Case 17.17

2014 ◽  
pp. 821-822
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Arterial Phase ◽  
Portal Venous Phase ◽  
Phase Images ◽  
Signal Void ◽  
Venous Phase

58-year-old woman with cirrhosis Axial precontrast (Figure 17.17.1) and arterial phase (Figure 17.17.2) and portal venous phase (Figure 17.17.3) postgadolinium water and fat images from a 3D SPGR Dixon acquisition. Notice that the phase and frequency directions have been swapped on the arterial phase acquisition and that there is a large geographic signal void in the middle of the liver on the water image, with the missing anatomy appearing on the corresponding fat image. All artifacts have been corrected on the portal venous phase images....

scholarly journals The utility of a dual-phase, dual-energy CT protocol in patients presenting with overt gastrointestinal bleeding

2021 ◽  
Vol 10 (7) ◽  
pp. 205846012110306
Author(s):  
Payam Mohammadinejad ◽  
Lukasz Kwapisz ◽  
Jeff L Fidler ◽  
Shannon P Sheedy ◽  
Jay P Heiken ◽  
...  
Keyword(s):  
Dual Energy ◽  
Arterial Phase ◽  
Gi Bleeding ◽  
Two Phase ◽  
Portal Venous Phase ◽  
Portal Phase ◽  
Ct Protocol ◽  
Phase Images ◽  
Venous Phase ◽  
Gi Bleed

Background Due to their easy accessibility, CT scans have been increasingly used for investigation of gastrointestinal (GI) bleeding. Purpose To estimate the performance of a dual-phase, dual-energy (DE) GI bleed CT protocol in patients with overt GI bleeding in clinical practice and examine the added value of portal phase and DE images. Materials and Methods Consecutive patients with GI bleeding underwent a two-phase DE GI bleed CT protocol. Two gastroenterologists established the reference standard. Performance was estimated using clinical CT reports. Three GI radiologists rated confidence in GI bleeding in a subset of 62 examinations, evaluating first mixed kV arterial images, then after examining additional portal venous phase images, and finally after additional DE images (virtual non-contrast and virtual monoenergetic 50 keV images). Results 52 of 176 patients (29.5%) had GI bleeding by the reference standard. The overall sensitivity, specificity, and positive and negative predictive values of the CT GI bleed protocol for detecting GI bleeding were 65.4%, 89.5%, 72.3%, and 86.0%, respectively. In patients with GI bleeding, diagnostic confidence of readers increased after adding portal phase images to arterial phase images ( p = 0.002), without additional benefit from dual energy images. In patients without GI bleeding, confidence in luminal extravasation appropriately decreased after adding portal phase, and subsequently DE images ( p = 0.006, p = 0.018). Conclusion A two-phase DE GI bleed CT protocol had high specificity and negative predictive value in clinical practice. Portal venous phase images improved diagnostic confidence in comparison to arterial phase images alone. Dual-energy images further improved radiologist confidence in the absence of bleeding.

Acute-onset abdominal pain in a woman in her 30s

Heart ◽  
2018 ◽  
Vol 105 (4) ◽  
pp. 275-322 ◽  
Author(s):  
Rory O’Donohoe ◽  
Samantha Fitzsimmons ◽  
Timothy J C Bryant
Keyword(s):  
Abdominal Pain ◽  
Hepatocellular Adenoma ◽  
Sudden Onset ◽  
Acute Onset ◽  
Arterial Phase ◽  
List Type ◽  
Portal Venous Phase ◽  
Venous Phase ◽  
Axial Ct ◽  
Multiphase Ct

Clinical introductionA woman in her 30s presented to the emergency department with sudden-onset abdominal pain with hypotension and tachycardia. She gave a history of congenital heart disease for which she had previously undergone multiple operations. On examination she demonstrated right upper quadrant tenderness. She underwent an urgent multiphase CT (figure 1A–C).Figure 1(A) Arterial phase coronal CT. (B) Arterial phase axial CT. (C) Portal venous phase axial CT.QuestionWhat is the underlying liver pathology?Hepatocellular adenomaCholangiocarcinomaHepatocellular carcinomaFocal nodular hyperplasiaHepatoblastoma

