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Stehlík, Ladislav, Morena Di Tommaso, Francesca Del Signore, et al. "Triple-Phase Multidetector Computed Tomography in Distinguishing Canine Hepatic Lesions." Animals 11, no. 1 (2020): 11. http://dx.doi.org/10.3390/ani11010011.
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The liver has a unique vascular supply, and triple-phase contrast-enhanced computed tomography examinations are being performed in order to characterize liver lesions. This study aimed to look for any associations between the attenuation values of liver lesions and their histological classification. The inclusion criteria for this retrospective study were focal or multifocal liver lesions and histological diagnosis. All of the dogs underwent pre-contrast and triple-phase postcontrast computed tomography (CT) examinations with identical timings of the postcontrast series. Thirty-one dogs were included in the study, and various benign and malignant pathologies were identified. The results did not identify any significant differences between the benign and malignant liver lesions, nor between the individual histological diagnoses. Inflammatory lesions were significantly different compared to the normal liver parenchyma, and significant hypoattenuation was found in the portal and delayed venous phases. Hemangiosarcomas were significantly hypoattenuating to the normal liver parenchyma in the pre-contrast and arterial phases, and also to all of the benign lesions in the arterial phase. The other pathologies showed variable attenuation patterns in the different postcontrast phases, and differentiation was not possible. On the basis of this study, triple-phase contrast-enhanced computed tomography cannot differentiate between benign and malignant liver lesions, and biopsy and further histological analysis are necessary.
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Takaji, Ryo, Yasunari Yamada, Shunro Matsumoto, et al. "Small pancreatic ductal carcinomas on triple-phase contrast-enhanced computed tomography: enhanced rims and the pathologic correlation." Abdominal Radiology 43, no. 12 (2018): 3374–80. http://dx.doi.org/10.1007/s00261-018-1645-6.
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Yu, Mei, Qianjin Feng, Wei Yang, Yang Gao, and Wufan Chen. "Extraction of Lesion-Partitioned Features and Retrieval of Contrast-Enhanced Liver Images." Computational and Mathematical Methods in Medicine 2012 (2012): 1–12. http://dx.doi.org/10.1155/2012/972037.
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The most critical step in grayscale medical image retrieval systems is feature extraction. Understanding the interrelatedness between the characteristics of lesion images and corresponding imaging features is crucial for image training, as well as for features extraction. A feature-extraction algorithm is developed based on different imaging properties of lesions and on the discrepancy in density between the lesions and their surrounding normal liver tissues in triple-phase contrast-enhanced computed tomographic (CT) scans. The algorithm includes mainly two processes: (1) distance transformation, which is used to divide the lesion into distinct regions and represents the spatial structure distribution and (2) representation using bag of visual words (BoW) based on regions. The evaluation of this system based on the proposed feature extraction algorithm shows excellent retrieval results for three types of liver lesions visible on triple-phase scans CT images. The results of the proposed feature extraction algorithm show that although single-phase scans achieve the average precision of 81.9%, 80.8%, and 70.2%, dual- and triple-phase scans achieve 86.3% and 88.0%.
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Akshaya, R., Satapathy Gitanjali, Sekhar Mohanty Sudhansu, et al. "Role of Ultrasonography Parameters to Characterise Benign vS Malignant Focal Hepatic Lesions in Correlation with Triple Phase Contrast Enhanced Computed Tomography and / or Histopathological Findings." International Journal of Pharmaceutical and Clinical Research 16, no. 10 (2024): 1301–9. https://doi.org/10.5281/zenodo.14194289.
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<strong>Objectives: </strong>The present study was to evaluate the role of ultrasonography parameters to characterise focal liver lesions. And to assessed the sensitivity and specificity of ultrasonography in the evaluation of focal liver lesions in correlation with Triple phase CECT and/or histopathological examination. <strong>Methods: </strong>Patients meeting the specified criteria underwent a thorough ultrasound examination of liver that was carried out with GE Voluson S10, GE Voluson S6 , using 1-5 MHz curvilinear probe and 12 MHz linear probe. The patients were followed up with Triple phase CECT abdomen and/or histopathological examination. <strong>Results: </strong>The mean age of study participants was 51.8 <u>+</u> 15.6 years. Majority of patients belonged to 41-50 and 51-60 years of age group. There was a higher prevalence of focal liver lesions in males (70%) compared to females (30%). In USG examination, normal size of liver was seen in 48% of patients while hepatomegaly was seen in 47% of patients. Multifocal lesions (54%) were more commonly observed than single lesion (46%). Hypoechoic pattern of echogenicity was the predominant finding on ultrasound, noted in 54.6% of cases. Of all the focal liver lesions, benign lesions were most commonly observed (52%) than malignant lesions (48%). <strong>Conclusions: </strong>USG with colour Doppler should be used as a first line screening modality due to its high diagnostic accuracy in the evaluation of focal liver lesions along with additional advantages like its non-invasiveness, widespread availability, cost effectiveness and lack of radiation exposure.
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Jain, Anshul, Jyoti Ranjan Swain, Lalchhandami Colney, Dilip Kumar Muduly, Mahesh Sultania, and Madhabananda Kar. "Incidental gallbladder cancer and its contemporary management: From evaluation to targeted therapy." Asian Journal of Oncology 10 (February 13, 2023): 1. http://dx.doi.org/10.25259/asjo-2022-64-(426).
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Gall bladder cancer (GBC) is the commonest malignancy of biliary tract. It is locally aggressive and potentially fatal in most of the patients. With the rise in the number of laparoscopic cholecystectomies being performed worldwide, incidental presentation of GBC is becoming common. The revelation of cancer for benign cholecystectomy presents a challenge. Incidental GBC needs detailed evaluation that includes review of preoperative imaging, histopathology report of cholecystectomy and high quality imaging to look for residual or metastatic disease. It is imperative to correctly stage the disease to formulate the best treatment strategy. For assessment of disease, triple-phase Contrast Enhanced Computed Tomography (CECT) scan and staging laparoscopy have definite roles; with Positron Emission Tomography and Computed Tomography (PET/CT) useful in confirming suspicious lesions. The factors associated with poor prognosis is presence of residual disease, lymphovascular invasion, grade of tumor and presence of metastatic lymph nodes. Neoadjuvant chemotherapy can be employed for the patients who are not candidate for upfront re-resection. Surgery includes liver excision and lymphadenectomy. Adjuvant therapy is indicated for higher stage tumor for improving survival, but response rate is low. Evaluation of biomarkers can provide a target for novel therapy.
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Godt, Johannes Clemens, Torsten Eken, Anselm Schulz, Cathrine K. Johansen, Anette Aarsnes, and Johann Baptist Dormagen. "Triple-split-bolus versus single-bolus CT in abdominal trauma patients: a comparative study." Acta Radiologica 59, no. 9 (2018): 1038–44. http://dx.doi.org/10.1177/0284185117752522.
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Background Split-bolus computed tomography (CT) is a recent development in trauma imaging. Instead of multiple scans in different contrast phases after a single contrast bolus, split-bolus protocols consist of one single scan of the thorax and abdomen after two or three contrast injections at different points of time. Purpose To evaluate and compare image quality and injury findings of a new triple-split-bolus CT (TS-CT) protocol of thorax and abdomen with those of a portal venous phase CT (PV-CT) in the same patient group. Material and Methods Trauma patients in 2009–2012 who underwent both the TS-CT initially and a PV-CT during the next six weeks were included. The TS-CT examination was performed as one CT run after application of three contrast boluses (total 175 mL) to enhance renal pelvis and urinary tract, the abdominal organs, and the large arterial vessels. The PV-CT had a fixed delay of 85 s. We measured attenuation in Hounsfield units (HU), evaluated possible organ injury and assessed image quality on a 5-point scale. Results Thirty-five patients were included. Attenuation measurements of major abdominal vessels, organs, and renal pelvis were significantly higher with the TS-CT protocol. Performance in organ injury diagnosis and image quality was equal in both protocols. Conclusion The overall performance of the TS-CT protocol is similar to the standard PV-CT. Excellent visualization of the arterial tree and the collecting system may eliminate the need for separate scans.
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TIBERMACINE, Walid, Mohamed Redha SAKER, Raouf MENOURA, et al. "Detection of liver metastases in patients with pancreatic adenocarcinoma: MRI versus CT." Batna Journal of Medical Sciences (BJMS) 11, no. 3 (2024): 361–65. http://dx.doi.org/10.48087/bjmsoa.2023.11312.
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Introduction. Detection of liver metastases is important to guide therapeutic management of pancreatic cancer. Data suggest that magnetic resonance imaging (MRI) is more sensitive than computed tomography (CT) for the diagnosis of liver metastases from pancreatic cancer. However, MRI is currently not recommended in several guidelines. Purpose. To compare the performance of CT vs MRI in detection of liver metastases in patients with pancreatic adenocarcinoma. Methods. This was a retrospective single-center study over 24 months from January 2020 to December 2021 of patients suspected of having PDAC. All patients underwent contrast-enhanced triple phase CT and contrast-enhanced MRI/MRCP. The CT and MRI assessment of resectability and detection of metastases were performed according to NCCN version 1.2024 criteria by one observer based on clinical report. Composite reference standard based on decision of operability (based on multidisciplinary tumor board decision), surgical findings (delay of 2 to 3 weeks after imaging) and histopathologic findings. Results. 117 patients (M/F 52/65, mean age 62±11y) were included. The mean tumor size was 43.6±15.2mm (add range). 42/46 patients (34.2%/39.3%) were diagnosed with metastatic disease on CT/MRI, 40/36 patients (34.2%/30.8%) were resectable, 20/16 patients (17.1%/13.7%) were borderline resectable and 15/19 patients (12.8%/16.2%) were locally advanced. The detection of liver metastases on CT and MRI was compared with surgical findings in 45 patients (38.5%). The analysis showed that MRI had superior performance to CT, with sensitivity at 100% vs 60% and specificity at 97.1% vs 97.1%, PPV at 90.9% vs 85.7% and NPV 100% vs 89.5% (MRI/CT). Conclusion. MRI is more sensitive than CT in detection of liver metastases in patients with pancreatic adenocarcinoma.
