Can we differentiate histologic subtypes of neuroendocrine tumour liver metastases at a single phase contrast-enhanced CT—correlation with Ga-68 DOTATATE PET/CT findings

Objective: To assess the usefulness of a single-phase contrast-enhanced CT to differentiate subtypes of neuroendocrine tumour (NET) liver metastases and to evaluate the correlation between CT features and Ga-68 DOTATATE positron emission tomography/CT (PET/CT) findings. Methods: Between December 2017 and April 2019 patients with liver metastases of neuroendocrine tumours who underwent CT and Ga-68 DOTATATE PET/CT were enrolled in the study. All patients involved in the study had undergone a standardised single-phase contrast-enhanced CT. Whole body PET/CT images were obtained with a combined PET/CT scanner. All CT images were retrospectively analysed by two radiologists. Enhancement patterns of lesions were assessed. For quantitative examination; CT attenuation values of metastatic lesions, liver parenchyma and aorta were measured using a freehand ROI and tumour-to-liver ratio [T–L = (Tumour–Liver) / Liver] and tumour-to-aorta ratio [T–A = (Tumour–Aorta) / Aorta] were calculated. The lesion with the highest Ga-68 DOTATATE uptake in the liver was used for calculations. The metabolic tumour volume (MTV), maximum standardised uptake value (SUV max) and SUV mean were calculated for the target liver lesion. Results: A total of 137 NET liver metastases divided into in three groups: 49 (35.7%) pancreatic, 60 (44.5%) gastroenteric and 26 (18.9%) lung NET liver metastases were analysed. Gastroenteric NET metastases often showed heterogeneous enhancement which was significantly higher than in the pancreas and lung NET liver metastases (p < 0.001). 96.72% (n = 59) of the gastroenteric NET liver metastases were hypoattenuating whereas the most frequent presentation for the pancreatic group was hyperattenuation (63.26%,n = 31). The difference in enhancement patterns of the liver metastases was statistically significant (p < 0.001) with respect to the location of the primary tumour. For quantitative analysis; tumour CT values were significantly different between the groups (p < 0.001). The T–L ratio was statistically different between gastroenteric and pancreatic NET liver metastases and pancreatic and lung NET groups (p < 0.001). The T–A ratio was significantly higher in the pancreatic NET metastases (p < 0.001). SUVmax, SUVmean and MTV values, however, were not significantly different between the subgroups. There was a weak positive correlation between T–L ratio and SUV meanvalues. Conclusion: We noticed statistically significant differences in both qualitative and quantitative CT features between histologic subgroups of neuroendocrine tumour liver metastases at a single phase contrast-enhanced CT. Advances in knowledge: Our study will be the first in the literature which extensively focus on assessing the CT features of liver metastases of NETs at a single phase CT and Ga-68DOTATATE PET/CT. As the different histological subtypes of NET liver metastases exhibit different clinical outcomes, these features might help to identify the primary tumour to provide optimal treatment.

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Automatic segmentation of the liver from multi- and single-phase contrast-enhanced CT images

Medical Image Analysis ◽

10.1016/j.media.2009.07.009 ◽

2009 ◽

Vol 13 (6) ◽

pp. 871-882 ◽

Cited By ~ 63

Author(s):

László Ruskó ◽

György Bekes ◽

Márta Fidrich

Keyword(s):

Phase Contrast ◽

Single Phase ◽

Automatic Segmentation ◽

Ct Images ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

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Can Adrenal Adenomas Be Differentiated From Adrenal Metastases at Single-Phase Contrast-Enhanced CT?

American Journal of Roentgenology ◽

10.2214/ajr.17.19276 ◽

2018 ◽

Vol 211 (5) ◽

pp. 1044-1050 ◽

Cited By ~ 4

Author(s):

Wendy Tu ◽

Raman Verma ◽

Satheesh Krishna ◽

Matthew D. F. McInnes ◽

Trevor A. Flood ◽

...

Keyword(s):

Phase Contrast ◽

Single Phase ◽

Adrenal Metastases ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

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Can PET–CT with FDG replace contrast enhanced CT for imaging of liver metastases?

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-007-0619-7 ◽

2007 ◽

Vol 34 (12) ◽

pp. 1902-1905 ◽

Cited By ~ 3

Author(s):

Ludwig G. Strauss ◽

Antonia Dimitrakopoulou-Strauss

Keyword(s):

Liver Metastases ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Pet Ct ◽

Enhanced Ct

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Determination of a cutoff attenuation value on single-phase contrast-enhanced CT for characterizing adrenal nodules via chemical shift MRI

Abdominal Radiology ◽

10.1007/s00261-016-0654-6 ◽

2016 ◽

Vol 41 (6) ◽

pp. 1170-1177 ◽

Cited By ~ 2

Author(s):

Yi-Wei Wu ◽

Cher Heng Tan

Keyword(s):

Chemical Shift ◽

Phase Contrast ◽

Single Phase ◽

Attenuation Value ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Chemical Shift Mri

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Faculty Opinions recommendation of Contrast-enhanced CT features of hepatoblastoma: Can we predict histopathology?

