Hepatic arterial phase and portal venous phase computed tomography for dose calculation of stereotactic body radiation therapy plans in liver cancer: a dosimetric comparison study

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.

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ROLE OF MULTIPHASE STUDY OF LIVER LESIONS ON 128 SLICE DUAL SOURCE COMPUTED TOMOGRAPHY (CT) WITH CYTOLOGY OR HISTOPATHOLOGICAL CORRELATION

SRMS Journal of Medical Science ◽

10.21761/jms.v1i2.7451 ◽

2016 ◽

Vol 1 (2) ◽

Author(s):

Nisma Waheed ◽

Rajneesh Madhok ◽

Ashish Kumar Gupta ◽

Tanu Agarwal

Keyword(s):

Computed Tomography ◽

Radiology Department ◽

Arterial Phase ◽

Liver Lesions ◽

Common Pattern ◽

Portal Venous Phase ◽

Histopathological Correlation ◽

Dual Source ◽

Venous Phase ◽

Delayed Scan

Introduction: Dual source Multidetector Computed Tomography (MDCT) provides multiphase study of various liver lesions for better detection and characterization. This study aims to detect and characterize the liver lesions in multiphase Computed Tomography (CT) with cytological and histopathological correlation to confirm the diagnosis. Material and Methods: This cross-sectional study included 65 patients who were referred to the Radiology Department of Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India with clinical features jaundice, pain in abdomen, nausea and vomiting. All patients were evaluated by five phase CT (unenhanced, early and late arterial, portal venous and delayed scan) of liver with Siemens128 slice dual source spiral CT. Protocols with a scan delay of 06 seconds, 09 seconds, 45 seconds and 180-300 seconds from contrast bolus was preselected for early and late arterial, portovenous and delayed scans. Results: Sixty five (age 10yrs- 90yrs) patients were included in the study. Most common neoplasm was metastases 33(51%). Hepatocellular carcinoma (HCC) were 18(28%), hemangioma 10(15%), peripheral intrahepatic cholangiocarcinoma 1 and 3 were non-neoplastic which included hepatic abscesses and hydatid cyst. Most common pattern of enhancement of metastasis in arterial phase was hypodense with peripheral enhancement and most were hypodense in portal venous phase. Portal venous phase had highest grade for hypovascular metastases and arterial phase had high grade to detect hypervascular metastasis. Delayed scan was better for smaller lesions less than 1cm. The sensitivity to detect metastases was 94%. Most common pattern of enhancement in HCC (variegated or heterogeneous enhancement in arterial phase with rapid washout in the portal venous phase. Total sensitivity to detect HCC was 83.3%. Hemangioma showed peripheral globular enhancement in arterial phase. In portal venous and delayed phase showed progressive enhancement with more centripetal filling. Sensitivity was 90% in case of hemangiomas. Conclusion: Multiphasic CT scan is a good non-invasive tool and can be used as first line imaging modality for differentiating benign and malignant liver lesions.

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Evaluation of kV Cone Beam Computed Tomography–Based Setup Errors in Stereotactic Body Radiation Therapy for Liver Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2016.06.2286 ◽

2016 ◽

Vol 96 (2) ◽

pp. E662

Author(s):

T. Li ◽

F. Li ◽

D.A. Clump ◽

D.E. Heron ◽

M.S. Huq

Keyword(s):

Computed Tomography ◽

Radiation Therapy ◽

Liver Cancer ◽

Cone Beam Computed Tomography ◽

Stereotactic Body Radiation Therapy ◽

Cone Beam ◽

Setup Errors ◽

Stereotactic Body Radiation

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Imaging Features of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Multicenter Study

10.21203/rs.3.rs-40799/v1 ◽

2020 ◽

Author(s):

Li-Ming Huang ◽

Jun-Yi Wu ◽

Yan-Nan Bai ◽

Jia-Yi Wu ◽

Yong-Gang Wei ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Bile Duct ◽

Tumor Thrombus ◽

Ct Scans ◽

Arterial Phase ◽

Imaging Features ◽

Portal Venous Phase ◽

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.

