Focal Liver Lesions: Pattern-based Classification Scheme for Enhancement at Arterial Phase CT

Nino-Murcia, Matilde; Olcott, Eric W.; Jeffrey, R. Brooke; Lamm, Robert L.; Beaulieu, Christopher F.; Jain, Kiran A

doi:10.1148/radiology.215.3.r00jn03746

Cited by 179 publications

(95 citation statements)

References 20 publications

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“…Central hypoattenuating foci have been interpreted as areas of necrosis and peripheral enhancement as inflammatory response (Almutairi et al, 2009;DeLone et al, 1999). A similar pattern of enhancement can be seen with neoplasia in humans, where peripheral enhancement has been interpreted as well-perfused, viable tumour tissue (Nino-Murcia et al, 2000). Whether post-contrast features will aid in differentiating SOA from neoplasia in cats requires characterisation of the latter.…”

Section: Discussionmentioning

confidence: 82%

Computed tomographic features of feline sino-nasal and sino-orbital aspergillosis

Barrs

Beatty

Dhand

et al. 2014

The Veterinary Journal

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Makara, M. (2014). Computed tomographic features of feline sino-nasal and sino-orbital aspergillosis. Vet J. 201(2):215-22. DOI:10.1016DOI:10. /j.tvjl.2014 Computed tomographic features of feline sino-nasal and sino-orbital aspergillosis AbstractFeline upper respiratory tract aspergillosis (URTA) occurs as two distinct anatomic forms, sinonasal aspergillosis (SNA) and sino-orbital aspergillosis (SOA). An emerging pathogen, Aspergillus felis is frequently involved. The pathogenesis of URTA, in particular, the relationship between the infecting isolate and outcome, is poorly understood. Computed tomography was used to investigate the route of fungal infection and extension in 16 cases (SNA n=7, SOA n=9) where the infecting isolate had been identified by molecular testing.All cases had nasal cavity involvement except one cat with SNA that had unilateral frontal sinus changes. A strong association between the infecting species and anatomic form was identified. A. fumigatus infections remained within the sino-nasal cavity. Cryptic species infections were associated 2 | P a g e with orbital and paranasal soft-tissue involvement and with orbital lysis. These species were further associated with a mass in the nasal cavity, paranasal sinuses or nasopharynx. Orbital masses showed heterogeneous contrast enhancement, with central coalescing hypoattenuating foci and peripheral rim enhancement. Severe, cavitated turbinate lysis, typical of canine SNA, was present only in cats with SNA.These findings support that the nasal cavity is the portal of entry for fungal spores in feline URTA and that the route of extension to involve the orbit is via direct naso-orbital communication from bone lysis. Additionally, a pathogenic role for A. wyomingensis and a sinolith in a cat with A. udagawae infection are reported for the first time.

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Section: Discussionmentioning

confidence: 82%

Computed tomographic features of feline sino-nasal and sino-orbital aspergillosis

Barrs

Beatty

Dhand

et al. 2014

The Veterinary Journal

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“…On CT/MRI, a nodule was considered to be HCC when both hyperattenuation in the arterial phase and hypoattenuation in the late phase were evidenced [8,17,18]. When CT/MRI findings were not conclusive, the nodule was followed up with ultrasonography within 3 months.…”

Section: Diagnosis Of Hccmentioning

confidence: 99%

Ultrasound surveillance for early detection of hepatocellular carcinoma among patients with chronic hepatitis C

et al. 2009

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Background and aims Ultrasonography is the most frequently used modality in surveillance for HCC among patients with chronic hepatitis C. However, the optimal surveillance interval is still controversial and the usefulness of supplementary tumor marker determination has not been confirmed. Methods A total of 243 cases of naive HCC were detected among 1,431 patients with chronic hepatitis C under outpatient-based surveillance. The mode of HCC detection, including ultrasound surveillance interval, was retrospectively examined and the relation between the interval and detected tumor size was analyzed. Tumor volume doubling time was estimated from exponential increase in serum tumor marker levels when applicable. Results HCC was first detected by ultrasonography in 221 patients. Ultrasound surveillance interval, ranging between 2 and 8 months, was not correlated with the size of tumor at detection. Patients with cirrhosis were likely to be surveyed at shorter intervals. The size of tumor exceeded 30 mm only in three (1.4%) cases. They were all positive for a biomarker and the estimated tumor doubling time was short. In 14 cases, HCC was first detected by CT indicated by abnormal rise in tumor marker levels despite negative ultrasound findings. In the remaining eight cases, ultrasonography had been replaced by CT as surveillance modality because of excessive obesity or coarseness of liver parenchyma.Conclusions Ultrasound surveillance at 6-month intervals was appropriate in general for the detection of HCC at a size smaller than 30 mm. However, in patient with established cirrhosis, more frequent screening would be needed to detect tumors of the same size.

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“…Several other imaging features can be used to distinguish HCC from other liver lesions: portal vein invasion, abnormal internal vessels [3,25], heterogeneous enhancement [3], large size [7], hyperintensity on T2 MRI sequences, and a pseudocapsule with delayed enhancement [26] all favor a diagnosis of HCC. Our findings should be confirmed with a prospective study, where the HAC and PVC are considered in the context of all of the other imaging and clinical data.…”

Section: Discussionmentioning

confidence: 99%

Classification of Hypervascular Liver Lesions Based on Hepatic Artery and Portal Vein Blood Supply Coefficients Calculated from Triphasic CT Scans

Boas

Kamaya

et al. 2014

J Digit Imaging

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Perfusion CT of the liver typically involves scanning the liver at least 20 times, resulting in a large radiation dose. We developed and validated a simplified model of tumor blood supply that can be applied to standard triphasic scans and evaluated whether this can be used to distinguish benign and malignant liver lesions. Triphasic CTs of 46 malignant and 32 benign liver lesions were analyzed. For each phase, regions of interest were drawn in the arterially enhancing portion of each lesion, as well as the background liver, aorta, and portal vein. Hepatic artery and portal vein blood supply coefficients for each lesion were then calculated by expressing the enhancement curve of the lesion as a linear combination of the enhancement curves of the aorta and portal vein. Hepatocellular carcinoma (HCC) and hypervascular metastases, on average, both had increased hepatic artery coefficients compared to the background liver. Compared to HCC, benign lesions, on average, had either a greater hepatic artery coefficient (hemangioma) or a greater portal vein coefficient (focal nodular hyperplasia or transient hepatic attenuation difference). Hypervascularity with washout is a key diagnostic criterion for HCC, but it had a sensitivity of 72 % and specificity of 81 % for diagnosing malignancy in our diverse set of liver lesions. The sensitivity for malignancy was increased to 89 % by including enhancing lesions that were hypodense on all phases. The specificity for malignancy was increased to 97 % (p=0.039) by also examining hepatic artery and portal vein blood supply coefficients, while maintaining a sensitivity of 76 %.

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Focal Liver Lesions: Pattern-based Classification Scheme for Enhancement at Arterial Phase CT

Abstract: The appearance of hepatic lesions in the arterial phase of enhancement has potential use in the determination of specific diagnoses. The classification scheme used in this study may be a useful tool for the interpretation of arterial phase CT studies.

Cited by 179 publications

References 20 publications

Computed tomographic features of feline sino-nasal and sino-orbital aspergillosis

Computed tomographic features of feline sino-nasal and sino-orbital aspergillosis

Ultrasound surveillance for early detection of hepatocellular carcinoma among patients with chronic hepatitis C

Classification of Hypervascular Liver Lesions Based on Hepatic Artery and Portal Vein Blood Supply Coefficients Calculated from Triphasic CT Scans

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