (at 15 minute) HU of 36 and APW was 81%, which are features consistent with lipid poor adenoma (LPA) rather than PCC or carcinoma. The patient referred to surgery, right adrenalectomy had been done after good preparation and the diagnosis of PCC had been confirmed by histopathological (HP) and immunohistochemical (IHC) staining. TCTAP used to differentiate adenomatous from non-adenomatous AI with good sensitivity and specificity (3). PCC is an uncommon with variable clinical presentation ranging from severe symptoms to very mild and even sometimes discovered incidentally as AI with about 1.5–14% of all cases of AIs (1). PCC has heterogeneous texture, variable sizes, native HU &amp;gt; 10, avid enhancement and slow washout (4). The present AI was homogenous, has a native HU of 25 and has avid enhancement at portal phase reaching to 86 HU, but the APW was 81% which is atypical for PCC, making lipid poor adenoma at the top list of differential diagnoses. Hormonal assessment revealed the diagnosis of PCC which was confirmed by histopathological (HP) and immunohistochemical (IHC) staining. An American study showed that two of eight PCCs have an APW &amp;gt; 60%, but both of these cases have native HU&amp;lt; 10 and the APW had been calculated at 10 minutes (5). Coincided with our patient and our protocol of 15-minute APW calculation, Yoon et al presented a case of PCC with native HU of 37, portal phase HU of 127 and delayed phase HU of 62 HU with APW of 72% (6). Conclusion PCC is serious condition, could be asymptomatic and may be presented with a typical radiological feature, so biochemical and hormonal assessment is a cornerstone in management of AI.

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

Computed Tomography Radiomics-Based Prediction of Microvascular Invasion in Hepatocellular Carcinoma.

BackgroundDue to the high recurrence rate in hepatocellular carcinoma (HCC) after resection, preoperative prognostic prediction of HCC is important for appropriate patient management. Exploring and developing preoperative diagnostic methods has great clinical value in treating patients with HCC. This study sought to develop and evaluate a novel combined clinical predictive model based on standard triphasic computed tomography (CT) to discriminate microvascular invasion (MVI) in hepatocellular carcinoma (HCC).MethodsThe preoperative findings of 82 patients with HCC, including conventional clinical factors, CT imaging findings, and CT texture analysis (TA), were analyzed retrospectively. All included cases were divided into MVI-negative (n = 33; no MVI) and MVI-positive (n = 49; low or high risk of MVI) groups. TA parameters were extracted from non-enhanced, arterial, portal venous, and equilibrium phase images and subsequently calculated using the Artificial Intelligence Kit. After statistical analyses, a clinical model comprising conventional clinical and CT image risk factors, radiomics signature models, and a novel combined model (fused radiomic signature) was constructed. The area under the curve (AUC) of the receiver operating characteristics (ROC) curve was used to assess the performance of the various models in discriminating MVI.ResultsWe found that tumor diameter and pathological grade were effective clinical predictors in clinical model and 12 radiomics features were effective for MVI prediction of each CT phase. The AUCs of the clinical, plain, artery, venous, and delay models were 0.77 (95% CI: 0.67–0.88), 0.75 (95% CI: 0.64–0.87), 0.79 (95% CI: 0.69–0.89), 0.73 (95% CI: 0.61–0.85), and 0.80 (95% CI: 0.70–0.91), respectively. The novel combined model exhibited the best performance, with an AUC of 0.83 (95% CI: 0.74–0.93).ConclusionsModels derived from triphasic CT can preoperatively predict MVI in patients with HCC. Of the models tested here, the novel combined model was most predictive and could become a useful tool to guide subsequent personalized treatment of HCC.

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.

Enhancement rate of venous phase to portal venous phase computed tomography and its correlation with ultrasound elastography determination of liver fibrosis

