Hypervascular liver metastases: do unenhanced and hepatic arterial phase CT images affect tumor detection?

Oliver, James H.; Baron, Richard L.; Federle, Michael P.; Jones, Blake C.; Sheng, Ruofan

doi:10.1148/radiology.205.3.9393525

Cited by 130 publications

(76 citation statements)

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“…[30][31][32][33] However, arterioportal shunts have been observed in hepatic hemangiomas not only through use of CEUS 25 but also through use of multiphase helical CT and MRI in a significant percentage of hemangiomas (19%-26%), [34][35][36][37][38][39] which is in the range reported in our study. One possible explanation for rapidly enhancing small hemangiomas is a hyperdynamic status with large arterial inflow, rapid tumoral enhancement, and consequently, large and rapid outflow, which seems to result in early opacification of the draining portal vein via shunts 39 (Fig.…”

Section: Discussionsupporting

confidence: 59%

Contrast‐enhanced ultrasound of histologically proven liver hemangiomas†

et al. 2007

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Differentiation of small and atypical hemangiomas from other hepatic masses using imaging methods can be difficult, especially in patients with underlying malignant disease. Therefore, contrast-enhanced ultrasound was assessed in patients with histologically confirmed hemangiomas with respect to contrast-enhancing kinetics and tumor characteristics. In 58 patients with indeterminate hepatic lesions demonstrated with at least 2 imaging methods (ultrasound/computed tomography/magnetic resonance imaging), ultrasound-guided liver biopsy revealed hemangioma. In all patients a hepatic neoplasm had been suspected because of underlying malignant disease (n ‫؍‬ 41), liver cirrhosis (n ‫؍‬ 15), or growth of the lesion (n ‫؍‬ 2). All patients underwent nonlinear, low mechanical index real-time contrast-enhanced ultrasound scanning with bolus injections of SonoVue. Peripheral nodular arterial enhancement was detected in 43 patients (74%), whereas the typical metastatic peripheral rim-like enhancement was not observed at all. Strong homogenous arterial enhancement was found in 9 of 58 (16%) patients. In 6 patients (10%), the arterial contrast enhancement pattern could not be determined because of the very small size of the lesions or fibrotic nodules. Forty-five (78%) of the hemangiomas showed homogenous centripetal filling within 180 seconds. Conclusion: Contrast-enhanced ultrasound demonstrates typical hemangioma imaging characteristics, that is, peripheral nodular contrast enhancement and iris-diaphragm sign in a high percentage of patients with undetermined lesions. This technique may therefore improve noninvasive functional characterization and differentiation of hemangiomas. (HEPATOLOGY 2007;45:1139-1145

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Section: Discussionsupporting

confidence: 59%

Contrast‐enhanced ultrasound of histologically proven liver hemangiomas†

et al. 2007

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“…Not all NET sufficiently express the SSTR-2 necessary for radiopeptide-PET imaging [2,5] nor do they always appear hypervascularised in CT [32]. Furthermore, therapy-associated clonal selections or changes in receptor status [33] as well as changes in vascularity [34] may further influence tumor visualization by PET and CT, respectively.…”

Section: Discussionmentioning

confidence: 99%

Impact of Multiphase <sup>68</sup>Ga-DOTATOC-PET/CT on Therapy Management in Patients with Neuroendocrine Tumors

Ruf

Heuck²,

Schiefer³

et al. 2009

Neuroendocrinology

121

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Aim: Retrospective evaluation of the impact of integrated positron emission tomography/computed tomography (PET/CT) using ⁶⁸Ga-DOTA(0)-Phe(1)-Tyr(3)-octreotide (⁶⁸Ga-DOTATOC) on the therapeutic management of patients with neuroendocrine tumors (NET). Methods: The ⁶⁸Ga-DOTATOC-PET/CT data of 66 patients (31 male, 35 female; age: 29–79, mean age: 56 years) with known or suspected NET were included. Imaging data (PET and triple-phase contrast-enhanced CT) were evaluated in consensus by two readers for the visualization of NET manifestations. Combined PET/CT, clinical and imaging follow-up as well as histopathology (if available) served as the reference standard. In order to assess the impact of the respective submodalities on the therapeutic strategy chosen, the results were compared to the treatment decision made by the interdisciplinary NET tumor board of our institution. Results: Two of the initial 66 patients included did not suffer from NET according to further immunohistopathological examination. In 50 of the remaining 64 (78%) NET patients, a total of 181 NET manifestations were detected by PET/CT. 59/181 (32.6%) were detected by one submodality only (CT 17.1%, PET 15.5%, p for comparison of both = 0.459). Combined PET/CT reading had an impact on the therapeutic management in 24 of 64 (38%) NET patients: primary resection (n = 5), curative lymph node resection (n = 1), initiation/switch of chemotherapy (CTx) due to progressive disease (n = 10), no surgery due to systemic disease (n = 2), radiopeptide receptor therapy instead of CTx (n = 1), additional bisphosphonate therapy (n = 4), and hepatic brachytherapy (n = 1). In 12 of 24 (50%) of these patients, relevant findings were detected by a single submodality only: CT (n = 5), PET (n = 7); p for comparison = 0.774). Conclusion:⁶⁸Ga-DOTATOC-PET/CT influences therapeutic management in about one third of patients examined. CT and PET are comparably sensitive, deliver complementary information and equally contribute to therapeutic decision-making. Thus, despite the merits of the PET modality, the CT component must not be neglected and an optimized multiphase CT protocol is recommended.

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“…Die biphasische Spiral-CT-Untersuchung kann derzeit als Methode der Wahl zum Nachweis und zur Differenzierung bekannter ober vermuteter La È sionen gelten [2]. Bei der Frage nach Lebermetastasen ist im Regelfall eine monophasische Untersuchung in der portalveno È sen Phase ausreichend [3,4]. Lediglich bei Verdacht auf gefa Èûreiche Metastasen (neuroendokrine Tumoren, Nierenzell-, Schilddru È senkarzinom, Sarkome; 5% aller Metastasen) sollte die Untersuchung biphasisch durchgefu È hrt werden, da diese Metastasen unter Umsta Ènden nur in der arteriellen Phase zur Darstellung kommen und in der portalveno È sen Phase bereits maskiert sind.…”

Section: Untersuchungsmodalita è Tenunclassified