1
|
Gómez FM, Van der Reijd DJ, Panfilov IA, Baetens T, Wiese K, Haverkamp-Begemann N, Lam SW, Runge JH, Rice SL, Klompenhouwer EG, Maas M, Helmberger T, Beets-Tan RG. Imaging in interventional oncology, the better you see, the better you treat. J Med Imaging Radiat Oncol 2023; 67:895-902. [PMID: 38062853 DOI: 10.1111/1754-9485.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/22/2023] [Indexed: 01/14/2024]
Abstract
Imaging and image processing is the fundamental pillar of interventional oncology in which diagnostic, procedure planning, treatment and follow-up are sustained. Knowing all the possibilities that the different image modalities can offer is capital to select the most appropriate and accurate guidance for interventional procedures. Despite there is a wide variability in physicians preferences and availability of the different image modalities to guide interventional procedures, it is important to recognize the advantages and limitations for each of them. In this review, we aim to provide an overview of the most frequently used image guidance modalities for interventional procedures and its typical and future applications including angiography, computed tomography (CT) and spectral CT, magnetic resonance imaging, Ultrasound and the use of hybrid systems. Finally, we resume the possible role of artificial intelligence related to image in patient selection, treatment and follow-up.
Collapse
Affiliation(s)
- Fernando M Gómez
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Ilia A Panfilov
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Tarik Baetens
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kevin Wiese
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Siu W Lam
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jurgen H Runge
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Samuel L Rice
- Radiology, Interventional Radiology Section, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas Helmberger
- Institut für Radiologie, Neuroradiologie und Minimal-Invasive Therapie, München Klinik Bogenhausen, Munich, Germany
| | - Regina Gh Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| |
Collapse
|
2
|
Oh S, Kwon H, Lim K, Cho J, Kang E, Kim S, Baek Y. The feasibility of early response evaluation using superb microvascular imaging one day after transcatheter arterial chemoembolization for hepatocellular carcinoma. J Clin Ultrasound 2023; 51:866-875. [PMID: 36897661 DOI: 10.1002/jcu.23449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the feasibility of early Superb microvascular imaging (SMI) for prediction of the effect of HCC treatment after transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS A total of 96 HCCs (70 patients) treated with TACE between September 2021 and May 2022 were included in this study. SMI, Color Doppler imaging (CDI), and Power Doppler imaging (PDI) were performed the day after TACE for evaluation of intratumoral vascularity of the lesion using an Aplio500 ultrasound scanner (Toshiba Medical Systems, Corporation, Tochigi, Japan). Grading of the vascular presence was performed using a five-point scale. A dynamic CT image taken after 29-42 days was used for comparison of sensitivity, specificity, and accuracy for detection of tumor vascularity between SMI, CDI, and PDI. Univariate and multivariate analysis were performed for assessment of factors affecting intratumoral vascularity. RESULTS Fifty-eight lesions (60%) showed complete remission (CR) and 38 lesions (40%) showed partial response (PR) or no response at 29-42 days on Multi-detector Computed Tomography (MDCT) after TACE. SMI showed sensitivity of 86.84% for detection of intratumoral flow, which was significantly higher compared with that of CDI (10.53%, p < 0.001) and PDI (36.84%, p < 0.001). The results of multivariate analysis indicated that tumor size was a significant factor in detection of blood flow using the SMI technique. CONCLUSION Early SMI may be utilized as an adjunctive diagnostic test for evaluation of treated lesions after TACE, particularly when the location of the tumor is in an area of the liver where a suitable sonic window can be identified.