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Monjardim, Rodrigo da Fonseca, Danilo Manuel Cerqueira Costa, Ricardo Francisco Tavares Romano, et al. "Diagnosis of hepatic steatosis by contrast-enhanced abdominal computed tomography." Radiologia Brasileira 46, no. 3 (2013): 134–38. http://dx.doi.org/10.1590/s0100-39842013000300005.
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Objective To evaluate the diagnostic capacity of abdominal computed tomography in the assessment of hepatic steatosis using the portal phase with a simplified calculation method as compared with the non-contrast-enhanced phase. Materials and Methods In the present study, 150 patients were retrospectively evaluated by means of non-contrast-enhanced and contrast-enhanced computed tomography. One hundred patients had hepatic steatosis and 50 were control subjects. For the diagnosis of hepatic steatosis in the portal phase, the authors considered a result of < 104 HU calculated by the formula [L - 0.3 × (0.75 × P + 0.25 × A)] / 0.7, where L, P and A represent the attenuation of the liver, of the main portal vein and abdominal aorta, respectively. Sensitivity, specificity, positive and negative predictive values were calculated, using non-contrast-enhanced computed tomography as the reference standard. Results The simplified calculation method with portal phase for the diagnosis of hepatic steatosis showed 100% sensitivity, 36% specificity, negative predictive value of 100% and positive predictive value of 75.8%. The rate of false positive results was 64%. False negative results were not observed. Conclusion The portal phase presents an excellent sensitivity in the diagnosis of hepatic steatosis, as compared with the non-contrast-enhanced phase of abdominal computed tomography. However, the method has low specificity.
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Kulamarva, Ganaraj, Supriya Prathibha Shankaranarayana Bhat, Sunil Dadhich, Narendra Bhargava, and Prabhat Ranjan. "Inspecting Management Strategies of Hepatocellular Carcinoma in a Tertiary Centre in Western Rajasthan." Journal of Evolution of Medical and Dental Sciences 10, no. 18 (2021): 1314–18. http://dx.doi.org/10.14260/jemds/2021/277.
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BACKGROUND Hepatocellular carcinoma (HCC) is a lethal malignancy which mostly develops in patients with cirrhosis. It is usually diagnosed late in the course of the illness and the median survival following diagnosis ranges between 6 - 20 months. India lacks data on management strategies and their efficacy. In the absence of data on treatment protocols and its adequacy; we evaluated our own centre data for a period of 1 year to get the estimate of incidence, aetiology, treatment adequacy and response to treatment. Barcelona Clinic Liver Cancer (BCLC) prognostic staging classification comprising five stages is used for prognostication, which is based on the extent of the primary lesion, performance status, vascular invasion and extrahepatic spread. Surgical therapies including resection and transplantation are feasible in early stages (BCLC stage 0 and stage A). Trans arterial chemoembolisation is recommended in intermediate stage (BCLC stage B) while systemic therapies are recommended in advanced stage (BCLC stage C). Best supportive care is recommended in terminal stage (BCLC stage D). This study has included BCLC staging for staging classification and patients were assessed for adequacy of management. METHODS This study was done as a retrospective hospital based observational study. All HCC patients presenting to Mahatma Gandhi Hospital attached to Dr. Sampurnanand Medical College, Jodhpur, Western Rajasthan from January to December 2014 were included. HCC was diagnosed based on European Association for the study of the Liver–European Organisation for Research and Treatment of Cancer (EASL–EORTC) clinical practice guidelines 2011. Patients were classified according to Barcelona Clinic Liver Cancer staging and management given was recorded. RESULTS Thirty-two patients who were diagnosed with HCC between January to December 2014 were included in the study. In three fourths of the patients (24) HCC was diagnosed based on typical findings on dynamic imaging studies (triple phase contrast enhanced CT-computed tomography abdomen and / or MRI- magnetic resonance imaging abdomen). Liver biopsy was needed in one fourth of the patients. Majority of the patients (87.5 %) had cirrhosis of the liver at the time of diagnosis of HCC. Some of these patients [5 (17.8 %)] were known cirrhotic patients. CONCLUSIONS Hepatitis B was the most common aetiology of HCC as mentioned previously in other studies, which is vaccine preventable. HCC is rarely diagnosed at an early stage in developing countries. Various treatment modalities are available which depend on the stage, local expertise and affordability. If the surveillance recommendations are strictly adhered,HCC can be diagnosed at an early stage. Affordability and compliance will remain issues in HCC management in our country increasing the socio-economic burden on the society. KEY WORDS Hepatocellular Carcinoma (HCC), BCLC Staging, Survival
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Costa, Danilo Manuel Cerqueira, Priscila Silveira Salvadori, Rodrigo da Fonseca Monjardim, et al. "When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases." Radiologia Brasileira 46, no. 4 (2013): 197–202. http://dx.doi.org/10.1590/s0100-39842013000400004.
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Objective: To evaluate the necessity of the non contrast-enhanced phase in abdominal computed tomography scans. Materials and Methods: A retrospective, cross-sectional, observational study was developed, evaluating 244 consecutive abdominal computed tomography scans both with and without contrast injection. Initially, the contrast-enhanced images were analyzed (first analysis). Subsequently, the observers had access to the non-contrast-enhanced images for a second analysis. The primary and secondary diagnoses were established as a function of the clinical indications for each study (such as tumor staging, acute abdomen, investigation for abdominal collection and hepatocellular carcinoma, among others). Finally, the changes in the diagnoses resulting from the addition of the non-contrast-enhanced phase were evaluated. Results: Only one (0.4%; p > 0.999; non-statistically significant) out of the 244 reviewed cases had the diagnosis changed after the reading of non-contrast-enhanced images. As the secondary diagnoses are considered, 35 (14%) cases presented changes after the second analysis, as follows: nephrolithiasis (10%), steatosis (3%), adrenal nodule (0.7%) and cholelithiasis (0.3%). Conclusion: For the clinical indications of tumor staging, acute abdomen, investigation of abdominal collections and hepatocellular carcinoma, the non-contrast-enhanced phase can be excluded from abdominal computed tomography studies with no significant impact on the diagnosis.
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Zhang, Yan, Jiabin Liu, Fei Li, Feng Cao, and Ang Li. "Contrast-Enhanced Computed Tomography Does Not Provide More Information about Sarcopenia than Unenhanced Computed Tomography in Patients with Pancreatic Cancer." Contrast Media & Molecular Imaging 2021 (April 23, 2021): 1–8. http://dx.doi.org/10.1155/2021/5546030.
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Objective. The aim of this study was to understand whether enhanced CT can provide more information than unenhanced CT on diagnosis of sarcopenia. Materials and Methods. We reviewed the enhanced CT data of 45 patients of pancreatic cancer. Manual tracing of the psoas muscles was used for measuring the cross-sectional muscle areas and attenuation at umbilicus level; afterwards, PMI, PMD, and Δ PMD were calculated. Results. In the unenhanced scanning, arterial, venous, and parenchymal phases of enhanced CT, PMI values were 6.905 ± 2.170, 6.886 ± 2.195, 6.923 ± 2.239, and 6.866 ± 2.218, respectively, and the difference was not statistically significant. The PMD values at different phases were 34.311 ± 7.535, 37.487 ± 7.118, 40.689 ± 7.116, and 42.989 ± 7.745, respectively, which were gradually increased, and the difference was statistically significant. Meanwhile, the PMD of arterial phase, venous phase, and parenchyma phase showed a linear correlation with PMD of unenhanced scanning phase. 31 patients had low PMD and 14 had normal PMD during the unenhanced scanning phase. With the addition of contrast agent, ΔPMD values increased faster in the low PMD group than in the normal PMD group during the venous and parenchymal phases (7.048 ± 3.067 vs 4.893 ± 2.558; 9.581 ± 3.033 vs 6.679 ± 2.621; p < 0.05 ), which made the gap between PMD after contrast-enhancement vs. unenhanced scanning smaller. Conclusion. The use of contrast agent has no effect on the manually measured PMI values but can change the results of PMD. This change makes the difference of PMD in different enhancement phases smaller than that in plain scan phase and furthermore increases the examination cost; therefore, it is not recommended to use enhanced CT routinely with fixed dose administration of contrast agent for patients’ assessment of PMI and PMD.
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Shirai, Ryota, Takuya Kunii, Akio Yoneyama, et al. "Enhanced renal image contrast by ethanol fixation in phase-contrast X-ray computed tomography." Journal of Synchrotron Radiation 21, no. 4 (2014): 795–800. http://dx.doi.org/10.1107/s1600577514010558.