Case 5.6

2014 ◽  
pp. 253-253
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Abdominal Pain ◽  
Equilibrium Phase ◽  
Arterial Phase ◽  
Recurrent Pancreatitis ◽  
Portal Venous Phase ◽  
History Of ◽  
Venous Phase ◽  
Delayed Phase

37-year-old woman with a history of recurrent pancreatitis and abdominal pain Arterial phase (Figure 5.6.1A), portal venous phase (Figure 5.6.1B), equilibrium phase (Figure 5.6.1C), and 8-minute delayed phase (Figure 5.6.1D) postgadolinium 3D SPGR images show multiple splenic lesions that are initially hypoenhancing relative to adjacent spleen and become hyperintense on delayed images....

scholarly journals CT differentiation of gastric ectopic pancreas from gastric stromal tumors

2020 ◽  
Author(s):  
Jian Wang ◽  
Chang LIU ◽  
Fang Yang ◽  
Wenming Zhang ◽  
Weiqun Ao ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Ectopic Pancreas ◽  
Arterial Phase ◽  
Portal Venous Phase ◽  
Test Efficiency ◽  
Attenuation Value ◽  
Ct Attenuation ◽  
Venous Phase ◽  
Ct Attenuation Value ◽  
Ct Features

Abstract BackgroundGastric ectopic pancreas (GEPs) is a rare developmental anomaly which is difficult to differentiate it from submucosal tumor such as gastrointestinal stromal tumor (GIST) by imaging methods. So we retrospectively investigated the CT features of them to help us make the correct diagnosis.Materials and MethodsThis study enrolled 17 GEPs and 119 GSTs, which were proven pathologically. We assessed clinical and CT features to identify significant differential features of GEPs from GSTs using univariate and multivariate analyses.ResultsIn univariate analysis, among all clinicoradiologic features, features of age, symptom, tumor marker, location, contour, blurred serosa or fat-line of peritumor, necrosis, calcification, CT attenuation value of unenhancement phase/arterial phase/portal venous phase (CTu/CTa/CTp), the CT attenuation value of arterial phase/portal venous phase minus that of unenhanced phase (DEAP/DEPP), long diameter (LD), short diameter (SD) were considered statistically significant for the differentiation of them. And the multivariate analysis revealed that location, blurred serosa or fat-line of peritumor, necrosis and DEPP were independent factors affecting the identification of them.What's more, ROC analysis showed that the test efficiency of CTp was perfect(AUC= 0.900).ConclusionLocation, blurred serosa or fat-line of peritumor, necrosis and DEPP are useful CT differentiators of GEPs from GSTs. In addition, the test efficiency of CTp in differentiating them was perfect (AUC=0.900).

scholarly journals Advanced Deep Learning Approach to Automatically Segment Malignant Tumors and Ablation Zone in the Liver With Contrast-Enhanced CT

2021 ◽  
Vol 11 ◽  
Author(s):  
Kan He ◽  
Xiaoming Liu ◽  
Rahil Shahzad ◽  
Robert Reimer ◽  
Frank Thiele ◽  
...  
Keyword(s):  
Deep Learning ◽  
Liver Tumors ◽  
Treatment Success ◽  
Detection Sensitivity ◽  
Arterial Phase ◽  
Liver Segmentation ◽  
Portal Venous Phase ◽  
Venous Phase ◽  
Pre Treatment ◽  
Multi Phase

