Publikation

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

Wissenschaftlicher Artikel/Review - 02.06.2016

Bereiche
PubMed
DOI

Zitation
Mileto A, Husarik D, Bellini D, Marin D, Reiner C, Nelson R. 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; 207:310-20.
Art
Wissenschaftlicher Artikel/Review (Englisch)
Zeitschrift
AJR Am J Roentgenol 2016; 207
Veröffentlichungsdatum
02.06.2016
eISSN (Online)
1546-3141
Seiten
310-20
Kurzbeschreibung/Zielsetzung

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.