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Assessment of Cirrhotic Liver Enhancement with Multiphasic Computed Tomography Using a Faster Injection Rate, Late Arterial Phase, and Weight-Based Contrast Dosing

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2017.01.001 ◽

2017 ◽

Vol 68 (4) ◽

pp. 371-378 ◽

Cited By ~ 5

Author(s):

Kathleen Eddy ◽

Andreu F. Costa

Keyword(s):

Computed Tomography ◽

Injection Rate ◽

Fixed Dose ◽

Arterial Phase ◽

Intravenous Contrast ◽

Portal Venous Phase ◽

Liver Ct ◽

Iodinated Contrast ◽

Ct Protocol ◽

Venous Phase

Purpose This study aimed to update our liver computed tomography (CT) protocol according to published guidelines, and to quantitatively evaluate the effect of these modifications. Methods The modified liver CT protocol employed a faster injection rate (5 vs 3 mL/s), later arterial phase (20-second vs 10-second postbolus trigger), and weight-based dosing of iodinated contrast (1.7 mL/kg vs 100 mL fixed dose). Liver and vascular attenuation values were measured on CTs of patients with cirrhosis from January to September 2015 (old protocol, n = 49) and from October to December 2015 (modified protocol, n = 31). CTs were considered adequate if liver enhancement exceeded 50 Hounsfield units (HU) in portal venous phase, or when the unenhanced phase was unavailable, if a minimum iodine concentration of 500 mg I/kg was achieved. Attenuations and iodine concentrations were compared using the t test and the number of suboptimal studies was compared with Fisher's exact test. Results CTs acquired with the modified protocol demonstrated higher aortic ( P = .001) and portal vein ( P < .0001) attenuations in the arterial phase as well as greater hepatic attenuation on all postcontrast phases ( P = .0006, .002, and .003 for arterial, venous, and equilibrium phases, respectively). Hepatic enhancement in the portal venous phase (61 ± 15 HU vs 51 ± 16 HU; P = .0282) and iodine concentrations (595 ± 88 mg I/kg vs 456 ± 112 mg I/kg; P < .0001) were improved, and the number of suboptimal studies was reduced from 57% to 23% ( P = .01). Conclusions A liver CT protocol with later arterial phase, faster injection rate, and weight-based dosing of intravenous contrast significantly improves liver enhancement and iodine concentrations in patients with cirrhosis, resulting in significantly fewer suboptimal studies.

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Hepatocellular carcinoma in a case of hepatitis C

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173600 ◽

2017 ◽

Vol 5 (8) ◽

pp. 3748

Author(s):

Pokhraj P. Suthar ◽

Gaurav R. Parmar ◽

Chinmay Trivedi ◽

Hemen I. Vithlani

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatitis C ◽

Arterial Phase ◽

Oesophageal Varices ◽

Abnormal Liver Function Test ◽

Hcv Rna ◽

Portal Venous Phase ◽

Hepatic Arterial Phase ◽

Liver Cancers ◽

Venous Phase

Hepatocellular carcinoma has incidence of 90% of all liver cancers. HCC is the second most common hepatic malignancy in children after the hepatoblastomas. Patients with hepatocellular carcinoma presents with symptoms like pruritus, splenomegaly, bleeding oesophageal varices etc. Computed Tomography of the liver can look for local spread and thorax can look for metastases. Our case was a 49-year- old hepatitis C positive female came with vague right upper quadrant abdominal discomfort with weight loss of 7 lbs in last 2 months. Mild icterus was present on examination. CT scan revealed a well-defined iso-dense lesion in the segment V of right lobe of the liver, which shows enhancement in the hepatic arterial phase and rapid washout in the portal venous phase. Laboratory investigations showed abnormal liver function test. The HCV RNA levels were 1.45×105 IU/ml by real time PCR. Histopathology examination of biopsy specimen shows characteristic morphological features of steatohepatitic variant of hepatocellular carcinoma. Then the patient was referred to the higher center for the further management.

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