Single-energy non-contrast hepatic steatosis criteria applied to virtual non-contrast images: is it still highly specific and positively predictive?

Haji-Momenian, Shawn; Parkinson, William; Khati, Nadia J.; Brindle, Kathleen A.; Earls, James P.; Zeman, Robert K.

doi:10.1016/j.crad.2018.01.018

Cited by 18 publications

(33 citation statements)

References 45 publications

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“…For example, Durieux et al 2018 evaluated VNC images for abdominal depiction from a third generation dual-source dual-energy CT and pointed out that despite high accuracies of attenuation values for the liver and spleen with mean attenuation differences between 0-2 HU, there have been substantial differences in fluid, fat and renal tissue with mean differences as high as 32 HU. Other recent dual-energy studies also showed accurate iodine subtraction by VNC for depiction of the liver 23,24,35,36 . Further, overestimation of fat by VNC has also been reported for spectral-detector CT by Ananthakrishnan Our study showed differences between TNC and VNC of 1.8 ± 4.6 HU for CTA-Chest and −1.1 ± 5.9 HU in CTA-Abdomen in liver.…”

Section: Resultsmentioning

confidence: 83%

“…Due to its toxicity amiodarone is also known to independently induce steatohepatitis 30 which can then result in liver cirrhosis, drastically increasing risk of mortality 1,7,8 . Further, liver steatosis, that is caused for other reasons than amiodarone, is common in a general population with non-alcoholic liver steatosis as its most common subtype and an incidence of 15% in general population 24,42 . A severe liver fat fraction of ≥30% is considered to have relevant clinical implications 43,44 but could be obscured in amiodarone patients due to amiodarone accumulation in liver 24,45,46 .…”

Section: Resultsmentioning

confidence: 99%

“…A severe liver fat fraction of ≥30% is considered to have relevant clinical implications 43,44 but could be obscured in amiodarone patients due to amiodarone accumulation in liver 24,45,46 . As described above, VNC can also overestimate attenuation of fat; therefore, it needs to be considered that VNC can negatively affect CT attenuation-based diagnosis of liver steatosis in CT imaging 24 .…”

Section: Resultsmentioning

confidence: 99%

“…In this cohort we were able to show that VNC of TNC can reliably reduce increased liver density due to amiodarone deposition. As frequently applied in comparable studies, we used ROI-based measurements of mean attenuation [22][23][24][25]35 . Still, a volumetric assessment of attenuation covering an entire organ might be less susceptible for any measuring bias.…”

Section: Resultsmentioning

confidence: 99%

“…Material decomposition can be used for the identification of iodine and thereby the creation of virtual non-contrast images (VNC) that offer a way to eliminate the iodine-associated attenuation from images. Usually this technique is used to remove iodine resulting from contrast media administration but it should also be able to remove iodine bound to amiodarone 21,[23][24][25] . Although recently suggested 13 , no study investigated the application of dual-energy CT for subtraction of the iodine in amiodarone patients.In our institution a cohort of patients received a dedicated CT-protocol for transcatheter-aortic-valve-replacement (TAVR) planning 26,27 , that included an unenhanced examination of the chest and CT angiographies (CTA) of the chest as well as the abdomen.…”

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confidence: 99%

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Iodine accumulation of the liver in patients treated with amiodarone can be unmasked using material decomposition from multiphase spectral-detector CT