Collapse
Affiliation(s)
- Soeui Oh
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Heejin Kwon
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Kyungjae Lim
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Jinhan Cho
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Eunju Kang
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Sanghyun Kim
- Department of Radiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Yanghyun Baek
- Department of Internal Medicine, Dong-A University Hospital, Busan, Republic of Korea
| |
Collapse
|
3
|
Chai B, Xiang D, Wang W, Ren Y, Wang F, Wang J, Zhou G, Zheng C. Arterial enhancement fraction in evaluating the therapeutic effect and survival for hepatocellular carcinoma patients treated with DEB-TACE. Cancer Imaging 2022; 22:38. [PMID: 35908071 DOI: 10.1186/s40644-022-00477-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Arterial enhancement fraction (AEF), derived from triphasic CT scans, is considered to indirectly reflect the ratio of hepatic arterial perfusion to total perfusion. The purpose of this study was to retrospectively investigate the relationship between AEF and treatment response and survival in hepatocellular carcinoma (HCC) patients treated with drug-eluting bead (DEB) TACE. METHODS AEF of primary lesion (AEFpre) and residual tumor (AEFpost) in 158 HCC patients were obtained from triphasic liver CT examinations pre- and post-treatment. Wilcoxon-signed rank test was used to compare the AEFpre and AEFpost for different response groups. Survival curves for overall survival (OS) in patients with different AEF were created by using Kaplan-Meier method. Cox regression analyses were used to determine the association between AEF and OS. RESULTS There was no correlation between AEFpre and treatment response. After DEB-TACE, AEFpost was significantly lower than AEFpre either in the partial response group (38.9% vs. 52.7%, p < 0.001) or in the stable disease group (49.3% vs. 52.1%, p = 0.029). In the progression disease group, AEFpost was numerically higher than AEFpre (55.5% vs. 53.0%, p = 0.604). Cox regression analyses showed that risk of death increased in patients with AEFpre > 57.95% (HR = 1.66, p = 0.019) or AEFpost > 54.85% (HR = 2.47, p < 0.001), and the risk reduced in patients with any reduction in tumor AEF (decrease ratio ≥ 0) and with increased AEF but not exceeding the ratio of 0.102 (increase ratio < 0.102) (HR = 0.32, p < 0.001). CONCLUSIONS The change in AEF of viable tumor is correlated with response of HCC to DEB-TACE. In addition, the AEF could be a helpful predictor in future studies on the embolization treatment for HCC.
Collapse
|
4
|
Mohammadi A, Bartholmae W, Woisetschläger M. Comparison of multiphase data from CT perfusion vs clinical 4-phase CT scans with respect to image quality, lesion detection, and LI-RADS classification in HCC patients. Heliyon 2022; 8:e08757. [PMID: 35146150 PMCID: PMC8819526 DOI: 10.1016/j.heliyon.2022.e08757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/16/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose The aim of this study was to assess the image quality and diagnostic performance of reconstructed arterial (A) and portal venous (PV) phases in computed tomography perfusion (CTP) scans compared to the corresponding phases in standard 4-phase CT and to assess the utility for LI-RADS classification using CTP and 4-phase 4CT. Methods A total of 26 scans with each method (CTP and 4-phase CT) from 19 hepatocellular carcinoma patients were analyzed and compared. Arterial and PV phases reconstructed by advanced modeled iterative reconstruction at strength 4 (ADMIRE 4) from raw CTP data were compared with image sets from arterial and PV phases of 4-phase CT (ADMIRE 3) in the same patient with respect to image quality. Results Quantitative image analysis showed that reconstructed CTP datasets were equivalent to 4-phase CT image sets. Qualitative image analysis revealed similar lesion detection rates with the 2 methods for patients with an abdominal diameter ≤36 cm and body weight <90 kg, but lower detection rates with CTP for patients with an abdominal diameter >37 cm. There was no difference in Liver Imaging Reporting and Data System (LI-RADS) classifications between the 2 methods. Conclusion Reconstructed CTP images can potentially replace 4-phase CT images in patients weighing <90 kg and with a body diameter <37 cm, as the 2 methods are comparable in terms of quantitative image quality and ability to detect and classify lesions based on LI-RADS criteria. Reconstructed A- and PV-CTP images have comparable image quality to 4-phase CT. Reconstructed A- and PV-CTP images can be used for LI-RADS classification of HCC. A-/PV-CTP has the potential to reliably detect lesions in patients weighing <90 kg with body diameter ≤36 cm.
Collapse
Affiliation(s)
- A Mohammadi
- Department of Radiology, Department of Medical and Health Sciences, Linköping, Sweden
| | - W Bartholmae
- Department of Radiology, Department of Medical and Health Sciences, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - M Woisetschläger
- Department of Radiology, Department of Medical and Health Sciences, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| |
Collapse
|
5
|
Garbino N, Brancato V, Salvatore M, Cavaliere C. A Systematic Review on the Role of the Perfusion Computed Tomography in Abdominal Cancer. Dose Response 2021; 19:15593258211056199. [PMID: 34880716 PMCID: PMC8647276 DOI: 10.1177/15593258211056199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background and purpose Perfusion Computed Tomography (CTp) is an imaging technique which allows
quantitative and qualitative evaluation of tissue perfusion through dynamic
CT acquisitions. Since CTp is still considered a research tool in the field
of abdominal imaging, the aim of this work is to provide a systematic
summary of the current literature on CTp in the abdominal region to clarify
the role of this technique for abdominal cancer applications. Materials and Methods A systematic literature search of PubMed, Web of Science, and Scopus was
performed to identify original articles involving the use of CTp for
clinical applications in abdominal cancer since 2011. Studies were included
if they reported original data on CTp and investigated the clinical
applications of CTp in abdominal cancer. Results Fifty-seven studies were finally included in the study. Most of the included
articles (33/57) dealt with CTp at the level of the liver, while a low
number of studies investigated CTp for oncologic diseases involving UGI
tract (8/57), pancreas (8/57), kidneys (3/57), and colon–rectum (5/57). Conclusions Our study revealed that CTp could be a valuable functional imaging tool in
the field of abdominal oncology, particularly as a biomarker for monitoring
the response to anti-tumoral treatment.