IntroductionThis study aimed to compare the correlation between the computed tomography (CT) enhancement rate of the venous to portal venous phase (VP-ER) and the extracellular volume (ECV) fraction with shear-wave ultrasound elastography (USE) findings in patients with liver fibrosis. MethodsWe included 450 patients with clinically suspected liver cirrhosis who underwent triphasic dynamic CT studies and USE. We compared the USE results with the unenhanced CT phase, with enhancement in the hepatic artery phase (HAP), portal venous phase (PVP), and venous phase (VP), and with the ECV fraction and the VP-ER. We also compared the area under the curve (AUC) of the receiver operating characteristic (ROC) curve of the ECV fraction and VP-ER with that of the values obtained with USE. ResultsThe VP-ER was the most highly correlated with the liver stiffness value determined with USE (Pearson's correlation coefficient: r = 0.37), followed by enhancement in the PVP (r = −0.25), CT number on unenhanced CT scans (r = −0.22), the ECV fraction (r = 0.19), enhancement in the VP (r = 0.059), and enhancement in the HAP (r = −0.023) (all p < 0.01). The VP-ER showed a significantly higher AUC than the ECV fraction (0.75 vs 0.62) when the liver stiffness was >15 kPa in USE studies (p = 0.04). ConclusionCompared to the ECV fraction, the VP-ER is more useful for predicting all degrees of liver fibrosis on routine triphasic dynamic CT images. Implications for practiceAlthough improvement is needed, the VP-ER has a higher diagnostic ability for liver fibrosis than the ECV fraction in clinical practice.

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.

Optimal diagnostic tool for surveillance of oesophageal varices during COVID-19 pandemic

AIMTo study the diagnostic accuracy and utility of triphasic abdominal computed tomography (CT) in the diagnosis and grading of oesophageal varices (OVs) as an alternative to endoscopy during the COVID-19 pandemic.MATERIALS AND METHODSA prospective analysis was undertaken of retrospective data from cirrhotic patients who underwent oesophago-gastro-duodenoscopy (OGD) and a triphasic abdominal CT from January to December 2019. Endoscopists and radiologists provided their respective independent assessment of OV grading after being blinded to the clinical details. Performance of CT grading of OVs was compared with the reference standard endoscopic grading using weighted kappa (k). Non-invasive scores such, as aspartate transaminase (AST)-to-platelet ratio index (APRI), Fibrosis-4 (FIB-4) Index, platelet: spleen (PS) ratio were correlated between the two techniques.RESULTSOV grading between endoscopists and radiologists showed 81.73% agreement (85 out of 104 patients) in the comparative analysis of 104 cirrhotic patients, of which no varices (57.1%, n=4), small (85.1%, n=23), medium (72.2%%, n=26), and large varices (94.1%, n=32) with a weighted k score of 0.88 (95% confidence interval 0.82–0.94). Overall, the sensitivity of CT in the diagnosis of no, small, medium, and large OVs was 66.6%, 79.3%, 89.6%, and 94.1%, respectively, with an area under the receiver operating curve (AUROC) score of 0.775, 0.887, 0.839, and 0.914. Performance of APRI, FIB-4, and PS ratio correlated well with the severity of OVs with no difference between OGD and CT grading.CONCLUSIONTriphasic abdominal CT can be an invaluable tool in the diagnosis and grading of OVs during the COVID-19 pandemic.

Hyperattenuating adrenal lesions in lung cancer: biphasic CT with unenhanced and 1-min enhanced images reliably predicts benign lesions.

To investigate usefulness of biphasic computed tomography (CT) in characterizing hyperattenuating adrenal lesions in lung cancer. This retrospective study included 239 patients with lung cancer who underwent adrenal CT for hyperattenuating (> 10 Hounsfield unit) adrenal lesions. Adrenal CT comprised unenhanced and 1-min and 15-min enhanced images. We dichotomized adrenal lesions depending on benign or metastatic lesions. Reference standard for benignity was histologic confirmation or ≥ 6-month stability on follow-up CT. Two independent readers analyzed absolute (APW) or relative percentage wash-out (RPW) using triphasic CT, and enhancement ratio (ER) or percentage wash-in (PWI) using biphasic CT (i.e., unenhanced and 1-min enhanced CT). Criteria for benignity were as follows: criteria 1, (a) APW ≥ 60% or (b) RPW ≥ 40%, and criteria 2, (a) ER > 3 and (b) PWI > 200%. We analyzed area under the curve (AUC) and accuracy for benignity, and inter-reader agreement. Proportion of benign adrenal lesion was 71.1% (170/239). For criteria 1 and 2, AUCs were 0.872 (95% confidence interval [CI], 0.822-0.911) and 0.886 (95% CI, 0.838-0.923), respectively, for reader 1 (p = 0.566) and 0.816 (95% CI, 0.761-0.863) and 0.814 (95% CI, 0.759-0.862), respectively, for reader 2 (p = 0.955), and accuracies were 87.9% (210/239) and 86.2% (206/239), respectively, for reader 1 (p = 0.479) and 81.2% (194/239) and 80.3% (192/239), respectively, for reader 2 (p = 0.763). Weighted kappa was 0.725 (95% CI, 0.634-0.816) for criteria 1 and 0.736 (95% CI, 0.649-0.824) for criteria 2. Biphasic CT can reliably characterize hyperattenuating adrenal lesions in patients with lung cancer. • Criteria from biphasic computed tomography (CT) for diagnosing benign adrenal lesions were enhancement ratio of > 3 and percentage wash-in of > 200%. • In the analysis by two independent readers, area under the curve between criteria 1 and 2 was not significantly different (0.872 and 0.886 for reader 1; 0.816 and 0.814, for reader 2; p > 0.05 for each comparison). • Wash-in characteristics from biphasic CT are helpful to predict benign adrenal lesions in lung cancer.