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Phase-contrast X-ray imaging using a crystal X-ray interferometer can depict the fine structures of biological objects without the use of a contrast agent. To obtain higher image contrast, fixation techniques have been examined with 100% ethanol and the commonly used 10% formalin, since ethanol causes increased density differences against background due to its physical properties and greater dehydration of soft tissue. Histological comparison was also performed. A phase-contrast X-ray system was used, fitted with a two-crystal X-ray interferometer at 35 keV X-ray energy. Fine structures, including cortex, tubules in the medulla, and the vessels of ethanol-fixed kidney could be visualized more clearly than that of formalin-fixed tissues. In the optical microscopic images, shrinkage of soft tissue and decreased luminal space were observed in ethanol-fixed kidney; and this change was significantly shown in the cortex and outer stripe of the outer medulla. The ethanol fixation technique enhances image contrast by approximately 2.7–3.2 times in the cortex and the outer stripe of the outer medulla; the effect of shrinkage and the physical effect of ethanol cause an increment of approximately 78% and 22%, respectively. Thus, the ethanol-fixation technique enables the image contrast to be enhanced in phase-contrast X-ray imaging.
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Dreier, Till, Robin Krüger, Gustaf Bernström, Karin Tran-Lundmark, Isabel Gonçalves, and Martin Bech. "Laboratory x-ray nano-computed tomography for biomedical research." Journal of Instrumentation 19, no. 10 (2024): P10021. http://dx.doi.org/10.1088/1748-0221/19/10/p10021.
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Abstract High-resolution x-ray tomography is a common technique for biomedical research using synchrotron sources. With advancements in laboratory x-ray sources, an increasing number of experiments can be performed in the lab. In this paper, the design, implementation, and verification of a laboratory setup for x-ray nano-computed tomography is presented using a nano-focus x-ray source and high geometric magnification not requiring any optical elements. Comparing a scintillator-based detector to a photon counting detector shows a clear benefit of using photon counting detectors for these applications, where the flux of the x-ray source is limited and samples have low contrast. Sample contrast is enhanced using propagation-based phase contrast. The resolution of the system is verified using 2D resolution charts and using Fourier Ring Correlation on reconstructed CT slices. Evaluating noise and contrast highlights the benefits of photon counting detectors and the contrast improvement through phase contrast. The implemented setup is capable of reaching sub-micron resolution and satisfying contrast in biological samples, like paraffin embedded tissue.
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Kotelnikova, L. P., and Yu V. Zhizhilev. "Computed tomography in the differential diagnosis of adrenal tumors." Endocrine Surgery 15, no. 4 (2022): 38–43. http://dx.doi.org/10.14341/serg12761.
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Background. Modern methods of topical diagnostics have high accuracy and can determine the morphological structure of the adrenal tumor with high probability before surgery, but none of them has 100% sensitivity and specificity. Contrast-enhanced computed tomography is most commonly used by clinicians. The criteria for the malignancy of an adrenal tumor determined by this method continue to be discussed.The aim is to evaluate the effectiveness of contrast-enhanced computed tomography in the preoperative diagnosis of adrenal tumors and to analyze errors.Materials and methods. Contrast-enhanced computed tomography was performed in 69 patients with adrenal tumors. After morphological examination of the removed tumors, the effectiveness of preoperative diagnostics was evaluated with the determination of sensitivity and specificity of the method. If the pre- and postoperative diagnosis did not match, the causes of errors were analyzed.Results. The attenuation on unenhanced CT in adenomas ranged from 5 to 36 HU, in adrenocortical cancer — from 26 to 80 HU, in pheochromocytomas — from 25 to 99 HU. The attenuation of adenomas on unenhanced CT was significantly less than with pheochromocytomas (p=0.005) and adrenocortical cancer (p=0.012). In the venous phase, no significant differences were found, and in the delayed phase, the attenuation of adenomas was also significantly less than in malignant tumors (p=0.008, p=0.008). The median of absolute percent contrast washout in adenomas was 85%, in pheochromocytes — 59%, in adrenocortical cancer — 57%. When comparing the diagnosis before and after surgery, its non-coincidence was found in 8 cases (10.39%). Two patients (2.59%) with small tumors (diameter of 15 mm) were diagnosed with adenoma in combination with pheochromocytoma and adenoma before surgery. After morphological examination, the diagnosis was changed to adrenocortical cancer in combination with adenoma and «mute» pheochromocytoma.Conclusion. The sensitivity and specificity of contrast-enhanced CT in the diagnosis of adenomas was 95.61% and 94.82%, pheochromocytomas — 95% and 95.08%, adrenocortical cancer — 92.31 and 98.48%. Diagnostic errors of «mute» pheochromocytoma and adrenocortical cancer occurred with small sizes (15 mm) of adrenal tumors.
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Mittal, Arjun, and R. R. Kumbhar. "Evaluation of focal liver lesions using triple phase contrast computed tomography among Indian patients." Bioinformation 20, no. 10 (2024): 1429–32. https://doi.org/10.6026/9732063002001429.
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Detecting and characterizing FLL remains a significant challenge in clinical practice. Therefore, it is of interest to evaluate the patients with FLL using TPC-CT. 80 patients spanned for around 18 months to correlate between CT scan findings & final diagnosis. We found male dominancy with high sensitivity for diagnosing hepatocellular carcinoma (HCC) at 73.7%, hemangioma’s at 94.1%, and metastases at 98.4%, whereas specificity for diagnosing all cases when the typical enhancement pattern for each lesion type was considered. We conclude that, tri-phasic CT can be widely accepted CT protocol used for assessing LL, allowing for the detection and characterization of most FL abnormalities (AB-N) across various pathological scenarios and stages of disease.
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Guha, Siddharth, Abdalla Ibrahim, Qian Wu, et al. "Machine learning-based identification of contrast-enhancement phase of computed tomography scans." PLOS ONE 19, no. 2 (2024): e0294581. http://dx.doi.org/10.1371/journal.pone.0294581.
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Contrast-enhanced computed tomography scans (CECT) are routinely used in the evaluation of different clinical scenarios, including the detection and characterization of hepatocellular carcinoma (HCC). Quantitative medical image analysis has been an exponentially growing scientific field. A number of studies reported on the effects of variations in the contrast enhancement phase on the reproducibility of quantitative imaging features extracted from CT scans. The identification and labeling of phase enhancement is a time-consuming task, with a current need for an accurate automated labeling algorithm to identify the enhancement phase of CT scans. In this study, we investigated the ability of machine learning algorithms to label the phases in a dataset of 59 HCC patients scanned with a dynamic contrast-enhanced CT protocol. The ground truth labels were provided by expert radiologists. Regions of interest were defined within the aorta, the portal vein, and the liver. Mean density values were extracted from those regions of interest and used for machine learning modeling. Models were evaluated using accuracy, the area under the curve (AUC), and Matthew’s correlation coefficient (MCC). We tested the algorithms on an external dataset (76 patients). Our results indicate that several supervised learning algorithms (logistic regression, random forest, etc.) performed similarly, and our developed algorithms can accurately classify the phase of contrast enhancement.
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Guha, Siddharth, Abdalla Ibrahim, Pengfei Geng, et al. "Variability of HCC Tumor Diameter and Density Measurements on Dynamic Contrast-Enhanced Computed Tomography." Tomography 11, no. 3 (2025): 36. https://doi.org/10.3390/tomography11030036.
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Purpose: In cancers imaged using contrast-enhanced protocols, such as hepatocellular carcinoma (HCC), formal guidelines rely on measurements of lesion size (in mm) and radiographic density (in Hounsfield units [HU]) to evaluate response to treatment. However, the variability of these measurements across different contrast enhancement phases remains poorly understood. This limits the ability of clinicians to discern whether measurement changes are accurate. Methods: In this study, we investigated the variability of maximal lesion diameter and mean lesion density of HCC lesions on CT scans across four different contrast enhancement phases: non-contrast-enhanced phase (NCE), early arterial phase (E-AP), late arterial phase (L-AP), and portal venous phase (PVP). HCC lesions were independently segmented by two expert radiologists. For each pair of a lesion’s scan timepoints, one was selected randomly as the baseline measurement and the other as the repeat measurement. Both absolute and relative differences in measurements were calculated, as were the coefficients of variance (CVs). Analysis was further stratified by both contrast enhancement phase and lesion diameter. Results: Lesion diameter was found to have a CV of 5.11% (95% CI: 4.20–6.01%). About a fifth of the measurement’s relative changes were greater than 10%. Although there was no significant difference in diameter measurements across different phases, there was a significant negative correlation (R = −0.303, p-value = 0.030) between lesion diameter and percent difference in diameter measurement. Lesion density measurements varied significantly across all phases, with the greatest relative difference of 47% in the late arterial phase and a CV of 22.84% (21.48–24.20%). The overall CV for lesion density measurements was 26.19% (24.66–27.72%). Conclusions: Changes in tumor diameter measurements within 10% may simply be due to variability, and lesion density is highly sensitive to contrast timing. This highlights the importance of paying attention to these two variables when evaluating tumor response in both clinical trials and practice.
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Dolidze, D. D., S. D. Covantsev, Z. A. Bagatelia, I. N. Lebedinskyi, E. G. Kirilenko, and A. V. Bumbu. "Assessment of malignant potential of thyroid mass using computed tomography." Endocrine Surgery 19, no. 1 (2025): 23–31. https://doi.org/10.14341/serg12935.