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.729943392.793541282 ◽

2018 ◽

Author(s):

Piotr Czauderna

Keyword(s):

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Ct Features

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EXTH-30. EXPANDING THE UTILITY OF PRE-CLINICAL CONTRAST ENHANCED CT (CE-CT) FOR TUMOR DETECTION IN ORTHOTOPIC GBM MODELS USING RADIOMICS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.384 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii93-ii93

Author(s):

Kate Connor ◽

Emer Conroy ◽

Kieron White ◽

Liam Shiels ◽

William Gallagher ◽

...

Keyword(s):

Imaging Modality ◽

Texture Features ◽

Tumor Detection ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Pet Ct ◽

Enhanced Ct ◽

Magnetic Resonance Imaging Mri ◽

Work Supports ◽

Selection Of

Abstract Despite magnetic resonance imaging (MRI) being the gold-standard imaging modality in the glioblastoma (GBM) setting, the availability of rodent MRI scanners is relatively limited. CT is a clinically relevant alternative which is more widely available in the pre-clinic. To study the utility of contrast-enhanced (CE)-CT in GBM xenograft modelling, we optimized CT protocols on two instruments (IVIS-SPECTRUM-CT;TRIUMPH-PET/CT) with/without delivery of contrast. As radiomics analysis may facilitate earlier detection of tumors by CT alone, allowing for deeper analyses of tumor characteristics, we established a radiomic pipeline for extraction and selection of tumor specific CT-derived radiomic features (inc. first order statistics/texture features). U87R-Luc2 GBM cells were implanted orthotopically into NOD/SCID mice (n=25) and tumor growth monitored via weekly BLI. Concurrently mice underwent four rounds of CE-CT (IV iomeprol/iopamidol; 50kV-scan). N=45 CE-CT images were semi-automatically delineated and radiomic features were extracted (Pyradiomics 2.2.0) at each imaging timepoint. Differences between normal and tumor tissue were analyzed using recursive selection. Using either CT instrument/contrast, tumors > 0.4cm3 were not detectable until week-9 post-implantation. Radiomic analysis identified three features (waveletHHH_firstorder_Median, original_glcm_Correlation and waveletLHL_firstorder_Median) at week-3 and -6 which may be early indicators of tumor presence. These features are now being assessed in CE-CT scans collected pre- and post-temozolomide treatment in a syngeneic model of mesenchymal GBM. Nevertheless, BLI is significantly more sensitive than CE-CT (either visually or using radiomic-enhanced CT feature extraction) with luciferase-positive tumors detectable at week-1. In conclusion, U87R-Luc2 tumors > 0.4cm3 are only detectable by Week-8 using CE-CT and either CT instrument studied. Nevertheless, radiomic analysis has defined features which may allow for earlier tumor detection at Week-3, thus expanding the utility of CT in the preclinical setting. Overall, this work supports the discovery of putative prognostic pre-clinical CT-derived radiomic signatures which may ultimately be assessed as early disease markers in patient datasets.

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18F-FDG PET/CT versus Diagnostic Contrast-Enhanced CT for Follow-Up of Stage IV Melanoma Patients Treated by Immune Checkpoint Inhibitors: Frequency and Management of Discordances over a 3-Year Period in a University Hospital

Diagnostics ◽

10.3390/diagnostics11071198 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1198

Author(s):

Jean-Baptiste Le Goubey ◽

Charline Lasnon ◽

Ines Nakouri ◽

Laure Césaire ◽

Michel de Pontville ◽

...

Keyword(s):

Fdg Pet ◽

Stage Iv ◽

Anatomical Site ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Pet Ct ◽

Enhanced Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Induced Changes

Aim: To perform a comprehensive analysis of discordances between contrast-enhanced CT (ceCT) and 18F-FDG PET/CT in the evaluation of the extra-cerebral treatment monitoring in patients with stage IV melanoma. Materials and methods: We conducted a retrospective monocentric observational study over a 3-year period in patients referred for 18F-FDG PET/CT and ceCT in the framework of therapy monitoring of immune checkpoint (ICIs) as of January 2017. Imaging reports were analyzed by two physicians in consensus. The anatomical site responsible for discordances, as well as induced changes in treatment were noted. Results: Eighty patients were included and 195 pairs of scans analyzed. Overall, discordances occurred in 65 cases (33%). Eighty percent of the discordances (52/65) were due to 18F-FDG PET/CT scans upstaging the patient. Amongst these discordances, 17/52 (33%) led to change in patient’s management, the most frequent being radiotherapy of a progressing site. ceCT represented 13/65 (20%) of discordances and induced changes in patients’ management in 2/13 cases (15%). The most frequent anatomical site involved was subcutaneous for 18F-FDG PET/CT findings and lung or liver for ceCT. Conclusions: Treatment monitoring with 18F-FDG PET/CT is more efficient than ceCT and has a greater impact in patient’s management.

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