Collapse
|
6
|
Mao X, Guo Y, Wen F, Liang H, Sun W, Lu Z. Applying arterial enhancement fraction (AEF) texture features to predict the tumor response in hepatocellular carcinoma (HCC) treated with Transarterial chemoembolization (TACE). Cancer Imaging 2021; 21:49. [PMID: 34384496 PMCID: PMC8359085 DOI: 10.1186/s40644-021-00418-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background To evaluate the application of Arterial Enhancement Fraction (AEF) texture features in predicting the tumor response in Hepatocellular Carcinoma (HCC) treated with Transarterial Chemoembolization (TACE) by means of texture analysis. Methods HCC patients treated with TACE in Shengjing Hospital of China Medical University from June 2018 to December 2019 were retrospectively enrolled in this study. Pre-TACE Contrast Enhanced Computed Tomography (CECT) and imaging follow-up within 6 months were both acquired. The tumor responses were categorized according to the modified RECIST (mRECIST) criteria. Based on the CECT images, Region of Interest (ROI) of HCC lesion was drawn, the AEF calculation and texture analysis upon AEF values in the ROI were performed using CT-Kinetics (C.K., GE Healthcare, China). A total of 32 AEF texture features were extracted and compared between different tumor response groups. Multi-variate logistic regression was performed using certain AEF features to build the differential models to predict the tumor response. The Receiver Operator Characteristic (ROC) analysis was implemented to assess the discriminative performance of these models. Results Forty-five patients were finally enrolled in the study. Eight AEF texture features showed significant distinction between Improved and Un-improved patients (p < 0.05). In multi-variate logistic regression, 9 AEF texture features were applied into modeling to predict “Improved” outcome, and 4 AEF texture features were applied into modeling to predict “Un-worsened” outcome. The Area Under Curve (AUC), diagnostic accuracy, sensitivity, and specificity of the two models were 0.941, 0.911, 1.000, 0.826, and 0.824, 0.711, 0.581, 1.000, respectively. Conclusions Certain AEF heterogeneous features of HCC could possibly be utilized to predict the tumor response to TACE treatment.
Collapse
Affiliation(s)
- Xiaonan Mao
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Yan Guo
- GE Healthcare (China), Shanghai, China
| | - Feng Wen
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Hongyuan Liang
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Wei Sun
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Zaiming Lu
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China.
| |
Collapse
|
7
|
Mottola M, Bevilacqua A. Reproducibility of Computed Tomography perfusion parameters in hepatic multicentre study in patients with colorectal cancer. Biomed Signal Process Control 2021; 64:102298. [DOI: 10.1016/j.bspc.2020.102298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
8
|
Abstract
Convective transport is an important phenomenon for nanomedicine delivery. We present an imaging-based approach to recover tissue properties that are significant in the accumulation of nanoparticles delivered via systemic methods. The classical pharmacokinetic analysis develops governing equations for the particle transport from a first principle mass balance. Fundamentally, the governing equations for compartmental mass balance represent a spatially invariant mass transport between compartments and do not capture spatially variant convection phenomena. Further, the parameters recovered from this approach do not necessarily have direct meaning with respect to the governing equations for convective transport. In our approach, a framework is presented for directly measuring permeability in the sense of Darcy flow through porous tissue. Measurements from our approach are compared to an extended Tofts model as a control. We demonstrate that a pixel-wise iterative clustering algorithm may be applied to reduce the parameter space of the measurements. We show that measurements obtained from our approach are correlated with measurements obtained from the extended Tofts model control. These correlations demonstrate that the proposed approach contains similar information to an established compartmental model and may be useful in providing an alternative theoretical framework for parameterizing mathematical models for treatment planning and diagnostic studies involving nanomedicine where convection dominated effects are important.