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BACKGROUND: Thyroid nodules are detected in 20-68% of patients. However, there is no data in the literature on the criteria for malignancy in CT studies. The introduction of CT into widespread practice has led to an increase in the detection of formations, including the thyroid gland, requiring additional examination. The use of additional imaging methods will improve the detection of malignant tumors of the thyroid gland.AIM: The purpose of this study was to address the gap in thyroid CT imaging and to evaluate whether contrast-enhanced multiphase multidetector CT is suitable for assessing the malignant potential of thyroid mass.MATERIALS AND METHODS: The study was conducted on the basis of the General Oncology Department No. 71 in Botkin Hospital from 2022 to 2023 A retrospective analysis of CT images included data from 146 electronic medical records of patients with differentiated carcinoma and follicular adenoma of the thyroid gland. A comparative evaluation was performed using contrast-enhanced CT (160 slices; Toshiba Aquilion Prime model) (Omnipaque 350 mg iodine/ml: 100 ml) with assessment in the native, arterial and venous phases.RESULTS: The study included 64 patients diagnosed with follicular adenoma of the thyroid gland and 82 patients with differentiated thyroid cancer. When assessing the relationship between thyroid carcinoma and tumor density in Hounsfield units, a positive correlation was revealed (Spearman correlation in the native phase r=0.48; arterial phase r=0.69; venous phase r=0.64; p<0.001). The sensitivity and specificity of assessing the density of thyroid nodules using CT data was analyzed. The most demonstrative results were demonstrated when analyzing CT scans in the arterial phase. At an arterial phase cut-off point of 121 Hounsfield units, the sensitivity was 75.6% and the specificity was 91.7%. Using a cutoff point of 113 Hounsfield units in the venous phase, the sensitivity was 62.2% and the specificity was 95.8%. In the native phase, a cut-off point of 49 Hounsfield units demonstrated a sensitivity of 68.9% and a specificity of 75%.CONCLUSION: Contrast-enhanced CT examination of the thyroid gland can become a promising method for the differential diagnosis of carcinomas and can be used in the presence of masses with unclear malignant potential.
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Sandomenico, Fabio, Valerio Arpaia, Ferdinando De Rosa, et al. "Spontaneously Ruptured Hepatocellular Carcinoma: Computed Tomography-Based Assessment." Diagnostics 13, no. 6 (2023): 1021. http://dx.doi.org/10.3390/diagnostics13061021.
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Spontaneously ruptured hepatocellular carcinoma (SRHCC) is an uncommon and life-threatening complication in patients with hepatocellular carcinoma (HCC). It is usually associated with chronic liver disease and has a poor prognosis with a high mortality rate during the acute phase. SRHCC can cause a severe and urgent condition of acute abdomen disease and requires a correct diagnosis to achieve adequate treatment. Clinical presentation is related to the presence of hemoperitoneum, and abdominal pain is the most common symptom (66–100% of cases). Although the treatment approach is not unique, trans-arterial (chemo)embolization (TAE/TACE) followed by staged hepatectomy has shown better results in long-term survival. A multi-phase contrast-enhanced CT (CECT) scan is a pivotal technique in the diagnosis of SRHCC due to its diagnostic accuracy and optimal temporal resolution. The correct interpretation of the main CT findings in SRHCC, such as active contrast extravasation and the sentinel clot sign, is fundamental for a prompt and correct diagnosis. Furthermore, CT also plays a role as a post-operative control procedure, especially in patients treated with TAE/TACE. Therefore, a multi-phase CECT scan should be the diagnostic tool of choice in SRHCC since it suggests an immediate need for treatment with a consequent improvement in prognosis.
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Guarnieri, Tommaso, Luciano Cardinale, Gianluca Macchia, Giancarlo Cortese, and Andrea Veltri. "Multiphasic Multidetector Computed Tomography Study of a Rare Tracheal Tumor: Granular Cell Tumor." Case Reports in Pulmonology 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/807430.
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Our aim is to present the case report of a woman affected by tracheal granular cell tumor analysed by multiphasic contrast-enhanced multidetector CT. The tumor presents as polypoid lesion (diameter 13 mm), with smooth and well-defined margins, elevated contrast enhancement in arterial phase, and a modest release of contrast in venous phase. This pattern is quite different from the other tracheal tumours. We have performed a comprehensive review of literature to assess all cases of granular cell tumors of the trachea; only 40 cases are reported. Of these, no one focused on the contrast enhancement aspect, so our work is the first showing a specific pattern in multidetector computed tomography (MDCT) of the tracheal granular cell tumour and may help in differential diagnosis.
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Žvinienė, Kristina, Inga Zaborienė, Algidas Basevičius, and Juozas Pundzius. "Comparative diagnostic value of computed tomography and contrast-enhanced ultrasonography in diagnosis of focal liver lesions." Medicina 45, no. 10 (2009): 751. http://dx.doi.org/10.3390/medicina45100098.
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Objective. The aim of the study was to evaluate focal liver lesions by computed tomography and contrast-enhanced ultrasonography and to compare their diagnostic values. Materials and methods. There were 67 patients, examined and treated in the Departments of Gastroenterology, Surgery, and Oncology, Hospital of Kaunas University of Medicine, during 2007 (study group). All the patients underwent contrast-enhanced ultrasonography and bolus computed tomography. Control group included 73 patients with focal hepatic lesions who were examined and treated in the Hospital of Kaunas University of Medicine during 2006. Focal hepatic lesions were detected and characterized by conventional ultrasonography and bolus computed tomography. The diagnosis was confirmed by biopsy or during surgery in both groups, and hemangiomas were confirmed by magnetic resonance imaging. Patients’ age varied from 20 to 80 years (there were 46 [68.7%] women and 21 [31.3%] men with a mean age of 55.85±13.417 years). The age of patients in the study group varied from 18 to 91 years (mean age, 60.81±16.059 years; out of 73 patients, 46 [63%] were women and 27 [37%] men). Results. The following was determined in the study group: hemangioma (n=18, 26.9%), focal nodular hyperplasia (n=4, 6%), adenoma (n=2, 3%), echinococcosis (n=2, 3%), hepatocellular carcinoma (n=11, 16.4%), cholangiocellular carcinoma (n=1, 1.5%), solitary metastasis (n=13, 19.4%), hepatic cyst (n=3, 4.5%), etc. The sensitivity and specificity of contrast-enhanced ultrasonography as compared with computed tomography in detecting and characterizing focal liver lesions was 44.2% and 46.7%, respectively; positive prognostic value was 74.2% and negative prognostic value was 19.4%. The sensitivity and specificity of conventional ultrasonography as compared with contrast-enhanced ultrasonography in detecting and characterizing focal liver lesions was 34.5% and 100%, respectively; positive prognostic value was 100% and negative prognostic value was 25%. Conclusions. Ultrasound contrast agents (SonoVue, Bracco®, Milan, Italy) definitely improve detection and characterization of focal liver lesions. Ultrasonography correlates with computed tomography and magnetic resonance imaging, particularly during arterial phase. The sensitivity of contrast-enhanced ultrasonography as compared with computed tomography in detecting and characterizing focal liver lesions was 74.2% and positive prognostic value was 44.2%; sensitivity of conventional ultrasonography as compared with contrastenhanced ultrasonography in detecting and characterizing focal liver lesions was 34.5% and positive prognostic value was 100%.
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Wang, Xing-Hua, Ying Shi, Huan-Hu Zhang, and Xia Ma. "Characteristics of Focal Liver Lesions in Arterial Phase on Contrast-enhanced Ultrasound and Contrast- -enhanced Computed Tomography – Comparative Study*." Advances in Clinical and Experimental Medicine 23, no. 1 (2014): 85–89. http://dx.doi.org/10.17219/acem/37027.
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Xin, Zhong, Xiangdang Long, Hongtian Chen, and Yongjun Hu. "The Imaging Performances of Contrast-Enhanced Ultrasound, Computed Tomography, and Magnetic Resonance Imaging for Extrahepatic Cholangiocarcinoma." Journal of Medical Imaging and Health Informatics 10, no. 9 (2020): 2192–97. http://dx.doi.org/10.1166/jmihi.2020.3162.
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Objective: To compare the imaging performances of contrast-enhanced ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), thereby explore their values and significances in clinical practices of diagnosing extrahepatic cholangiocarcinoma. Methods: A total of 56 patients with extrahepatic cholangiocarcinoma were included as research objects. All the patients underwent contrast-enhanced ultrasound examination, enhanced MRI examination, and multi-slice helical CT (MSCT) examination. The major contents of analysis and observation included the location of the lesion, the range, the features of blood flow signal, the echoes of lesions at various phases, the enhancement levels, and the morphology. Then, the tabu search algorithm was applied to reconstruct the images, thereby completing the construction of the image objective function. Results: In terms of histopathological typing, 9 papillary adenocarcinomas, 22 invasive adenocarcinomas, and 25 poorly-to-moderate differentiated adenocarcinomas were found. In terms of ultrasound results, 27 lesions were isoechoic, 23 lesions were hypoechoic, and 6 lesions were hyperechoic. In terms of MRI results, 66% of the patients had hyperechoic lesions during the arterial phase, and 55.1% of the patients had isoechoic lesions during the portal phase. During the delay phase, 30.3% of the patients had isoechoic lesions, and 58.9% of the patients had hyperechoic lesions. Conclusion: Contrast-enhanced ultrasound, CT, and MRI had magnificent values and significance in the clinical diagnosis of extrahepatic cholangiocarcinoma, which could be widely applied in the diagnosis and treatment of extrahepatic cholangiocarcinoma. In addition, the contrast-enhanced ultrasound and CT could be used as an effective supplementary basis for enhanced MRI diagnosis. These three diagnostic methods had respective advantages and could be used in combination.
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Ren, Shuai, Ling Zhan, Shuchao Chen, et al. "Segmentation and Registration of the Liver in Dynamic Contrast-Enhanced Computed Tomography Images." Journal of Medical Imaging and Health Informatics 11, no. 3 (2021): 773–80. http://dx.doi.org/10.1166/jmihi.2021.3327.