Is Doppler/Dopplex ultrasonography reliable in the assessment of percutaneous ablative therapies of hepatocellular carcinoma: a prospective cross-sectional study.

After hepatocellular carcinoma (HCC) interventional therapies, noninvasive vascular diagnostic imaging [duplex, Color/power Doppler ultrasonography, and triphasic computed tomography (CT)] determines the lesion complete/incomplete ablation. The aim was to analyze the usefulness of duplex, color/power Doppler ultrasonography in HCC ablation after percutaneous ablative therapies (PATs). We included 30 patients with 33 HCCs subjected to duplex/Doppler ultrasonography, ultrasound-guided fine-needle aspiration cytology (FNAC), and triphasic CT, all these before and after PATs. One week after treatment ended, out of 21 lesions with pretreatment positive color-Doppler, signals disappeared in 19 (90.5%) lesions. Out of 29 lesions with pretreatment positive power-Doppler, signals disappeared in 24 (82.8%). Out of 13 lesions with pretreatment intralesional power/duplex arterial signals, signals disappeared in eight (61.5%). There was a significant correlation (P < 0.05) between power-Doppler arterial signals and FNAC. Before HCC ablation, power-Doppler demonstrated a sensitivity 40% and specificity 96% in HCC detection in relation to FNAC, it had a sensitivity 60% and specificity 85% in HCC detection compared to triphasic CT. After HCC ablation, power-Doppler had a sensitivity and specificity of 100% in viable malignancy detection in relation to FNAC. Power-Doppler had a sensitivity 89% and specificity 93% in residual malignancy detection in relation to triphasic CT. Power-Doppler is a good positive test as intralesional arterial signals in a cirrhotic liver lesion is highly suggestive of HCC. Power-Doppler was sensitive in HCC ablation assessment in pretreatment positive cases only. Both triphasic CT and duplex/Doppler are complementary and the use of different diagnostic modalities after ablation is mandatory.

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.

Impact value of laparoscopic ultrasound over triphasic computed tomography in the management of hepatic focal lesions

AimIntraoperative ultrasound has an established role in hepatic resections for patients who undergo surgery for potential liver resection. The aim of the present study was to evaluate the impact of laparoscopic intraoperative ultrasonography (LUS) findings compared to pre‐operative triphasic computed tomography (TCT) findings in the management of hepatic focal lesions.Patient and methodsEighty‐seven patients with 192 hepatic focal lesions underwent preoperative TCT and intraoperative LUS evaluation. Data in each case were collected, including number, site and size of hepatic focal lesions.ResultsThere were 112 lesions detected on preoperative TCT, and 80 additional new lesions (42 per cent) were detected in 50 patients, as confirmed by LUS. Twenty‐three lesions (12 per cent) in 20 patients were treated by resection or ablation, and correct staging of the tumours was possible in 61 patients (70 per cent).ConclusionThe use of LUS can be considered a cornerstone for any contemplated hepatic surgery, as it corrects the staging of these lesions. In addition, the present study proved that LUS is more sensitive than TCT in detecting liver tumours, especially smaller lesions and those on the inferior and diaphragmatic surfaces of the liver.