Collapse
Affiliation(s)
- D Fuentes
- Departments of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.,Department of Computational and Applied Mathematics, Rice University, Houston, TX, USA
| | - E Thompson
- Departments of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - M Jacobsen
- Departments of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - A Colleen Crouch
- Interventional Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - R R Layman
- Departments of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - B Riviere
- Department of Computational and Applied Mathematics, Rice University, Houston, TX, USA
| | - E Cressman
- Interventional Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
9
|
Woeste MR, Geller AE, Martin RCG, Polk HC. Optimizing the Combination of Immunotherapy and Trans-Arterial Locoregional Therapy for Stages B and C Hepatocellular Cancer. Ann Surg Oncol 2021; 28:1499-1510. [PMID: 33393028 DOI: 10.1245/s10434-020-09414-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC), the most common primary hepatic malignancy worldwide, is the second leading cause of cancer-related death. Underlying liver dysfunction and advanced stage of disease require treatments to be optimally timed and implemented to minimize hepatic parenchymal damage while maximizing disease response and quality of life. Locoregional therapies (LRTs) such as trans-arterial chemo- and radio-embolization remain effective for intermediate liver-only and advanced HCC disease (i.e., Barcelona-Clinic liver cancer stages B and C) not amendable to primary resection or ablation. Additionally, these minimally invasive interventions have been shown to augment the immune system. This and the recent success of immune-oncologic treatments for HCC have generated interest in applying these therapies in combination with such locoregional interventions to improve patient outcomes and response rates. This report reviews the use of trans-arterial LRTs with immunotherapy for stages B and C HCC, potential biomarkers, and imaging methods for assessing the response and safety of such combinations.
Collapse
Affiliation(s)
- Matthew R Woeste
- Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Department of Microbiology and Immunology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Anne E Geller
- Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Department of Microbiology and Immunology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Robert C G Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
| | - Hiram C Polk
- Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| |
Collapse
|
10
|
Gupta P, Kalra N, Gulati A, Dev V, Gorsi U, Cheluvashetty SB, Kumar-M P, Duseja A, Singh V, Dhiman RK, Sandhu MS. Response Assessment Following Image-Guided Therapy of Hepatocellular Carcinoma. Journal of Clinical Interventional Radiology ISVIR 2020. [DOI: 10.1055/s-0040-1708579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractImage-guided locoregional therapies have an important role in the management of patients with hepatocellular carcinoma (HCC). Recent advances in the ablative as well as endovascular therapies have expanded the role of interventional radiologists in the treatment of HCC. Following image-guided therapy, an accurate response assessment is vital. Knowledge regarding normal postprocedure changes and subtle signs of residual or recurrent disease is important. In this review, we discuss various response evaluation criteria currently employed for HCC. We also discuss the postprocedure imaging features suggestive of residual disease or recurrence and imaging biomarkers for response assessment.
Collapse
Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Gulati
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishnu Dev
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sreedhara B. Cheluvashetty
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
11
|
Weiss J, Ruff C, Grosse U, Grözinger G, Horger M, Nikolaou K, Gatidis S. Assessment of Hepatic Perfusion Using GRASP MRI: Bringing Liver MRI on a New Level. Invest Radiol 2019; 54:737-43. [PMID: 31206392 DOI: 10.1097/RLI.0000000000000586] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to demonstrate the feasibility of hepatic perfusion imaging using dynamic contrast-enhanced (DCE) golden-angle radial sparse parallel (GRASP) magnetic resonance imaging (MRI) for characterizing liver parenchyma and hepatocellular carcinoma (HCC) before and after transarterial chemoembolization (TACE) as a potential alternative to volume perfusion computed tomography (VPCT). METHODS AND MATERIALS Between November 2017 and September 2018, 10 patients (male = 8; mean age, 66.5 ± 8.6 years) with HCC were included in this prospective, institutional review board-approved study. All patients underwent DCE GRASP MRI with high spatiotemporal resolution after injection of liver-specific MR contrast agent before and after TACE. In addition, VPCT was acquired before TACE serving as standard of reference. From the dynamic imaging data of DCE MRI and VPCT, perfusion maps (arterial liver perfusion [mL/100 mL/min], portal liver perfusion [mL/100 mL/min], hepatic perfusion index [%]) were calculated using a dual-input maximum slope model and compared with assess perfusion measures, lesion characteristics, and treatment response using Wilcoxon signed-rank test. To evaluate interreader agreement for measurement repeatability, the interclass correlation coefficient (ICC) was calculated. RESULTS Perfusion maps could be successfully generated from all DCE MRI and VPCT data. The ICC was excellent for all perfusion maps (ICC ≥ 0.88; P ≤ 0.001). Image analyses revealed perfusion parameters for DCE MRI and VPCT within the same absolute range for tumor and liver tissue. Dynamic contrast-enhanced MRI further enabled quantitative assessment of treatment response showing a significant decrease (P ≤ 0.01) of arterial liver perfusion and hepatic perfusion index in the target lesion after TACE. CONCLUSIONS Dynamic contrast-enhanced GRASP MRI allows for a reliable and robust assessment of hepatic perfusion parameters providing quantitative results comparable to VPCT and enables characterization of HCC before and after TACE, thus posing the potential to serve as an alternative to VPCT.