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Dynamic contrast-enhanced computed tomography (DCE-CT) is the main auxiliary diagnostic tool for liver diseases. Liver segmentation and registration in all stages of DCE-CT images are the key technology for big data analysis of liver disease diagnosis. The change of imaging conditions in different stages of DCE-CT brings enormous challenges to the segmentation of liver CT images. This study proposes an automatic model for liver segmentation from abdominal CT images in different stages of DCE on the basis of U-Net. The skip connection in U-Net can improve the ability of complex feature recognition. A total of 4863 CT slices from 16 patients with hepatocellular carcinoma (HCC) were selected as the training set, and 1754 CT slices from 6 patients with HCC were selected as the test set. The training and test sets included plain scan, hepatic arterial-dominant phase, and portal venous-dominant phase CT scans. Results showed that the Dice value of the proposed method was significantly higher than those of the full convolutional network and region-growing method. Then, 3D reconstruction and registration were performed on the segmentation results of the liver region of DCE-CT images. The proposed method obtained the best performance, which can provide technical support for the big data analysis of liver diseases.
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Kivisaari, L., P. Nuutinen, A. Lehtola, et al. "Ionic and Non-Ionic Contrast Media Used for Contrast-Enhanced Computed Tomography in Experimental Pancreatitis." Acta Radiologica 29, no. 2 (1988): 243–46. http://dx.doi.org/10.1177/028418518802900221.
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Contrast enhancement of the pancreas was studied in pigs using dynamic computed tomography in experimental oedematous and haemorrhagic/necrotizing pancreatitis during the first two minutes after injection of an intravenous bolus of non-ionic contrast medium (iohexol). The prospects of separating the two forms of the disease, known to be possible with ionic contrast media, were tested with a non-ionic contrast medium. In the oedematous form, contrast enhancement after 5 hours of the disease was significantly higher than in the haemorrhagic/necrotizing form. Contrast enhancement after 30 hours of disease tended to vary with the severity of the disease, showing that the course of oedematous pancreatitis is dynamic. Intermediate forms occur and follow-up studies are needed during the disease. A non-ionic contrast medium proved as good for separating the two forms of the disease in the early phase as were ionic contrast media. In severely ill patients, non-ionic contrast media should therefore be used.
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BADER, TILL R., RUPERT W. PROKESCH, and FLORIAN GRABENWÖGER. "Timing of the Hepatic Arterial Phase During Contrast-Enhanced Computed Tomography of the Liver." Investigative Radiology 35, no. 8 (2000): 486–92. http://dx.doi.org/10.1097/00004424-200008000-00005.
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Nakahashi, Kenta, Hiroyuki Oizumi, Hirohisa Kato, et al. "Venous phase contrast-enhanced computed tomography facilitates the detection of pulmonary venous tumor thrombus." General Thoracic and Cardiovascular Surgery 66, no. 8 (2018): 488–91. http://dx.doi.org/10.1007/s11748-018-0898-x.
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Jiang, Jian, Ke Wang, Yufeng Xu, et al. "Preoperative Assessment of Hepatocellular Carcinoma with Split-Bolus Combined Phase Contrast-Enhanced Computed Tomography." Medical Science Monitor 23 (April 16, 2017): 1834–41. http://dx.doi.org/10.12659/msm.904129.
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Lehti, Leena, Marcus Söderberg, Peter Höglund, Ulf Nyman, Anders Gottsäter, and Johan Wassélius. "Reliability of virtual non-contrast computed tomography angiography: comparing it with the real deal." Acta Radiologica Open 7, no. 7-8 (2018): 205846011879011. http://dx.doi.org/10.1177/2058460118790115.
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Background Computed tomographic angiography (CTA) may require a non-contrast enhanced dataset for the diagnostic workup. By using dual-energy acquisition, it is possible to obtain a virtual non-contrast-enhanced (VNC) dataset, thereby possibly eliminating the non-contrast acquisition and reducing the radiation dose. Purpose To compare image quality of VNC images reconstructed from arterial phase dual-energy CTA to true non-contrast (TNC) images, and to assess whether VNC images were of sufficient quality to replace TNC images. Material and methods Thirty consecutive patients with suspected abdominal aortic aneurysm, aortic dissection, or subacute control after EVAR/TEVAR were examined with dual-energy CT (DECT). The examination protocol included a single-energy TNC, DECT arterial phase (80 kV/Sn140 kV), and single-energy in venous phase of the aorta. A VNC dataset was obtained from the DE acquisition from arterial phase scans. Mean attenuation and image noise were measured within regions of interest at three levels in the aorta in TNC and VNC images. Comparison of the TNC and VNC images for artefacts was made side-by-side. Subjective evaluation included overall image quality on a 4-grade scale, and quantitative analysis of algorithm-induced artefacts by two experienced readers. Results For all cases, the aortic attenuation was significantly higher at VNC than at TNC. Image noise measured quantitatively was also significantly higher at VNC than at TNC. Subjective image quality was lower for VNC (mean = 3.1 for VNC, 3.7 = for TNC) but there were no cases rated non-diagnostic. Conclusion VNC images based on arterial phase CTA have significantly higher mean attenuation and higher noise levels compared to TNC.
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Liu, Hua, and Kang-Yan Zhao. "Application of CD34 expression combined with three-phase dynamic contrast-enhanced computed tomography scanning in preoperative staging of gastric cancer." World Journal of Gastrointestinal Surgery 15, no. 11 (2023): 2513–24. http://dx.doi.org/10.4240/wjgs.v15.i11.2513.
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BACKGROUND Accurate preoperative staging of gastric cancer (GC), a common malignant tumor worldwide, is critical for appropriate treatment plans and prognosis. Dynamic three-phase enhanced computed tomography (CT) scanning for preoperative staging of GC has limitations in evaluating tumor angiogenesis. CD34, a marker on vascular endothelial cell surfaces, is promising in evaluating tumor angiogenesis. We explored the value of their combination for preoperative staging of GC to improve the efficacy and prognosis of patients with GC. AIM To explore the evaluation value of CD34 expression + dynamic three-phase enhanced CT scanning in preoperative staging of GC. METHODS Medical records of 106 patients with GC treated at the First People's Hospital of Lianyungang between February 2021 and January 2023 were retrospectively studied. All patients underwent three-phase dynamic contrast-enhanced CT scanning before surgery, and CD34 was detected in gastroscopic biopsy specimens. Using surgical and pathological results as the gold standard, the diagnostic results of three-phase dynamic contrast-enhanced CT scanning at different T and N stages were analyzed, and the expression of CD34-marked microvessel density (MVD) at different T and N stages was determined. The specificity and sensitivity of three-phase dynamic contrast-enhanced CT and CD34 in T and N staging were calculated; those of the combined diagnosis of the two were evaluated in parallel. Independent factors affecting lymph node metastasis were analyzed using multiple logistic regression. RESULTS The accuracy of three-phase dynamic contrast-enhanced CT scanning in diagnosing stages T1, T2, T3 and T4 were 68.00%, 75.00%, 79.41%, and 73.68%, respectively, and for diagnosing stages N0, N1, N2, and N3 were 75.68%, 74.07%, 85.00%, and 77.27%, respectively. CD34-marked MVD expression increased with increasing T and N stages. Specificity and sensitivity of three-phase dynamic contrast-enhanced CT in T staging were 86.79% and 88.68%; for N staging, 89.06% and 92.86%; for CD34 in T staging, 64.15% and 88.68%; and for CD34 in N staging, 84.38% and 78.57%, respectively. Specificity and sensitivity of joint diagnosis in T staging were 55.68% and 98.72%, and N staging were 75.15% and 98.47%, respectively, with the area under the curve for diagnosis improving accordingly. According to multivariate analysis, a longer tumor diameter, higher pathological T stage, lower differentiation degree, and higher expression of CD34-marked MVD were independent risk factors for lymph node metastasis in patients with GC. CONCLUSION With high accuracy in preoperatively determining the invasion depth and lymph node metastasis of GC, CD34 expression and three-phase dynamic contrast-enhanced CT can provide a reliable basis for surgical resection.
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Zhao, Yusen, Yaoyi Wang, Yuanbo Xu, et al. "Comparison of Diagnostic Value for Chronic Kidney Disease between 640-Slice Computed Tomography Kidney Scan and Conventional Computed Tomography Scan." Contrast Media & Molecular Imaging 2022 (August 24, 2022): 1–6. http://dx.doi.org/10.1155/2022/6587617.
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Objective. To explore the diagnostic value for chronic kidney disease (CKD) between 640-slice computed tomography (CT) kidney scan and conventional CT scan. Methods. A total of 120 CKD patients who received kidney plain scan plus enhanced examination in the CT room of the Medical Imaging Department of our hospital from June 2019 to September 2019 were selected and randomly divided into the experimental group (n = 60) and the control group (n = 60). Patients in the control group received the conventional CT plain scan and enhanced scan, and for patients in the experimental group, CT plain scan was performed first, the range of 640-slice CT dynamic volume scan was determined, and after bolus injection of contrast agent, dynamic volume scan was performed for scanning in the cortical phase, myeloid phase, and secretory phase. The imaging quality and effective scanning dose were compared between the two modalities, and the relationship between CT values obtained from 640-slice CT scan and conventional CT scan and the renal impairment was analyzed. Results. Compared with the control group, the image quality of 640-slice CT scan conducted in the experimental group was significantly better ( P < 0.05 ); the effective radiation doses of the experimental group and the control group were, respectively, (1.89 ± 0.32) mSv and (3.26 ± 0.47) mSv, indicating that the dose was significantly lower in the experimental group than in the control group (t = 18.664, P < 0.001 ), and the correlation analysis showed that the relationship between the sum of CT values in the cortical phase of both kidneys and kidney injury in the experimental group was r = 0.835, P < 0.001 . Conclusion. Both 640-slice CT kidney scan and conventional CT scan can be used in the diagnosis of CKD. 640-slice CT has a lower radiation dose, better image quality, and higher application value.