ObjectiveLiver cancer is one of the most commonly diagnosed cancer, and energy-based tumor ablation is a widely accepted treatment. Automatic and robust segmentation of liver tumors and ablation zones would facilitate the evaluation of treatment success. The purpose of this study was to develop and evaluate an automatic deep learning based method for (1) segmentation of liver and liver tumors in both arterial and portal venous phase for pre-treatment CT, and (2) segmentation of liver and ablation zones in both arterial and portal venous phase for after ablation treatment.Materials and Methods252 CT images from 63 patients undergoing liver tumor ablation at a large University Hospital were retrospectively included; each patient had pre-treatment and post-treatment multi-phase CT images. 3D voxel-wise manual segmentation of the liver, tumors and ablation region by the radiologist provided reference standard. Deep learning models for liver and lesion segmentation were initially trained on the public Liver Tumor Segmentation Challenge (LiTS) dataset to obtain base models. Then, transfer learning was applied to adapt the base models on the clinical training-set, to obtain tumor and ablation segmentation models both for arterial and portal venous phase images. For modeling, 2D residual-attention Unet (RA-Unet) was employed for liver segmentation and a multi-scale patch-based 3D RA-Unet for tumor and ablation segmentation.ResultsOn the independent test-set, the proposed method achieved a dice similarity coefficient (DSC) of 0.96 and 0.95 for liver segmentation on arterial and portal venous phase, respectively. For liver tumors, the model on arterial phase achieved detection sensitivity of 71%, DSC of 0.64, and on portal venous phase sensitivity of 82%, DSC of 0.73. For liver tumors >0.5cm3 performance improved to sensitivity 79%, DSC 0.65 on arterial phase and, sensitivity 86%, DSC 0.72 on portal venous phase. For ablation zone, the model on arterial phase achieved detection sensitivity of 90%, DSC of 0.83, and on portal venous phase sensitivity of 90%, DSC of 0.89.ConclusionThe proposed deep learning approach can provide automated segmentation of liver tumors and ablation zones on multi-phase (arterial and portal venous) and multi-time-point (before and after treatment) CT enabling quantitative evaluation of treatment success.

scholarly journals Conspicuity of Malignant Pleural Mesothelioma in Contrast Enhanced MDCT – Arterial Phase or Late Phase?

2021 ◽  
Author(s):  
Lukas Luerken ◽  
Philipp Laurin Thurn ◽  
Florian Zeman ◽  
Christian Stroszczynski ◽  
Okka Wilkea Hamer
Keyword(s):  
Multiple Regression ◽  
Late Phase ◽  
Objective Analysis ◽  
Surrounding Tissue ◽  
Arterial Phase ◽  
Subjective Analysis ◽  
Portal Venous Phase ◽  
Contrast Enhanced ◽  
Venous Phase ◽  
Phase Scan

Abstract Background: To compare two different contrast phases intraindividually regarding conspicuity of MPM in chest MDCT. Methods: 28 patients with MPM were included in this retrospective study. For all patients, chest CT in standard arterial phase and abdominal CT in portal venous phase (scan delay ca. 70 s) was performed. First, subjective analysis of tumor conspicuity was done independently by two radiologists. Second, objective analysis was done by measuring Hounsfield units (HU) in tumor lesions and in the surrounding tissue in identical locations in both phases. Differences of absolute HUs in tumor lesions between phases and differences of contrast (HU in lesion – HU in surrounding tissue) between phases were determined. HU measurements were compared using paired t-test for related samples. Potential confounding effects by different technical and epidemiological parameters between phases were evaluated performing a multiple regression analysis.Results: Subjective analysis: In all 28 patients and for both readers conspicuity of MPM was better on late phase compared to arterial phase. Objective analysis: MPM showed a significantly higher absolute HU in late phase (75.4 vs 56.7 HU, p < 0.001). Contrast to surrounding tissue was also significantly higher in late phase (difference of contrast between phases 18.5 HU, SD 10.6 HU, p < 0.001). Multiple regression analysis revealed contrast phase and tube voltage to be the only significant independent predictors for tumor contrast.Conclusions: In contrast enhanced chest-MDCT for MPM late phase scanning seems to provide better conspicuity and higher contrast to surrounding tissue compared to standard arterial phase scans.

scholarly journals Imaging features of hepatocellular carcinoma with bile duct tumor thrombus：a multicenter study

2020 ◽  
Author(s):  
Li-Ming Huang ◽  
Jun-Yi Wu ◽  
Yan-Nan Bai ◽  
Jia-Yi Wu ◽  
Yong-Gang Wei ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Bile Duct ◽  
Ct Scans ◽  
Arterial Phase ◽  
Imaging Features ◽  
Portal Venous Phase ◽  
Bile Duct Tumor ◽  
Hepatic Arterial Phase ◽  
Mri Scans ◽  
Venous Phase

