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Adoption of Splenic Enhancement to Time and Trigger the Late Hepatic Arterial Phase During MDCT of the Liver: Proof of Concept and Clinical Feasibility.

Publication ,  Journal Article
Mileto, A; Husarik, DB; Bellini, D; Marin, D; Reiner, CS; Nelson, RC
Published in: AJR Am J Roentgenol
August 2016

OBJECTIVE: The purpose of this study was to prospectively investigate the clinical feasibility of adopting splenic enhancement for timing and triggering the acquisition of late hepatic arterial phase images during multiphasic liver MDCT for assessment of hypervascular tumors. SUBJECTS AND METHODS: Forty-eight patients (33 men, 15 women; median age, 59 years; chronic liver disease, 23 patients; portal venous hypertension, 17 patients) with a total of 81 hypervascular liver tumors underwent liver MDCT by random assignment to one of two scanning protocols. Scanning delay for the late hepatic arterial phase was determined by assessment of time-to-peak splenic enhancement (splenic-triggering protocol) or aortic enhancement (aortic-triggering protocol). Acquisition timing, vascular attenuation, liver attenuation and homogeneity, signal-to-noise ratio, tumor-to-liver contrast, and tumor-to-liver contrast-to-noise ratio were compared. Two blinded independent observers used Likert scales to score timing adequacy (3-point scale), diagnostic confidence (5-point scale), and per lesion conspicuity (4-point scale) for hypervascular tumor detection. RESULTS: The splenic- and aortic-triggering protocols had significant differences in mean late hepatic arterial phase imaging timing (splenic, 36 ± 6 seconds; aortic, 32 ± 3 seconds; p = 0.010). Images obtained with the splenic-triggering protocol had significantly better observer-based judgment of adequacy (splenic, 2.04; aortic, 1.58; p = 0.002). Mean attenuation and signal-to-noise ratios from liver and portal vein were significantly higher with the splenic- than with the aortic-triggering protocol (p < 0.0001). The splenic-triggering protocol was associated with significant improvement in homogeneity of liver attenuation (p < 0.0001). Although the splenic-triggering protocol was associated with significantly higher lesion conspicuity than was the aortic-triggering protocol (p = 0.022), there was no significant difference in tumor detection rate. CONCLUSION: Our results provide a clinical foundation for and proof of principle that the adoption of splenic enhancement renders an optimal temporal window for late hepatic arterial phase imaging during MDCT of the liver for assessment of hypervascular tumors.

Duke Scholars

Published In

AJR Am J Roentgenol

DOI

EISSN

1546-3141

Publication Date

August 2016

Volume

207

Issue

2

Start / End Page

310 / 320

Location

United States

Related Subject Headings

  • Spleen
  • Signal-To-Noise Ratio
  • Sensitivity and Specificity
  • Prospective Studies
  • Nuclear Medicine & Medical Imaging
  • Multidetector Computed Tomography
  • Middle Aged
  • Male
  • Liver Neoplasms
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Mileto, A., Husarik, D. B., Bellini, D., Marin, D., Reiner, C. S., & Nelson, R. C. (2016). Adoption of Splenic Enhancement to Time and Trigger the Late Hepatic Arterial Phase During MDCT of the Liver: Proof of Concept and Clinical Feasibility. AJR Am J Roentgenol, 207(2), 310–320. https://doi.org/10.2214/AJR.15.15808
Mileto, Achille, Daniela B. Husarik, Davide Bellini, Daniele Marin, Caecilia S. Reiner, and Rendon C. Nelson. “Adoption of Splenic Enhancement to Time and Trigger the Late Hepatic Arterial Phase During MDCT of the Liver: Proof of Concept and Clinical Feasibility.AJR Am J Roentgenol 207, no. 2 (August 2016): 310–20. https://doi.org/10.2214/AJR.15.15808.
Mileto A, Husarik DB, Bellini D, Marin D, Reiner CS, Nelson RC. Adoption of Splenic Enhancement to Time and Trigger the Late Hepatic Arterial Phase During MDCT of the Liver: Proof of Concept and Clinical Feasibility. AJR Am J Roentgenol. 2016 Aug;207(2):310–20.
Mileto, Achille, et al. “Adoption of Splenic Enhancement to Time and Trigger the Late Hepatic Arterial Phase During MDCT of the Liver: Proof of Concept and Clinical Feasibility.AJR Am J Roentgenol, vol. 207, no. 2, Aug. 2016, pp. 310–20. Pubmed, doi:10.2214/AJR.15.15808.
Mileto A, Husarik DB, Bellini D, Marin D, Reiner CS, Nelson RC. Adoption of Splenic Enhancement to Time and Trigger the Late Hepatic Arterial Phase During MDCT of the Liver: Proof of Concept and Clinical Feasibility. AJR Am J Roentgenol. 2016 Aug;207(2):310–320.

Published In

AJR Am J Roentgenol

DOI

EISSN

1546-3141

Publication Date

August 2016

Volume

207

Issue

2

Start / End Page

310 / 320

Location

United States

Related Subject Headings

  • Spleen
  • Signal-To-Noise Ratio
  • Sensitivity and Specificity
  • Prospective Studies
  • Nuclear Medicine & Medical Imaging
  • Multidetector Computed Tomography
  • Middle Aged
  • Male
  • Liver Neoplasms
  • Humans