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Kurita, Yusuke, Daisuke Utsunomiya, Kensuke Kubota, et al. "Diagnostic Value of Contrast-Enhanced Dual-Energy Computed Tomography in the Pancreatic Parenchymal and Delayed Phases for Pancreatic Cancer." Tomography 10, no. 10 (2024): 1591–604. http://dx.doi.org/10.3390/tomography10100117.
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Background/Objectives: The usefulness of dual-energy computed tomography (DECT) for low absorption in the parenchymal phase and contrast effects in the delayed phase for pancreatic cancer is not clear. Therefore, the diagnostic capability of low-KeV images obtained using DECT for pancreatic cancer in the pancreatic parenchymal and delayed phases was evaluated quantitatively and qualitatively. Methods: Twenty-five patients with pancreatic cancer who underwent contrast-enhanced DECT were included. A total of 50 and 70 KeV CT images, classified as low-keV and conventional CT-equivalent images, were produced, respectively. The tumor-to-pancreas contrast (Hounsfield units [HU]) in the pancreatic parenchymal and delayed phases was calculated by subtracting the CT value of the pancreatic tumor from that of normal parenchyma. Results: The median tumor-to-pancreas contrast on 50 KeV CT in the pancreatic parenchymal phase (133 HU) was higher than that on conventional CT (68 HU) (p < 0.001). The median tumor-to-pancreas contrast in the delayed phase was −28 HU for 50 KeV CT and −9 HU for conventional CT (p = 0.545). For tumors < 20 mm, the tumor-to-pancreas contrast of 50 KeV CT (−39 HU) had a significantly clearer contrast effect than that of conventional CT (−16.5 HU), even in the delayed phase (p = 0.034). Conclusions: These 50 KeV CT images may clarify the low-absorption areas of pancreatic cancer in the pancreatic parenchymal phase. A good contrast effect was observed in small pancreatic cancers on 50 KeV delayed-phase images, suggesting that DECT is useful for the visualization of early pancreatic cancer with a small tumor diameter.
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Park, Se Jin, Haing-Woon Baik, Myung Hyun Cho, and Ju Hyung Kang. "Acute dural venous sinus thrombosis in a child with idiopathic steroid-dependent nephrotic syndrome: a case report." Childhood Kidney Diseases 26, no. 2 (2022): 101–6. http://dx.doi.org/10.3339/ckd.22.041.
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Nephrotic syndrome (NS) is a hypercoagulable state in which children are at risk of venous thromboembolism. A higher risk has been reported in children with steroid-resistant NS than in those with steroid-sensitive NS. The mortality rate of cerebral venous sinus thrombosis (CVST) is approximately 10% and generally results from cerebral herniation in the acute phase and an underlying disorder in the chronic phase. Our patient initially manifested as a child with massive proteinuria and generalized edema. He was treated with albumin replacement and diuretics, angiotensin-converting enzyme inhibitor, and deflazacort. Non-contrast computed tomography showed areas of hyperattenuation in the superior sagittal sinus when he complained of severe headache and vomiting. Subsequent magnetic resonance imaging revealed empty delta signs in the superior sagittal, lateral transverse, and sigmoid sinuses, suggesting acute CVST. Immediate anticoagulation therapy was started with unfractionated heparin, antithrombin III replacement, and continuous antiproteinuric treatment. The current report describes a life-threatening CVST in a child with steroid-dependent NS, initially diagnosed by contrast non-enhanced computed tomography and subsequently confirmed by contrast-enhanced magnetic resonance imaging, followed by magnetic resonance venography for recanalization, addressing successful treatment.
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Kim, Yo Na, Ji Soo Song, Woo Sung Moon, Hong Pil Hwang, and Young Kon Kim. "Intra-individual comparison of hepatocellular carcinoma imaging features on contrast-enhanced computed tomography, gadopentetate dimeglumine-enhanced MRI, and gadoxetic acid-enhanced MRI." Acta Radiologica 59, no. 6 (2017): 639–48. http://dx.doi.org/10.1177/0284185117728534.
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Background Gadoxetic acid is being widely used for detection and characterization of hepatic nodules. However, there are no data regarding intra-individual comparison of imaging features of hepatocellular carcinoma (HCC) on dynamic computed tomography (CT), gadopentetate dimeglumine-enhanced magnetic resonance imaging (Gd-DTPA-MRI), and gadoxetic acid-enhanced MRI (Gd-EOB-MRI). Purpose To evaluate typical imaging features of HCC and capsule appearance with dynamic CT, Gd-DTPA-MRI, and Gd-EOB-MRI. Material and Methods We retrospectively reviewed 56 HCCs in 49 patients. Lesion attenuation/signal intensity was graded using a five-point scale based on dynamic phase and hepatobiliary phase (HBP) imaging. Subjective washout and capsule appearance were evaluated on portal venous phase (PVP) or delayed/transitional phase (DP/TP) imaging. The tumor-to-liver contrast ratio (TLCR) was calculated. Results Gd-DTPA-MRI and Gd-EOB-MRI was graded higher than CT on arterial phase ( P < 0.001). Gd-EOB-MRI was graded lower than Gd-DTPA-MRI on PVP and DP/TP ( P < 0.05). The detection rate of subjective washout and capsule appearance did not differ among the three imaging studies on either PVP or DP/TP. TLCR of Gd-EOB-MRI was lower than CT on PVP ( P = 0.004) and was lower than Gd-DTPA-MRI on DP/TP ( P = 0.001). Conclusion Arterial phase hyperenhancement and washout appearance of HCC were well demonstrated in Gd-EOB-MRI. The detection of capsule appearance using Gd-EOB-MRI was not inferior to Gd-DTPA-MRI or CT.
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Takaji, Ryo, Yasunari Yamada, Ryuichi Shimada, et al. "Retrospective evaluation of venous phase contrast-enhanced computed tomography images in patients who developed pancreatic adenocarcinomas after treatment for nonpancreatic primary cancer." BJR|Open 3, no. 1 (2021): 20200069. http://dx.doi.org/10.1259/bjro.20200069.
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Objectives: To clarify venous phase contrast-enhanced CT findings in early pancreatic adenocarcinomas by retrospectively evaluating CT images of pancreatic adenocarcinomas that developed during follow-up after treatment for non-pancreatic cancers. Methods: The study cohort comprised six patients who developed pancreatic adenocarcinomas between April 2005 and April 2020 during follow-up after treatment for non-pancreatic primary cancers. Two radiologists retrospectively evaluated CT images and reached consensus on previously reported CT findings that were suggestive of small pancreatic adenocarcinomas; namely pancreatic duct interruption and dilatation, pancreatic parenchymal atrophy, focal hypoattenuated areas, and appearance of cystic lesions. Time intervals between the first CT with these suggestive findings and the latest pre-operative CT were recorded. Doubling times were calculated in patients with hypoattenuated areas on initial CT scans. Results: Small (<10 mm) focal hypoattenuated areas with (n = 2) or without rim enhancement (n = 1) were identified on initial CT images of three patients. Pancreatic duct interruption and dilatation, pancreatic parenchymal atrophy, and cystic lesion were identified in two, one and one patient, respectively. Time intervals between initial and latest preoperative CT examination were 6–19 months (median, 14.5 months). Tumor doubling time according to CT findings was calculated as 46–407 days (median 106 days). Conclusion: Venous phase contrast-enhanced CT can provide findings that are suggestive of early pancreatic adenocarcinoma. Pancreatic phase contrast-enhanced CT should therefore be performed in patients with such findings with the aim of early detection of pancreatic adenocarcinoma. Advances in knowledge: Pancreatic adenocarcinoma can develop subsequently in patients with non-pancreatic malignancies. Patients with non-pancreatic cancers are often followed up with monophasic contrast-enhanced CT in venous phase timing. Venous phase contrast-enhanced CT can provide some findings suggestive of early pancreatic adenocarcinoma. Knowledge of these findings is important for early detection of pancreatic adenocarcinoma.
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Sekino, Hirofumi, Shiro Ishii, Yumi Saito, et al. "Aortomesenteric angle: A contrast-enhanced computed tomography analysis of respiratory phase and visceral fat impact." Journal of Clinical Imaging Science 15 (January 6, 2025): 2. https://doi.org/10.25259/jcis_65_2024.
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Objectives: The objective of this study was to evaluate the relationship between the aortomesenteric angle at end-inspiration and end-expiration and its variation rate with several anthropometric parameters. Material and Methods: Sagittal reconstructed computed tomography (CT) images of 59 patients who underwent contrast-enhanced CT at end-inspiration and end-expiration between 2015 and 2020 were reviewed. All these patients underwent dynamic contrast CT during both inspiration and expiration for adrenal venous sampling purposes. Two experienced radiologists measured the aortomesenteric angle during both end-inspiration and end-expiration, and its variation rate. Pearson’s or Spearman’s correlation analysis was used to assess correlations between the angle or variation rate and height, weight, body mass index (BMI), visceral fat, subcutaneous fat, and diaphragm motion. Results: The aortomesenteric angle was significantly larger at end-expiration (88.65 ± 25.15, 95% confidence interval [CI] 82.09–95.20) compared to end-inspiration (62.22 ± 21.90, 95% CI 56.51–67.93, P < 0.001). The aortomesenteric angles at both end-inspiration and end-expiration correlated significantly with weight, BMI, visceral fat, and subcutaneous fat. The strongest correlation was between aortomesenteric angle and visceral fat at both end-inspiration (r = 0.523, P < 0.001) and end-expiration (r = 0.546, P < 0.001). The variation rate correlated only with diaphragm motion (r = 0.550, P < 0.001). Conclusion: The aortomesenteric angle at end-expiration was significantly larger than at end-inspiration, with the strongest correlation found between the angle and visceral fat.