Abstract Background: There are still difficult and challenging problems in diagnosis of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) before operation. This study aimed to analyze the imaging features of HCC with B1-B3 BDTT. Methods: The clinicopathological data and imaging findings of 30 HCC patients with B1-B3 BDTT from three high-volume institutions were retrospectively reviewed. Eighteen patients underwent computed tomography (CT) scans and twelve patients underwent magnetic resonance imaging (MRI) scans before operation, respectively. The diagnosis of HCC with BDTT was confirmed by postoperative pathologic examination.Results: According to Japanese classification, 5 patients were classified as B1 BDTT, 12 B2, 13 B3, and 82 B4, respectively. The HCC lesions were detected in all patients, and the localized bile duct dilation were detected in 28 (93.3%) patients. The BDTT was observed in all B3 patients and 3 B2 patients, but it was not observed in all B1 patients on CT or MRI. The BDTT showed relatively hypoattenuation on plain CT scans and T1W images, relatively hyperattenuation signals on T2W. The BDTT showed hyperattenuation at hepatic arterial phase with washout at portal venous phase. The localized biliary dilation showed no enhancement at hepatic arterial phase and no progressively delayed enhancement at portal venous phase, but it was more obvious at portal venous phase on CT.Conclusions: The HCC lesions and the localized bile duct dilatation on CT or MRI scans are imaging features of HCC with BDTT, which might facilitate the early diagnosis for B1-B3 BDTT.

Radiomic texture analysis correlates with PDAC patient outcomes on SM-88.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16776-e16776
Author(s):  
Allyson J. Ocean ◽  
Ronald Lee Korn ◽  
Semmie Kim ◽  
Andre Burkett ◽  
Ziad Hindosh ◽  
...  
Keyword(s):  
Region Of Interest ◽  
Tumor Diameter ◽  
Portal Venous Phase ◽  
Prior Therapy ◽  
Coarse Texture ◽  
Size Number ◽  
Phase Images ◽  
Venous Phase ◽  
Textural Changes ◽  
Ecog Ps

e16776 Background: SM-88 (racemetyrosine) is a dysfunctional tyrosine derivative; previous studies demonstrated a well-tolerated profile with encouraging efficacy. Recent advances in image analysis using Quantitative Textural Analysis (QTA) have uncovered non-invasive biomarkers that correlate with molecular drivers of cancer and prognostic signatures of response in PDAC. Earlier radiomic data from subjects treated with SM-88 showed a positive correlation between circulating tumor cells and tumor texture at baseline. This study extends those findings to focus on radiomic changes associated with SM-88 doses in a Phase II dose escalation trial (NCT03512756). Methods: Retrospective evaluation of 18 subjects with >1 prior therapy, ECOG PS <2, with no restriction on size, number, or locations of mets, and had baseline (BL) and follow up (FUP) contrast enhanced CTs. Subjects received > 1 cycle of SM-88 at either 460mg (n = 8) or 920mg (n = 10) QD oral doses. CTs were analyzed by the QTA platform (TexRad, Essex, UK) for tumor texture. The largest met of each subject was selected using portal venous phase images. A region of interest was posited on the axial slice with the longest tumor diameter and features automatically generated using voxel resampling to correct for scanner variability across subjects and time points. Results were displayed as histogram frequency curves (HFCs) of pixel densities (Hounsfield Units). First order HFC analysis (mean, StDev, MPP, skewness, kurtosis) at spatial scale filters (SSF) ranging from no filter, to fine, to coarse texture (SSF:0, SSF:2, SSF:6, respectively) were reported. Results: Subjects whose largest lesions showed greater changes in tumor texture at FUP vs. BL were more likely to develop tumor progression (StDev in PD (n = 10) vs SD (n = 7) (1 N/A): -0.07 vs -0.25, p = 0.05). Greater tumor textural changes were associated with poor survival at 180 days (Skewness: Chi-Sq. = 4.81, p = 0.03; HR = 4.1 for above median □Skewssf3). There was a negative change in FUP kurtosis vs BL in the 6 subjects who developed new lesions vs the 12 who did not (mean □kurtosis = -0.67 vs +2.63, p = 0.05). Greater change in tumor texture on FUP vs BL scans was seen in the 460mg vs 920mg group (MPPLD = -0.29, MPPHD = -0.04; p = 0.05) suggesting more tumor stability (less change in texture and better outcomes) was associated with the 920mg dose. Conclusions: Tumor lesions in subjects on 920mg of SM-88 were less likely to show a change in tumor texture and were associated with better outcomes. Using radiomic QTA, less tumor texture variability from baseline may be associated with better outcomes in PDAC subjects.

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