Contrast Enhancement Boost Technique at Aortic Computed Tomography Angiography: Added Value for the Evaluation of Type II Endoleaks After Endovascular Aortic Aneurysm Repair

Delayed-phase acquisition of the computed tomography (CT) angiography is important for the evaluation of type II endoleaks after endovascular aortic aneurysm repair because the endoleak cavity area is associated with aneurysm sac expansion. Contrast enhancement boost (CE-boost) is a postprocessing technique for increasing the degree of contrast enhancement on contrast-enhanced CT. We aimed to investigate the usefulness of the CE-boost technique for the visualization of type II endoleaks. This retrospective study included 28 patients with type II endoleaks after endovascular aortic aneurysm repair who underwent triphasic contrast-enhanced CT. Objective (CT number, signal-to-noise ratio, and contrast-to-noise ratio) and subjective quality analyses using a four-point scale (1, poor; 4, excellent) were performed for the conventional early- and delayed-phase images as well as CE-boost delayed-phase images. The CE-boost delayed-phase images yielded a significantly higher CT number (134.5 ± 41.7 HU), signal-to-noise ratio (23.4 ± 10.5), and contrast-to-noise ratio (15.3 ± 8.4) and showed a significantly larger endoleak area (145.0 ± 134.8 mm2) than did the conventional early-phase (95.6 ± 53.2 HU, 7.3 ± 4.7, 4.0 ± 4.2, and 56.2 ± 99.3 mm2, respectively) and delayed-phase (110.5 ± 33.3 HU, 8.2 ± 2.7, 4.9 ± 2.0, and 124.8 ± 131.9 mm2, respectively) images (p < 0.01). The endoleak visibility score was highest for the CE-boost delayed-phase images (2.0 ± 1.0, 3.0 ± 0.6, and 3.4 ± 0.7 for conventional early-phase, delayed-phase, and delayed-phase CE-boost images, respectively; p < 0.001). The CE-boost technique facilitates clear visualization of type II endoleak cavities.

A Novel Method for the Prediction of Pancreatic Fistula Following Pancreaticoduodenectomy by the Assessment of Fatty Infiltration

Pancreaticoduodenectomy is the gold standard treatment of neoplastic lesions of periampullary region. It is a well-known fact that postoperative pancreatic fistula is considered as the most common cause of morbidity. We aimed to present a novel technique using preoperative computed tomography (CT) evaluating the ratio of fatty volume to total pancreatic volume. A total of 40 patients who had been operated for periampullary neoplasm in a single tertiary center were included in the study. Study group was composed of 20 patients who had developed clinically relevant pancreatic fistula. Preoperative CT scans were evaluated retrospectively. Analysis of the image data was based on axial images and two-dimensional (2D) and three-dimensional (3D) post-processing images. Lipid component was estimated as the ratio of lipid volume to the total volume of the pancreas. Adenocarcinoma was the most frequent histopathological diagnosis in both groups (n = 33, 82.5%). Due to preoperative CT scan measurements, both pancreatic fat volume and the ratio of fatty volume to the whole pancreatic volume were found to be statistically higher in the study group (p < 0.01). Hospital stay was longer, and mortality rates were higher in study group. A ratio of 15% fat may be counted as a risk factor for PF development with a 95% sensitivity and 70% specificity, according to the ROC curve analysis. Preoperatively obtained triphasic CT can help in the prediction of postoperative pancreatic fistula. The assessment of the ratio of pancreatic lipid component may be a predictive factor (15%) for anastomotic failure, with the help of an experienced radiologist.

Does Enhancement or Perfusion on Preprocedure CT Predict Outcomes After Embolization of Hepatocellular Carcinoma?

The objective of this study was to evaluate whether quantitative enhancement or perfusion measurements on preprocedure triphasic computed tomography (CT) can be used to predict response or overall survival after embolization of hepatocellular carcinoma. The institutional review board approved this retrospective review of 63 patients with hepatocellular carcinoma treated with particle embolization between March 2009 and December 2014. Quantitative enhancement and perfusion measurements were performed on the target tumor and the background liver on the triphasic CT performed before treatment. Microvascular invasion (MVI) and degree of differentiation were determined from a core biopsy specimen. Quantitative enhancement and perfusion values were then correlated with pathology (two-tailed t test), response to embolization on modified Response Evaluation Criteria In Solid Tumors (two-tailed t test), and overall survival after embolization (Cox proportional hazards model). Arterial enhancement did not predict immediate response or overall survival after embolization. The degree of differentiation or presence of MVI also did not predict immediate response or overall survival after embolization. However, high hepatic artery coefficient or low portal vein coefficient, both in the tumor (P = .011 and P = .004) and in the background liver (P = .015 and P = .009), were associated with worse survival. Hepatic artery coefficient, both in the tumor (P = .025) and in the background liver (P = .013), were independent predictors of survival in a multivariate model including the Child-Pugh score and the BCLC stage. Tumor and liver perfusion parameters estimated from preprocedure triphasic CT were predictive of survival after embolization. Arterial-phase enhancement and histology (degree of differentiation or MVI) did not predict immediate response or overall survival after particle embolization.