Laukamp

Lennartz

Hashmi

et al. 2020

Sci Rep

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Amiodarone accumulates in the liver, where it increases x-ray attenuation due to its iodine content. We evaluated liver attenuation in patients treated and not treated with amiodarone using true-noncontrast (TNC) and virtual-non-contrast (VNC) images acquired with spectral-detector-CT (SDCT). 142 patients, of which 21 have been treated with amiodarone, receiving SDCT-examinations (unenhancedchest CT [TNC], CT-angiography of chest and abdomen [CTA-Chest, CTA-Abdomen]) were included. TNC, CTA-Chest, CTA-Abdomen, and corresponding VNC-images (VNC-Chest, VNC-Abdomen) were reconstructed. Liver-attenuation-index (LAI) was calculated as difference between liver-and spleenattenuation. Liver-attenuation and LAI derived from TNC-images of patients receiving amiodarone were higher. Contrary to TNC, liver-attenuation and LAI were not higher in amiodarone patients in VNC-Chest and in VNC-Abdomen. To verify these initial results, a phantom scan was performed and an additional patient cohort included, both confirming that VNC is viable of accurately subtracting iodine of hepatic amiodarone-deposits. This might help to monitor liver-attenuation more accurately and thereby detect liver steatosis as a sign of liver damage earlier as well as to verify amiodarone accumulation in the liver.Amiodarone is an antiarrhythmic drug that has shown its effectiveness for several decades to treat various forms of tachyarrhythmia 1,2 . However, oral absorption and bioavailability are poor and greatly variable. Onset of therapeutic effects using oral application range between 2-21 days and after long-term treatment plasma half-life is around 100 days. Because of its lipophilic properties, iodine-containing amiodarone accumulates, among others, in hepatocytes. Here, it inhibits the enzyme phospholipase which subsequentially stops the removal of lysosomal phospholipids. Consequently, amiodarone forms a nondigestible complex with the phospholipids, resulting in phospholipidosis and extended amiodarone accumulation. Amiodarone concentrations in the liver can be up to 500-times higher than in the blood serum and release from hepatocytes is slow after treatment discontinuation 1-6 . Earlier studies found that this condition can lead to steatohepatitis and liver cirrhosis 1,7,8 .Iodinated contrast media is broadly applied in CT imaging. Due to its high physical density and k-edge effects of iodine, it increases attenuation and image contrast that improves depiction of anatomical structures (e.g. organ parenchyma and vessels) 9,10 . For intravascular injections in CT imaging almost exclusively non-ionic low-or iso-osmotic iodinated contrast media is applied. Molecular structures between agents are similar, a commonly applied agent is for example Ioversol (C 18 H 24 I 3 N 3 O 9 , molecular mass of 807.1 g/mol). It contains three iodine atoms that constitute almost 50% of its molecular mass 9-12 . Amiodarone shows several similarities to iodinated contrast media regarding the molecular structure. It is a di-iodinated benzofuran derivate, as a drug it is u...

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Section: Resultsmentioning

confidence: 83%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Iodine accumulation of the liver in patients treated with amiodarone can be unmasked using material decomposition from multiphase spectral-detector CT

Laukamp

Lennartz

Hashmi

et al. 2020

Sci Rep

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Detection of fatty liver using virtual non-contrast dual-energy CT

2022

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Purpose Determine whether liver attenuation measured on dual-energy CT (DECT) virtual non-contrast examinations predicts the presence of fatty liver. Methods Single-institution retrospective review from 2016 to 2020 found patients with DECT and proton density fat fraction MRI (MRI PDFF) within 30 days. MRI PDFF was the reference standard for determining hepatic steatosis. Attenuation measurements from VNC and mixed 120 kVp-like images were compared to MRI PDFF in the right and left lobes. Performance of VNC was compared to measurement of the liver-spleen attenuation difference (LSAD). Results 128 patients were included (69 men, 59 women) with mean age 51.6 years (range 14–98 years). > 90% of patients received CT and MRI in the emergency department or as inpatients. Median interval between DECT and MRI PDFF was 2 days (range 0–28 days). Prevalence of fatty liver using the reference standard (MRI PDFF > 6%) was 24%. Pearson correlation coefficient between VNC and MRI- DFF was -0.64 (right) and -0.68 (left, both p < 0.0001). For LSAD, correlation was − 0.43 in both lobes (p < 0.0001). Considering MRI PDFF > 6% as diagnostic of steatosis, area under the receiver operator characteristic curve (AUC) was 0.834 and 0.872 in the right and left hepatic lobes, with an optimal threshold of 54.8 HU (right) and 52.5 HU (left), yielding sensitivity/specificity of 57%/93.9% (right) and 67.9%/90% (left). For LSAD, AUC was 0.808 (right) and 0.767 (left) with optimal sensitivity/specificity of 93.3%/57.1% (right) and 78.6%/68% (left). Conclusion Attenuation measured at VNC CT was moderately correlated with liver fat content and had > 90% specificity for diagnosis of fatty liver. Graphical abstract

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Dual-energy CT applications on liver imaging: what radiologists and radiographers should know? A systematic review

Asmundo,

Rizzetto,

Srinivas Rao

et al. 2024

Abdom Radiol

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Single-energy non-contrast hepatic steatosis criteria applied to virtual non-contrast images: is it still highly specific and positively predictive?

Cited by 18 publications

References 45 publications

Iodine accumulation of the liver in patients treated with amiodarone can be unmasked using material decomposition from multiphase spectral-detector CT

Iodine accumulation of the liver in patients treated with amiodarone can be unmasked using material decomposition from multiphase spectral-detector CT

Detection of fatty liver using virtual non-contrast dual-energy CT

Dual-energy CT applications on liver imaging: what radiologists and radiographers should know? A systematic review

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