Collapse
|
12
|
Cruz JC, Watchmaker JM, Albin MM, Wang L, Wu G, Baker JC, Fritsche MR, Alexopoulos SP, Matsuoka L, Fleming JW, Su J, Borgmann AJ, Banovac F, Brown DB. Neutrophil/Lymphocyte Ratio Predicts Increased Risk of Immediate Progressive Disease following Chemoembolization of Hepatocellular Carcinoma. J Vasc Interv Radiol 2019; 30:1887-1892. [PMID: 31669086 DOI: 10.1016/j.jvir.2019.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/19/2019] [Accepted: 08/04/2019] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To demonstrate that patients with hepatocellular carcinoma (HCC) and elevated baseline neutrophil/lymphocyte ratio (NLR) have a significantly greater risk of progressive disease following initial transarterial chemoembolization. MATERIALS AND METHODS A total of 190 HCC patients (149 male/41 female) treated with transarterial chemoembolization between July 2013 and July 2017 were reviewed. Mean patient age was 62. Child-Pugh grades were 132 A, 61 B, and 4 C. Tracked criteria included etiology of cirrhosis, tumor number, Barcelona Clinic Liver Cancer score, diameter of the largest 2 tumors, and presence of portal vein thrombosis. Complete blood count with differential before the procedure was used for NLR calculation. Follow-up imaging was performed 2 months after treatment. The modified response evaluation criteria in solid tumors were used to assess response. The association between baseline NLR and tumor response (ordinal modified response evaluation criteria in solid tumors categories) on 2-month follow-up imaging was evaluated using the proportional odds logistic regression model. RESULTS A total of 194 patients (76.6%) patients had a preprocedural NLR <3.5, and 59 (23%) patients had a preprocedural NLR ≥3.5. There was a statistically significant association between baseline NLR and immediate progression on 2-month follow-up imaging (mean NLR 4.10, 2.76, 2.72, and 2.48 for progressive and stable disease and partial and complete response, respectively; odds ratio 2.1, P = .04). NLR (P = .021) and tumor multiplicity (P = .011) predicted progressive disease at 2-month imaging. CONCLUSIONS Elevated baseline NLR is associated with higher rates of HCC tumor progression at 2-month follow-up imaging after transarterial chemoembolization.
Collapse
Affiliation(s)
- Jeffrey C Cruz
- Division of Interventional Radiology, Vanderbilt University Medical Center, 1161 Medical Center Drive, CCC-1118 Medical Center North, Nashville, TN 37232
| | | | - Matthias M Albin
- Division of Interventional Radiology, Vanderbilt University Medical Center, 1161 Medical Center Drive, CCC-1118 Medical Center North, Nashville, TN 37232
| | - Li Wang
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Gong Wu
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jennifer C Baker
- Division of Interventional Radiology, Vanderbilt University Medical Center, 1161 Medical Center Drive, CCC-1118 Medical Center North, Nashville, TN 37232
| | - Micah R Fritsche
- Division of Interventional Radiology, Vanderbilt University Medical Center, 1161 Medical Center Drive, CCC-1118 Medical Center North, Nashville, TN 37232
| | - Sophoclis P Alexopoulos
- Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lea Matsuoka
- Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jacob W Fleming
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - James Su
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Anthony J Borgmann
- Division of Interventional Radiology, Vanderbilt University Medical Center, 1161 Medical Center Drive, CCC-1118 Medical Center North, Nashville, TN 37232
| | - Filip Banovac
- Division of Interventional Radiology, Vanderbilt University Medical Center, 1161 Medical Center Drive, CCC-1118 Medical Center North, Nashville, TN 37232
| | - Daniel B Brown
- Division of Interventional Radiology, Vanderbilt University Medical Center, 1161 Medical Center Drive, CCC-1118 Medical Center North, Nashville, TN 37232.
| |
Collapse
|
13
|
Abstract
PURPOSE To quantitate the tumor blush of hepatocellular carcinoma (HCC) at the time of transarterial chemoembolization (TACE) using principal component analysis (PCA), and to correlate the quantitated tumor blush to response to therapy. MATERIALS AND METHODS In this proof-of-concept study, 27 primary HCC tumors in 25 patients (18 men, 7 women; mean age 66 years ± 9) were analyzed. We conducted a retrospective analysis of TACE procedures that were performed during March through July of 2017. Digital subtraction angiography (DSA) was combined with PCA to condense spatial and temporal information into a single image. The tumor and liver contrast enhancements were calculated, and the ratio was used to determine the relative vascular enhancement of the tumor. Tumor response to therapy was determined at 1-month post procedure. RESULTS Using PCA-generated fluoroscopic imaging (PCA-FI), we quantitated the tumor blush and assigned a vascular enhancement value (VEV) to each tumor. Tumors that responded to treatment (N = 12) had statistically higher VEVs compared with the nonresponders (N = 15), with a mean value of 0.96 ± 0.455 vs. 0.57 ± 0.309, (p = 0.013). CONCLUSIONS We developed a method for quantitating tumor blush using routine angiographic images. The VEVs calculated using these images may allow for the prediction of tumor response to therapy. This pilot study suggests that there is a correlation between tumor blush intensity and tumor response.
