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Graafen D, Müller L, Halfmann MC, Stoehr F, Foerster F, Düber C, Yang Y, Emrich T, Kloeckner R. Soft Reconstruction Kernels Improve HCC Imaging on a Photon-Counting Detector CT. Acad Radiol 2023; 30 Suppl 1:S143-S154. [PMID: 37095047 DOI: 10.1016/j.acra.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/08/2023] [Accepted: 03/20/2023] [Indexed: 04/26/2023]
Abstract
RATIONALE AND OBJECTIVES Hepatocellular carcinoma (HCC) is the only tumor entity that allows non-invasive diagnosis based on imaging without further histological proof. Therefore, excellent image quality is of utmost importance for HCC diagnosis. Novel photon-counting detector (PCD) CT improves image quality via noise reduction and higher spatial resolution, inherently providing spectral information. The aim of this study was to investigate these improvements for HCC imaging with triple-phase liver PCD-CT in a phantom and patient population study focusing on identification of the optimal reconstruction kernel. MATERIALS AND METHODS Phantom experiments were performed to analyze objective quality characteristics of the regular body and quantitative reconstruction kernels, each with four sharpness levels (36-40-44-48). For 24 patients with viable HCC lesions on PCD-CT, virtual monoenergetic images at 50 keV were reconstructed using these kernels. Quantitative image analysis included contrast-to-noise ratio (CNR) and edge sharpness. Three raters performed qualitative analyses evaluating noise, contrast, lesion conspicuity, and overall image quality. RESULTS In all contrast phases, the CNR was highest using the kernels with a sharpness level of 36 (all p < 0.05), with no significant influence on lesion sharpness. Softer reconstruction kernels were also rated better regarding noise and image quality (all p < 0.05). No significant differences were found in image contrast and lesion conspicuity. Comparing body and quantitative kernels with equal sharpness levels, there was no difference in image quality criteria, neither regarding in vitro nor in vivo analysis. CONCLUSION Soft reconstruction kernels yield the best overall quality for the evaluation of HCC in PCD-CT. As the image quality of quantitative kernels with potential for spectral post-processing is not restricted compared to regular body kernels, they should be preferred.
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Affiliation(s)
- D Graafen
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (D.G., L.M., M.C.H., F.S., C.D., Y.Y., T.E., R.K.).
| | - L Müller
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (D.G., L.M., M.C.H., F.S., C.D., Y.Y., T.E., R.K.)
| | - M C Halfmann
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (D.G., L.M., M.C.H., F.S., C.D., Y.Y., T.E., R.K.); German Center for Cardiovascular Research (DZHK), Partner-Site Rhine-Main, Mainz, Germany (M.C.H., T.E.)
| | - F Stoehr
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (D.G., L.M., M.C.H., F.S., C.D., Y.Y., T.E., R.K.)
| | - F Foerster
- Department of Medicine I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (F.F.)
| | - C Düber
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (D.G., L.M., M.C.H., F.S., C.D., Y.Y., T.E., R.K.)
| | - Y Yang
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (D.G., L.M., M.C.H., F.S., C.D., Y.Y., T.E., R.K.)
| | - T Emrich
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (D.G., L.M., M.C.H., F.S., C.D., Y.Y., T.E., R.K.); German Center for Cardiovascular Research (DZHK), Partner-Site Rhine-Main, Mainz, Germany (M.C.H., T.E.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E.)
| | - R Kloeckner
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (D.G., L.M., M.C.H., F.S., C.D., Y.Y., T.E., R.K.)
