Dual energy spectral CT imaging for the evaluation of small hepatocellular carcinoma microvascular invasion

Chen, Yang; Zhang, Shuang; Jia, Yongjun; Yan, Yu; Duan, Haifeng; Zhang, Xirong; Ma, Genshan; Ren, Chenglong; Ye, Nan

doi:10.1016/j.ejrad.2017.08.022

Cited by 41 publications

(29 citation statements)

References 32 publications

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“…We also found that the NIC of the peritumoral region up to 2 mm from the tumor margin was an independent predictive factor for MVI in multivariate analysis. Yang et al indicated that the NICs of HCCs with MVI were significantly higher than those of HCCs without MVI [18]. However, our results showed no significant difference in the NICs of HCCs between the two groups.…”

Section: Discussioncontrasting

confidence: 84%

Prediction of microvascular invasion of hepatocellular carcinoma: value of volumetric iodine quantification using preoperative dual-energy computed tomography

et al. 2020

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Background: To investigate the potential value of volumetric iodine quantification using preoperative dual-energy computed tomography (DECT) for predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC). Methods: This retrospective study included patients with single HCC treated through surgical resection who underwent preoperative DECT. Quantitative DECT features, including normalized iodine concentration (NIC) to the aorta and mixed-energy CT attenuation value in the arterial phase, were three-dimensionally measured for peritumoral and intratumoral regions: (i) layer-by-layer analysis for peritumoral layers (outer layers 1 and 2; numbered in close order from the tumor boundary) and intratumoral layers (inner layers 1 and 2) with 2-mm layer thickness and (ii) volume of interest (VOI)-based analysis with different volume coverage (tumor itself; VOI O1 , tumor plus outer layer 1; VOI O2 , tumor plus outer layers 1 and 2; VOI I1 , tumor minus inner layer 1; VOI I2 , tumor minus inner layers 1 and 2). In addition, qualitative CT features, including peritumoral enhancement and tumor margin, were assessed. Qualitative and quantitative CT features were compared between HCC patients with and without MVI. Diagnostic performance of DECT parameters of layers and VOIs was assessed using receiver operating characteristic curve analysis. Results: A total of 36 patients (24 men, mean age 59.9 ± 8.5 years) with MVI (n = 14) and without MVI (n = 22) were included. HCCs with MVI showed significantly higher NICs of outer layer 1, outer layer 2, VOI O1 , and VOI O2 than those without MVI (P = 0.01, 0.04, 0.02, 0.02, respectively). Among the NICs of layers and VOIs, the highest area under the curve was obtained in outer layer 1 (0.747). Qualitative features, including peritumoral enhancement and tumor margin, and the mean CT attenuation of each layer and each VOI were not significantly different between HCCs with and without MVI (both P > 0.05).

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Section: Discussioncontrasting

confidence: 84%

Prediction of microvascular invasion of hepatocellular carcinoma: value of volumetric iodine quantification using preoperative dual-energy computed tomography

et al. 2020

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“…Dual‐energy CT is used at many institutions for HCC screening because dual‐energy images can increase the iodine signal at contrast‐enhanced CT, thereby increasing the conspicuity of key imaging features of HCC such as arterial enhancement and tumor washout. ( 22‐25 ) The current study was able to demonstrate this validation especially with regard to sensitivity and NPV and it suggests little impact on test performance when delayed‐phase images are used.…”

Section: Discussionmentioning

confidence: 58%

Triple‐Phase Computed Tomography May Replace Dual‐Energy X‐ray Absorptiometry Scan for Evaluation of Osteoporosis in Liver Transplant Candidates

et al. 2021

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Assessment of bone density is an important part of liver transplantation (LT) evaluation for early identification and treatment of osteoporosis. Dual‐energy X‐ray absorptiometry (DXA) is currently the standard clinical test for osteoporosis; however, it may contribute to the appointment burden on LT candidates during the cumbersome evaluation process, and there are limitations affecting its accuracy. In this study, we evaluate the utility of biomechanical analysis of vertebral images obtained during dual‐energy abdominal triple‐phase computed tomography (TPCT) in diagnosing osteoporosis among LT candidates. We retrospectively reviewed cases evaluated for LT between January 2017 and March 2018. All patients who underwent TPCT within 3 months of DXA were included. The biomechanical computed tomography (BCT) analysis was performed at a centralized laboratory (O.N. Diagnostics, Berkeley, CA) by 2 trained analysts blinded to the DXA data. DXA‐based osteoporosis was defined as a T score ≤−2.5 at the hip or spine. BCT‐based osteoporosis was defined as vertebral strength ≤4500 N for women or ≤6500 N for men or trabecular volumetric bone mineral density ≤80 mg/cm3. Comparative data were available for 91 patients who had complete data for both DXA and BCT: 31 women and 60 men, age 54 ± 11 years (mean ± standard deviation), mean body mass index 28 ± 6 kg/m2. Using DXA as the clinical reference, sensitivity of BCT to detect DXA‐defined osteoporosis was 83.3% (20/24 patients) and negative predictive value was 91.7%; specificity and positive predictive value were 65.7% and 46.5%, respectively. BCT analysis of vertebral images on triple‐phase computed tomography, routinely obtained during transplant evaluation, can reliably rule out osteoporosis in LT candidates. Patients with suspicion of osteoporosis on TPCT may need further evaluation by DXA.

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“…Contrast-enhanced CT examinations have a high sensitivity and allow the detection of hypervascular HCCs as small as 3 mm [ 32 ]. Triple-phase CT scan of the liver during contrast injection include an arterial phase shortly after injection, a portal phase, and a delayed phase [ 33 ]. It can visualize tumors that are isoattenuated on the arterial and portal phases, increasing the sensitivity.…”

Section: Diagnostic Imaging and Vascular Invasionmentioning

confidence: 99%

Microvascular Invasion in HCC: The Molecular Imaging Perspective

Cuccurullo

Stasio

Mazzarella

et al. 2018

Contrast Media & Molecular Imaging

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Hepatocellular carcinoma represents the most frequent primary liver tumor; curative options are only surgical resection and liver transplantation. From 1996, Milan Criteria are applied in consideration of patients with cirrhosis and hepatocellular for liver transplantation; nonetheless, more recently, Milan Criteria have been criticized because they appear over conservative. Apart from number and size of lesions and biomarker levels, which already have been associated with poorer prognosis, overall survival and recurrence rates after transplantation are affected also by the presence of vascular invasion. Microvascular invasion suggests a poor prognosis but it is often hard to detect before transplant. Diagnostic imaging and tumor markers may play an important role and become the main tools to define microvascular invasion. In particular, a possible role could be found for computed tomography, magnetic resonance imaging, and positron emission tomography. In this paper, we analyze the possible role of positron emission tomography as a preoperative imaging biomarker capable of predicting microvascular invasion in patients with hepatocellular carcinoma and thus selecting optimal candidates for liver transplantation.

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Dual energy spectral CT imaging for the evaluation of small hepatocellular carcinoma microvascular invasion

Cited by 41 publications

References 32 publications

Prediction of microvascular invasion of hepatocellular carcinoma: value of volumetric iodine quantification using preoperative dual-energy computed tomography

Prediction of microvascular invasion of hepatocellular carcinoma: value of volumetric iodine quantification using preoperative dual-energy computed tomography

Triple‐Phase Computed Tomography May Replace Dual‐Energy X‐ray Absorptiometry Scan for Evaluation of Osteoporosis in Liver Transplant Candidates

Microvascular Invasion in HCC: The Molecular Imaging Perspective

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