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Jiang, Changqin, Lianfang Shen, Lichao Xia, et al. "Mixed Imaging on Port-Venous Phase of Contrast-Enhanced Dual-Source Dual-Energy Computed Tomography." Journal of Computer Assisted Tomography 42, no. 6 (2018): 944–53. http://dx.doi.org/10.1097/rct.0000000000000820.
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Kong, Weihui, Yanjie Liu, Yueqin Chen, Linsheng Wang, Yuhong Wang, and Ti Gao. "Computed Tomography and Magnetic Resonance Imaging Findings and Differential Diagnosis of the Renal Oncocytoma." Journal of Medical Imaging and Health Informatics 10, no. 12 (2020): 2820–24. http://dx.doi.org/10.1166/jmihi.2020.3241.
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Objective: To discuss the imaging features of renal oncocytoma, and to improve the preoperative diagnostic accuracy. Methods: Radiology data of 16 renal oncocytoma patients were analyzed retrospectively. All the cases were confirmed by pathology. All patients underwent pre-contrast and multiple phase contrast scanning on multi-slice CT. The patients also underwent MRI examination. Results: All patients had solitary lesion, the location of oncocytoma were in right kidney (n = 9) and left kidney (n = 7). Round or round-like shape, clear boundary, protruding mass. Isodense or slightly higher density on CT pre-contrast scanning, among them, 2 cases developed into the renal sinus, 2 cases with calcification. 13 lesions showed obvious enhancement on the cortical phase, and on the medullary phase showed continuous enhancement. 4 lesions showed segmental enhancement inversion and central stellate scar was found in 8 lesions. Bleeding, necrosis, cystic change or fatty change was rare. 9 lesions showed tortuous expansion of the support vessel on the cortical phase, 6 lesions with invasion to the perirenal fat tissue. In our study, 3 samples of lesions underwent MR examination, which showed iso/hypo-intensity on T1WI. On T2WI, 1 lesion showed slightly lower signal, 2 lesion showed mixed signal. Clear pseudocapsule was revealed in MR imaging. Enhanced scan showed mild continuous enhancement. Conclusion: Most of the oncocytomas showed certain characteristic imaging, multiple phase contrast scanning are helpful in the accurate preoperative diagnosis.
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Koh, Teng Kiat, Jocelyn Zi Lin Ting, Bernard Wee, et al. "Coronary and arch hybrid surgery in a patient with infrarenal aortic occlusion." Asian Cardiovascular and Thoracic Annals 26, no. 2 (2018): 148–50. http://dx.doi.org/10.1177/0218492318755181.
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A 65-year-old gentleman with claudication underwent contrast-enhanced computed tomography. The scan showed occlusion of the infrarenal abdominal aorta and a 6.0 × 3.7 cm saccular zone-3 arch aneurysm. The left ventricular ejection fraction was 35% and a coronary angiogram revealed triple-vessel disease. In view of the patient’s high risk with EuroSCORE II 20.34%, coronary artery surgery was combined with hybrid type I arch aneurysm repair. An endovascular stent was delivered in an antegrade manner. Open heart surgery and a hybrid type I arch intervention can be performed simultaneously through a midline sternotomy approach.
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Noda, Yoshifumi, Nobuyuki Kawai, Takuma Ishihara, et al. "Optimized scan delay for late hepatic arterial or pancreatic parenchymal phase in dynamic contrast-enhanced computed tomography with bolus-tracking method." British Journal of Radiology 94, no. 1122 (2021): 20210315. http://dx.doi.org/10.1259/bjr.20210315.
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Objectives: To determine the optimal scan delay corresponding to individual hemodynamic status for pancreatic parenchymal phase in dynamic contrast-enhanced CT of the abdomen. Methods: One hundred and fourteen patients were included in this retrospective study (69 males and 45 females; mean age, 67.9 ± 12.1 years; range, 39–87 years). These patients underwent abdominal dynamic contrast-enhanced CT between November 2019 and May 2020. We calculated and recorded the time from contrast material injection to the bolus-tracking trigger of 100 Hounsfield unit (HU) at the abdominal aorta (s) (TimeTRIG) and scan delay from the bolus-tracking trigger to the initiation of pancreatic parenchymal phase scanning (s) (TimeSD). The scan delay ratio (SDR) was defined by dividing the TimeSD by TimeTRIG. Non-linear regression analysis was conducted to assess the association between CT number of the pancreas and SDR and to reveal the optimal SDR, which was ≥120 HU in pancreatic parenchyma. Results: The non-linear regression analysis showed a significant association between CT number of the pancreas and the SDR (p < 0.001). The mean TimeTRIG and TimeSD were 16.1 s and 16.8 s, respectively. The SDR to peak enhancement of the pancreas (123.5 HU) was 1.00. An SDR between 0.89 and 1.18 shows an appropriate enhancement of the pancreas (≥120 HU). Conclusion: The CT number of the pancreas peaked at an SDR of 1.00, which means TimeSD should be approximately the same as TimeTRIG to obtain appropriate pancreatic parenchymal phase images in dynamic contrast-enhanced CT with bolus-tracking method. Advances in knowledge: The hemodynamic state is different in each patient; therefore, scan delay from the bolus-tracking trigger should also vary based on the time from contrast material injection to the bolus-tracking trigger. This is necessary to obtain appropriate late hepatic arterial or pancreatic parenchymal phase images in dynamic contrast-enhanced CT of the abdomen.
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Shin, Dong Woo, Jaewon Park, Jong-Chan Lee, Jaihwan Kim, Young Hoon Kim, and Jin-Hyeok Hwang. "Multi-Phase, Contrast-Enhanced Computed Tomography-Based Radiomic Prognostic Marker of Non-Metastatic Pancreatic Ductal Adenocarcinoma." Cancers 14, no. 10 (2022): 2476. http://dx.doi.org/10.3390/cancers14102476.
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Background/Aim: This study investigated the predictive ability of intra-tumor enhancement on computed tomography (CT) for the outcomes of patients with pancreatic ductal adenocarcinoma (PDA). Methods: Multi-phase, contrast-enhanced CT (including unenhanced, pancreatic parenchymal phase (PPP) and portal venous phase (PVP)) images of patients diagnosed with non-metastatic PDA were analyzed to investigate prognostic factors. Results: Two hundred ninety-eight patients with PDA (159 with resectable pancreatic cancer (RPC) and 139 with borderline resectable pancreatic cancer (BRPC)/locally advanced pancreatic cancer (LAPC)) were included. The attenuation values of PDA during the PPP (94.5 vs. 60.7 HU; p <0.001) and PVP (101.5 vs. 75.5 HU; p <0.001) were higher in patients with RPC than in those with BRPC/LAPC. Well-enhanced PDA during the PPP was associated with longer overall survival in the RPC group (27.9 vs. 15.4 months; p <0.001) and the BRPC/LAPC group (22.7 vs. 13.6 months; p = 0.024). Patients with BRPC/LAPC who underwent neoadjuvant treatment and had well-enhanced PDA during the PPP were more likely to undergo resection. Although tumor size was also an independent prognostic factor, it was not correlated with intra-tumoral enhancement during the PPP. Conclusions: Intra-tumoral contrast enhancement on CT is an independent prognostic factor in patients with non-metastatic PDA.
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Lombardo, Michael, Martin Schneebeli, and Henning Löwe. "A casting method using contrast-enhanced diethylphthalate for micro-computed tomography of snow." Journal of Glaciology 67, no. 265 (2021): 847–61. http://dx.doi.org/10.1017/jog.2021.35.
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AbstractCasting snow is necessary to prevent metamorphism and deformation prior to X-ray micro-computed tomography (μCT) imaging. Current methods are insufficient for large-scale field sampling of snow due to safety considerations associated with the casting medium and/or lengthy sample preparation times. Here, a casting method using contrast-enhanced diethylphthalate (DEP) for μCT of snow is presented. The X-ray contrast of DEP is enhanced with barium titanate nanoparticles (BaTiO3) and iodine (I2). A partially unsupervised, three-phase segmentation method utilizing traditional Gaussian smoothing followed by a three-step process to address transition voxels is also presented. Synthetic images derived from real snow samples are used to evaluate the segmentation method with various configurations of trapped air bubbles. Real snow samples spanning a range of specific surface areas (SSAs) (8–28 m2 kg−1) and densities (135–463 kg m−3) are used to assess the performance of the segmentation method on real, cast samples. The method yields SSA, density and correlation length errors of less than 10% for synthetic images with air bubble surface areas less than 333 m−1 per sample volume for eight of the nine snow samples. For eight of the nine cast samples, the method yields errors of less than 10% for all three parameters.
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Ibrahim, Abdalla, Siddharth Guha, Lin Lu, et al. "The reproducibility and predictivity of radiomic features extracted from dynamic contrast-enhanced computed tomography of hepatocellular carcinoma." PLOS ONE 19, no. 9 (2024): e0310486. http://dx.doi.org/10.1371/journal.pone.0310486.