Collapse
Affiliation(s)
- Jessica P Miller
- Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| | - Raja Ramaswamy
- Department of Interventional Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Olaguoke Akinwande
- Department of Interventional Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St. Louis, MO, 63110, USA
| |
Collapse
|
14
|
Bevilacqua A, Malavasi S, Vilgrain V. Liver CT perfusion: which is the relevant delay that reduces radiation dose and maintains diagnostic accuracy? Eur Radiol 2019; 29:6550-6558. [PMID: 31115620 DOI: 10.1007/s00330-019-06259-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/20/2019] [Accepted: 04/30/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES High radiation dose during CT perfusion (CTp) studies contributes to prevent CTp application in daily clinical practice. This work evaluates the consequences of scan delay on perfusion parameters and provides guidelines to help reducing the radiation dose by choosing the most appropriate delay. METHODS Fifty-nine patients (34 men, 25 women; mean age 68 ± 12) with colorectal cancer, without underlying liver disease, underwent liver CTp, with the acquisition starting simultaneously with iodinated contrast agent injection. Blood flow (BF) and hepatic perfusion index (HPI) were computed on the acquired examinations and compared with those of the same examinations when a variable scan delay (τ) is introduced. Dose length product, CT dose index, and effective dose were also computed on original and delayed examinations. RESULTS Altogether, three groups of delays (τ ≤ 4 s, 5 s ≤ τ ≤ 9 s, τ ≥ 10 s) were identified, yielding increasing radiation dose saving (RDS) (RDS ≤ 9.5%, 11.9% ≤ RDS ≤ 21.4%, RDS ≥ 23.8%) and decreasing perfusion accuracy (high (τ ≤ 4 s), medium (5 s ≤ τ ≤ 9 s), low (τ ≥ 10 s)). In particular, single-input and arterial BF and HPI were more insensitive to delay as regards the absolute variations (only 1 ml/min/100 g and 1%, respectively, for τ ≤ 9 s), than portal and total BF. CONCLUSION Using delays lower than 4 s does not change perfusion accuracy and conveys unnecessary dose to patients. Conversely, starting the acquisition 9 s after contrast agent injection yields a RDS of about 21%, with no significant losses in perfusion accuracy. KEY POINTS • Scan delays lower than 4 s do not alter perfusion accuracy and deliver an unnecessary radiation dose to patients. • Radiation dose delivered to patients can be reduced by 21.4% by introducing a 9-s scan delay, while keeping accurate perfusion values. • Using scan delays higher than 10 s, some perfusion parameters (portal and total BF) were inaccurate.
Collapse
Affiliation(s)
- Alessandro Bevilacqua
- DISI (Department of Computer Science and Engineering), University of Bologna, Viale Risorgimento, 2, I-40136, Bologna, Italy.,ARCES (Advanced Research Center on Electronic Systems), University of Bologna, Via Toffano 2/2, I-40125, Bologna, Italy
| | - Silvia Malavasi
- ARCES (Advanced Research Center on Electronic Systems), University of Bologna, Via Toffano 2/2, I-40125, Bologna, Italy.,CIG (Interdepartmental Centre "L. Galvani" for integrated studies of Bioinformatics, Biophysics and Biocomplexity), University of Bologna, Via Petroni 26, I-40126, Bologna, Italy
| | - Valérie Vilgrain
- Department of Radiology, Assistance-Publique Hôpitaux de Paris, APHP, HUPNVS, Hôpital Beaujon, 100 bd du Général Leclerc, 92110, Clichy, France. .,Sorbonne Paris Cité, INSERM CRI, Université Paris Diderot, 75018, Paris, France.
| |
Collapse
|
15
|
Ruff C, Grözinger G, Syha R, Elser S, Partovi S, Bitzer M, Horger M, Nikolaou K, Grosse U. Transarterial Chemoembolization of Hepatocellular Carcinoma Using Radiopaque Drug-Eluting Embolics: How to Pursue Periprocedural Cross-Sectional Imaging? J Vasc Interv Radiol 2019; 30:380-389.e4. [PMID: 30819480 DOI: 10.1016/j.jvir.2018.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/31/2018] [Accepted: 09/01/2018] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To compare different imaging techniques (volume perfusion CT, cone-beam CT, and dynamic gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced dynamic contrast-enhanced MR imaging with golden-angle radial sparse parallel MR imaging) in evaluation of transarterial chemoembolization of hepatocellular carcinoma (HCC) using radiopaque drug-eluting embolics (DEE). MATERIALS AND METHODS MR imaging and CT phantom investigation of radiopaque DEE was performed. In the clinical portion of the study, 13 patients (22 HCCs) were prospectively enrolled. All patients underwent cross-sectional imaging before and after transarterial chemoembolization using 100-300 μm radiopaque DEE. Qualitative assessment of images using a Likert scale was performed. RESULTS In the phantom study, CT-related beam-hardening artifacts were markedly visible at a concentration of 12% (v/v) radiopaque DEE; MR imaging demonstrated no significant detectable signal intensity changes. Imaging obtained before transarterial chemoembolization showed no significant difference regarding tumor depiction. Visualization of tumor feeding arteries was significantly improved with volume perfusion CT (P < .001) and cone-beam CT (P = .002) compared with MR imaging. Radiopaque DEE led to significant decrease in tumor depiction (P = .001) and significant increase of beam-hardening artifacts (P = .012) using volume perfusion CT before versus after transarterial chemoembolization. Greater residual arterial tumor enhancement was detected with MR imaging (10 HCCs) compared with volume perfusion CT (8 HCCs) and cone-beam CT (6 HCCs). CONCLUSIONS Using radiopaque DEE, the imaging modalities provided comparable early treatment assessment. In HCCs with dense accumulation of radiopaque DEE, treatment assessment using volume perfusion CT or cone-beam CT may be impaired owing to resulting beam-hardening artifacts and contrast stasis. Dynamic contrast-enhanced MR imaging may add value in detection of residual arterial tumor enhancement.
Collapse
|
16
|
Lee H, Hong H, Seong J, Kim JS, Kim J. Treatment Response Prediction of Hepatocellular Carcinoma Patients from Abdominal CT Images with Deep Convolutional Neural Networks. Predictive Intelligence in Medicine 2019. [DOI: 10.1007/978-3-030-32281-6_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
17
|
Bayle M, Clerc-Urmès I, Ayav A, Bronowicki JP, Petit I, Orry X, Laurent V. Computed tomographic perfusion with 160-mm coverage: comparative analysis of hepatocellular carcinoma treated by two transarterial chemoembolization courses relative to magnetic resonance imaging findings. Abdom Radiol (NY) 2019; 44:85-94. [PMID: 30054686 DOI: 10.1007/s00261-018-1714-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study was to assess hepatocellular carcinoma (HCC) response with CT perfusion parameters before and after two transarterial chemo embolization (TACE) courses compared with MRI, and to search for predictive factors of response. METHODS 37 lesions (19 patients) were included between October 2015 and September 2017, based on the Barcelona Clinic Liver Cancer guidelines. CT perfusion with 160-mm coverage and MRI were performed before and after the first TACE course, and after the second TACE course. Quantitative perfusion parameters were compared to the response assessed with MRI using mRECIST criteria, defining response groups: complete response (CR), partial response (PR), no response (NR), response (including CR and PR), no complete response (NCR, including PR and NR). RESULTS Pre-TACE blood flow (BF) and hepatic arterial blood flow (HABF) were significantly higher in lesions with post-TACE 1 CR than in those with NCR (BF: 118.8 vs. 76.3 mL/100 g/min, p = 0.0231; HABF: 76 vs. 44.2 mL/100 g/min, p = 0.0112). Pre-TACE time to peak (TTP) and mean transit time (MTT) were significantly lower in lesions with post-TACE 2 response than in those with NR (TTP: 31.5 vs. 46.1 s, p = 0.0313; MTT: 15.8 vs. 22.8 s, p = 0.0204). Post-TACE 1 and post-TACE 2 perfusion parameters did not exhibit any statistically significant differences relative to MRI response. CONCLUSION Our study did not find, after a first TACE course, perfusion parameters associated with a response to a second TACE course. However, baseline perfusion parameters analysis could lead to better therapeutic management of HCC by targeting lesions likely to respond well to TACE courses.