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Purpose To assess the reproducibility of radiomic features (RFs) extracted from dynamic contrast-enhanced computed tomography (DCE-CT) scans of patients diagnosed with hepatocellular carcinoma (HCC) with regards to inter-observer variability and acquisition timing after contrast injection. The predictive ability of reproducible RFs for differentiating between the degrees of HCC differentiation is also investigated. Methods We analyzed a set of DCE-CT scans of 39 patients diagnosed with HCC. Two radiologists independently segmented the scans, and RFs were extracted from each sequence of the DCE-CT scans. The same lesion was segmented across the DCE-CT sequences of each patient’s scan. From each lesion, 127 commonly used RFs were extracted. The reproducibility of RFs was assessed with regard to (i) inter-observer variability, by evaluating the reproducibility of RFs between the two radiologists; and (ii) timing of acquisition following contrast injection (inter- and intra-imaging phase). The reproducibility of RFs was assessed using the concordance correlation coefficient (CCC), with a cut-off value of 0.90. Reproducible RFs were used for building XGBoost classification models for the differentiation of HCC differentiation. Results Inter-observer analyses across the different contrast-enhancement phases showed that the number of reproducible RFs was 29 (22.8%), 52 (40.9%), and 36 (28.3%) for the non-contrast enhanced, late arterial, and portal venous phases, respectively. Intra- and inter-sequence analyses revealed that the number of reproducible RFs ranged between 1 (0.8%) and 47 (37%), inversely related with time interval between the sequences. XGBoost algorithms built using reproducible RFs in each phase were found to be high predictive ability of the degree of HCC tumor differentiation. Conclusions The reproducibility of many RFs was significantly impacted by inter-observer variability, and a larger number of RFs were impacted by the difference in the time of acquisition after contrast injection. Our findings highlight the need for quality assessment to ensure that scans are analyzed in the same physiologic imaging phase in quantitative imaging studies, or that phase-wide reproducible RFs are selected. Overall, the study emphasizes the importance of reproducibility and quality control when using RFs as biomarkers for clinical applications.
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Suttichaimongkol, Tanita, Kawin Tangvoraphonkchai, and Arin Pisanuwongse. "Mass-forming cholangiocarcinoma." Thai Journal of Hepatology 2, no. 1 (2019): 15–17. http://dx.doi.org/10.30856/h.jhep2019vol2iss1_05.
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Cholangiocarcinoma is the second most common primary liver cancers. It is arising from epithelial cells of the biliary tract. It has been categorized to intrahepatic and extrahepatic. The Intrahepatic orperipheral cholangiocarcinoma can be presented as mass-forming, periductal infiltrating and intraductal growth. Many patients of mass-forming cholangiocarcinoma have symptoms such as abdominal pain about 85% but some patients don’t have any symptoms. This is the difficult cancer to diagnose. While patients were having any symptom, the disease was an advanced stage (unresectable). The diagnostic tools for assess this disease are imaging modalities include ultrasound (US), computed tomography (CT) with contrast, magnetic resonance imaging (MRI) with contrast. However, the goal standard for confirm diagnosis is tissue pathology. This article showed a case presentation and reviewed the imaging appearance of mass-forming cholangiocarcinoma.
 
 Figure 1 Axial non-contrast (A), axial contrast enhanced in arterial phase (B), axial contrast enhanced in portal venous phase (C) and axial contrast enhanced in 5-minute delay phase (D) CT scans show a large ill-defined hypodense mass at hepatic segment 7/8, about 7.0x7.0x5.0 cm in APxLxH diameter, which has poor enhancement on arterial phase with gradual progressive enhancement on portal venous and 5-minute delay phase. Coronal contrast enhanced in portal venous phase CT scan (E) shows mass confined in peripheral area of right hepatic lobe with hepatic vein abutment.
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Honkanen, Miitu K. M., Annina E. A. Saukko, Mikael J. Turunen, et al. "Triple Contrast CT Method Enables Simultaneous Evaluation of Articular Cartilage Composition and Segmentation." Annals of Biomedical Engineering 48, no. 2 (2019): 556–67. http://dx.doi.org/10.1007/s10439-019-02362-6.
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Abstract Early degenerative changes of articular cartilage are detected using contrast-enhanced computed tomography (CT) with a cationic contrast agent (CA). However, cationic CA diffusion into degenerated cartilage decreases with proteoglycan depletion and increases with elevated water content, thus hampering tissue evaluation at early diffusion time points. Furthermore, the contrast at synovial fluid-cartilage interface diminishes as a function of diffusion time hindering accurate cartilage segmentation. For the first time, we employ quantitative dual-energy CT (QDECT) imaging utilizing a mixture of three CAs (cationic CA4+ and non-ionic gadoteridol which are sensitive to proteoglycan and water contents, respectively, and bismuth nanoparticles which highlight the cartilage surface) to simultaneously segment the articulating surfaces and determine of the cartilage condition. Intact healthy, proteoglycan-depleted, and mechanically injured bovine cartilage samples (n = 27) were halved and imaged with synchrotron microCT 2-h post immersion in triple CA or in dual CA (CA4+ and gadoteridol). CA4+ and gadoteridol partitions were determined using QDECT, and pairwise evaluation of these partitions was conducted for samples immersed in dual and triple CAs. In conclusion, the triple CA method is sensitive to proteoglycan depletion while maintaining sufficient contrast at the articular surface to enable detection of cartilage lesions caused by mechanical impact.
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Zouraq, Sara Azzabi, N. Bouardi, M. Haloua, et al. "Anterior Mediastinal Capillary Hemangioma: A Very Rare Finding." Scholars Journal of Medical Case Reports 11, no. 05 (2023): 831–34. http://dx.doi.org/10.36347/sjmcr.2023.v11i05.022.
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Hemangiomas are benign vascular tumors. Their location in the mediastinum represents a very rare finding. The definite diagnosis is sometimes difficult to make due to nonspecific features on single-phase contrast-enhanced computed tomography (CT) images. Our case shows a 53-year-old male that had presented with chest pain and dyspnea. On the dynamic CT study, there was a mediastinal mass that showed peripheral nodular enhancement on early phase images and progressive centripetal fill-in on delayed phase images. Hemangioma was preoperatively diagnosed on the basis of this characteristic CT appearance.
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Li, Ruimin, Hualei Gan, Shujuan Ni, Yi Fu, Hui Zhu, and Weijun Peng. "Differentiation of Gastric Schwannoma From Gastric Gastrointestinal Stromal Tumor With Dual-Phase Contrast-Enhanced Computed Tomography." Journal of Computer Assisted Tomography 43, no. 5 (2019): 741–46. http://dx.doi.org/10.1097/rct.0000000000000902.
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Mani, N. B. S., Sudha Suri, Sanjay Gupta, and J. D. Wig. "Two-phase dynamic contrast-enhanced computed tomography with water-filling method for staging of gastric carcinoma." Clinical Imaging 25, no. 1 (2001): 38–43. http://dx.doi.org/10.1016/s0899-7071(99)00134-5.
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Vos, Cornelis G., Ruben van Veen, Richte CL Schuurmann, Johannes T. Boersen, Daniel AF van den Heuvel, and Jean-Paul PM de Vries. "Subtraction computed tomography imaging to detect endoleaks after endovascular aneurysm sealing with sac anchoring." Vascular 26, no. 4 (2017): 393–99. http://dx.doi.org/10.1177/1708538117746041.
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Background Early detection of small type I endoleaks after endovascular aneurysm sealing is mandatory because they can rapidly progress and lead to severe complications. Recognition of endoleaks can be challenging due to the appearances on computed tomography unique to endovascular aneurysm sealing. We aimed to validate the accuracy and added value of subtraction computed tomography imaging using a post-processing software algorithm to improve detection of endovascular aneurysm sealing-associated endoleaks on postoperative surveillance imaging. Methods The computed tomography scans of 17 patients (16 males; median age: 78, range: 72–84) who underwent a post-endovascular aneurysm sealing computed tomography including both non-contrast and arterial phase series were used to validate the post processing software algorithm. Subtraction images are produced after segmentation and alignment. Initial alignment of the stent segmentations is automatically performed by registering the geometric centers of the 3D coordinates of both computed tomography series. Accurate alignment is then performed by translation with an iterative closest point algorithm. Accuracy of alignment was determined by calculating the root mean square error between matched 3D coordinates of stent segmentations. Results The median root mean square error after initial center of gravity alignment was 0.62 mm (IQR: 0.55–0.80 mm), which improved to 0.53 mm (IQR: 0.47–0.69 mm) after the ICP alignment. Visual inspection showed good alignment and no manual adjustment was necessary. Conclusions The possible merit of subtraction computed tomography imaging for the detection of small endoleaks during surveillance after endovascular aneurysm sealing was illustrated. Alignment of different computed tomography phases using a software algorithm was very accurate. Further studies are needed to establish the exact role of this technique during surveillance after endovascular aneurysm sealing compared to less invasive techniques like contrast-enhanced ultrasound.
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Chiu, William C., K. Shanmuganathan, Stuart E. Mirvis, and Thomas M. Scalea. "Determining the Need for Laparotomy in Penetrating Torso Trauma: A Prospective Study Using Triple-Contrast Enhanced Abdominopelvic Computed Tomography." Journal of Trauma: Injury, Infection, and Critical Care 51, no. 5 (2001): 860–69. http://dx.doi.org/10.1097/00005373-200111000-00007.
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