Collapse
Affiliation(s)
- Matthieu Bayle
- Department of Radiology, CHRU Nancy, Brabois Adults Hospital, 54500, Vandoeuvre-lès-Nancy, France.
| | | | - Ahmet Ayav
- Department of HBP Surgery, CHRU Nancy, Brabois Adults Hospital, 54500, Vandoeuvre-lès-Nancy, France
- Université de Lorraine, Faculté de Médecine, 54500, Vandoeuvre-lès-Nancy, France
| | - Jean-Pierre Bronowicki
- Université de Lorraine, Faculté de Médecine, 54500, Vandoeuvre-lès-Nancy, France
- Department of Hepato-gastroenterology, CHRU Nancy, Brabois Adults Hospital, 54500, Vandoeuvre-lès-Nancy, France
- INSERM, U954, Vandoeuvre-lès-Nancy, France
| | - Isabelle Petit
- Department of Radiology, CHRU Nancy, Brabois Adults Hospital, 54500, Vandoeuvre-lès-Nancy, France
| | - Xavier Orry
- Department of Radiology, CHRU Nancy, Brabois Adults Hospital, 54500, Vandoeuvre-lès-Nancy, France
| | - Valérie Laurent
- Department of Radiology, CHRU Nancy, Brabois Adults Hospital, 54500, Vandoeuvre-lès-Nancy, France
- Université de Lorraine, Faculté de Médecine, 54500, Vandoeuvre-lès-Nancy, France
- INSERM, U947, IADI, 54000, Vandoeuvre-lès-Nancy, France
| |
Collapse
|
18
|
Vande Lune P, Abdel Aal AK, Klimkowski S, Zarzour JG, Gunn AJ. Hepatocellular Carcinoma: Diagnosis, Treatment Algorithms, and Imaging Appearance after Transarterial Chemoembolization. J Clin Transl Hepatol 2018; 6:175-188. [PMID: 29951363 PMCID: PMC6018317 DOI: 10.14218/jcth.2017.00045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/02/2017] [Accepted: 12/02/2017] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a common cause of cancer-related death, with incidence increasing worldwide. Unfortunately, the overall prognosis for patients with HCC is poor and many patients present with advanced stages of disease that preclude curative therapies. Diagnostic and interventional radiologists play a key role in the management of patients with HCC. Diagnostic radiologists can use contrast-enhanced computed tomography (CT), magnetic resonance imaging, and ultrasound to diagnose and stage HCC, without the need for pathologic confirmation, by following established criteria. Once staged, the interventional radiologist can treat the appropriate patients with percutaneous ablation, transarterial chemoembolization, or radioembolization. Follow-up imaging after these liver-directed therapies for HCC can be characterized according to various radiologic response criteria; although, enhancement-based criteria, such as European Association for the Study of the Liver and modified Response Evaluation Criteria in Solid Tumors, are more reflective of treatment effect in HCC. Newer imaging technologies like volumetric analysis, dual-energy CT, cone beam CT and perfusion CT may provide additional benefits for patients with HCC.
Collapse
Affiliation(s)
- Patrick Vande Lune
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Ahmed K. Abdel Aal
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sergio Klimkowski
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessica G. Zarzour
- Division of Abdominal Imaging, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew J. Gunn
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
- *Correspondence to: Andrew J. Gunn, Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, 619 19 St S, NHB 623, Birmingham, AL 35249, USA. Tel: +1-205-975-4850, Fax: +1-205-975-5257, E-mail:
| |
Collapse
|
19
|
Jiang HY, Chen J, Xia CC, Cao LK, Duan T, Song B. Noninvasive imaging of hepatocellular carcinoma: From diagnosis to prognosis. World J Gastroenterol 2018; 24:2348-2362. [PMID: 29904242 PMCID: PMC6000290 DOI: 10.3748/wjg.v24.i22.2348] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a major public health problem worldwide. Hepatocarcinogenesis is a complex multistep process at molecular, cellular, and histologic levels with key alterations that can be revealed by noninvasive imaging modalities. Therefore, imaging techniques play pivotal roles in the detection, characterization, staging, surveillance, and prognosis evaluation of HCC. Currently, ultrasound is the first-line imaging modality for screening and surveillance purposes. While based on conclusive enhancement patterns comprising arterial phase hyperenhancement and portal venous and/or delayed phase wash-out, contrast enhanced dynamic computed tomography and magnetic resonance imaging (MRI) are the diagnostic tools for HCC without requirements for histopathologic confirmation. Functional MRI techniques, including diffusion-weighted imaging, MRI with hepatobiliary contrast agents, perfusion imaging, and magnetic resonance elastography, show promise in providing further important information regarding tumor biological behaviors. In addition, evaluation of tumor imaging characteristics, including nodule size, margin, number, vascular invasion, and growth patterns, allows preoperative prediction of tumor microvascular invasion and patient prognosis. Therefore, the aim of this article is to review the current state-of-the-art and recent advances in the comprehensive noninvasive imaging evaluation of HCC. We also provide the basic key concepts of HCC development and an overview of the current practice guidelines.
Collapse
Affiliation(s)
- Han-Yu Jiang
- Department of Radiology, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Jie Chen
- Department of Radiology, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Chun-Chao Xia
- Department of Radiology, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Li-Kun Cao
- Department of Radiology, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Ting Duan
- Department of Radiology, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Bin Song
- Department of Radiology, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
| |
Collapse
|