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Graafen D, Stoehr F, Halfmann MC, Emrich T, Foerster F, Yang Y, Düber C, Müller L, Kloeckner R. Quantum iterative reconstruction on a photon-counting detector CT improves the quality of hepatocellular carcinoma imaging. Cancer Imaging 2023; 23:69. [PMID: 37480062 PMCID: PMC10362630 DOI: 10.1186/s40644-023-00592-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/08/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Excellent image quality is crucial for workup of hepatocellular carcinoma (HCC) in patients with liver cirrhosis because a signature tumor signal allows for non-invasive diagnosis without histologic proof. Photon-counting detector computed tomography (PCD-CT) can enhance abdominal image quality, especially in combination with a novel iterative reconstruction algorithm, quantum iterative reconstruction (QIR). The purpose of this study was to analyze the impact of different QIR levels on PCD-CT imaging of HCC in both phantom and patient scans. METHODS Virtual monoenergetic images at 50 keV were reconstructed using filtered back projection and all available QIR levels (QIR 1-4). Objective image quality properties were investigated in phantom experiments. The study also included 44 patients with triple-phase liver PCD-CT scans of viable HCC lesions. Quantitative image analysis involved assessing the noise, contrast, and contrast-to-noise ratio of the lesions. Qualitative image analysis was performed by three raters evaluating noise, artifacts, lesion conspicuity, and overall image quality using a 5-point Likert scale. RESULTS Noise power spectra in the phantom experiments showed increasing noise suppression with higher QIR levels without affecting the modulation transfer function. This pattern was confirmed in the in vivo scans, in which the lowest noise levels were found in QIR-4 reconstructions, with around a 50% reduction in median noise level compared with the filtered back projection images. As contrast does not change with QIR, QIR-4 also yielded the highest contrast-to-noise ratios. With increasing QIR levels, rater scores were significantly better for all qualitative image criteria (all p < .05). CONCLUSIONS Without compromising image sharpness, the best image quality of iodine contrast optimized low-keV virtual monoenergetic images can be achieved using the highest QIR level to suppress noise. Using these settings as standard reconstruction for HCC in PCD-CT imaging might improve diagnostic accuracy and confidence.
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Affiliation(s)
- Dirk Graafen
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Fabian Stoehr
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Moritz C Halfmann
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner-Site Rhine-Main, Mainz, Germany
| | - Tilman Emrich
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner-Site Rhine-Main, Mainz, Germany
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Friedrich Foerster
- Department of Medicine I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Yang Yang
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Christoph Düber
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lukas Müller
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Roman Kloeckner
- Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Present Address: Institute of Interventional Radiology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Agostini A, Borgheresi A, Mariotti F, Ottaviani L, Carotti M, Valenti M, Giovagnoni A. New frontiers in oncological imaging with Computed Tomography: from morphology to function. Semin Ultrasound CT MR 2023; 44:214-227. [DOI: 10.1053/j.sult.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. JOURNAL OF LIVER CANCER 2023; 23:1-120. [PMID: 37384024 PMCID: PMC10202234 DOI: 10.17998/jlc.2022.11.07] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 06/30/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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Affiliation(s)
- Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea
- Corresponding author: KLCA-NCC Korea Practice Guideline Revision Committee (KPGRC) (Committee Chair: Joong-Won Park) Center for Liver and Pancreatobiliary Cancer, Division of Gastroenterology, Department of Internal Medicine, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea Tel. +82-31-920-1605, Fax: +82-31-920-1520, E-mail:
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Added value of contrast enhancement boost images in routine multiphasic contrast-enhanced CT for the diagnosis of small (<20 mm) hypervascular hepatocellular carcinoma. Eur J Radiol 2023; 160:110696. [PMID: 36680909 DOI: 10.1016/j.ejrad.2023.110696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate the added value of contrast enhancement boost (CE-boost) images in multiphasic contrast-enhanced CT (CE-CT) for diagnosing small (<20 mm) hypervascular hepatocellular carcinoma (HCC). MATERIALS AND METHODS This retrospective study included 69 patients (age, 74 ± 8 years; 52 men) with 70 hypervascular HCCs (<20 mm) who underwent multiphasic CE-CT (pre-contrast, late arterial phase [LAP], portal venous phase [PVP], and equilibrium phase). Two types of CE-boost images were generated by subtracting PVP from LAP (LA-PV) images and LAP from PVP (PV-LA) images to enhance the contrast effect of hepatic arterial and portal venous perfusion more selectively. Tumor-to-liver contrast-to-noise ratios (CNRs) in CE-boost images were compared with those in CE-CT images using the Wilcoxon signed-rank test. Two independent readers reviewed the imaging datasets: CE-CT alone and CE-CT with CE-boost images. The diagnostic performance of each dataset was compared using jackknife alternative free-response receiver operating characteristics (JAFROC-1). RESULTS The tumor-to-liver CNRs in the LA-PV (6.4 ± 3.0) and PV-LA (-3.3 ± 2.1) images were greater than those in the LAP (3.2 ± 1.7) and PVP images (-1.1 ± 1.4) (p <.001 for both). The reader-averaged figures of merit were 0.751 for CE-CT alone and 0.807 for CE-CT with CE-boost images (p <.001). Sensitivities increased by adding CE-boost images for both readers (p <.001 and = 0.03), while positive predictive values were equivalent (p >.99). CONCLUSION Adding CE-boost images to multiphasic CE-CT can improve the diagnostic accuracy and sensitivity for small hypervascular HCC by increasing the tumor-to-liver CNR.
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2022 KLCA-NCC Korea Practice Guidelines for the Management of Hepatocellular Carcinoma. Korean J Radiol 2022; 23:1126-1240. [PMID: 36447411 PMCID: PMC9747269 DOI: 10.3348/kjr.2022.0822] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. Clin Mol Hepatol 2022; 28:583-705. [PMID: 36263666 PMCID: PMC9597235 DOI: 10.3350/cmh.2022.0294] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/27/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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Ichikawa S, Motosugi U, Shimizu T, Kromrey ML, Aikawa Y, Tamada D, Onishi H. Diagnostic performance and image quality of low-tube voltage and low-contrast medium dose protocol with hybrid iterative reconstruction for hepatic dynamic CT. Br J Radiol 2021; 94:20210601. [PMID: 34586900 DOI: 10.1259/bjr.20210601] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance and image quality of the low-tube voltage and low-contrast medium dose protocol for hepatic dynamic CT. METHODS This retrospective study was conducted between January and May 2018. All patients underwent hepatic dynamic CT using one of the two protocols: tube voltage, 80 kVp and contrast dose, 370 mgI/kg with hybrid iterative reconstruction or tube voltage, 120 kVp and contrast dose, 600 mgI/kg with filtered back projection. Two radiologists independently scored lesion conspicuity and image quality. Another radiologist measured the CT numbers of abdominal organs, muscles, and hepatocellular carcinoma (HCC) in each phase. Lesion detectability, HCC diagnostic ability, and image quality of the arterial phase were compared between the two protocols using the non-inferiority test. CT numbers and HCC-to-liver contrast were compared between the protocols using the Mann-Whitney U test. RESULTS 424 patients (70.5 ± 10.1 years) were evaluated. The 80-kVp protocol showed non-inferiority in lesion detectability and diagnostic ability for HCC (sensitivity, 85.7-89.3%; specificity, 96.3-98.6%) compared with the 120-kVp protocol (sensitivity, 91.0-93.3%; specificity, 93.6-97.3%) (p < 0.001-0.038). The ratio of fair image quality in the 80-kVp protocol also showed non-inferiority compared with that in the 120-kVp protocol in assessments by both readers (p < 0.001). HCC-to-liver contrast showed no significant differences for all phases (p = 0.309-0.705) between the two protocols. CONCLUSION The 80-kVp protocol with hybrid iterative reconstruction for hepatic dynamic CT can decrease iodine doses while maintaining diagnostic performance and image quality compared with the 120-kVp protocol. ADVANCES IN KNOWLEDGE The 80- and 120-kVp protocols showed equivalent hepatic lesion detectability, diagnostic ability for HCC, image quality, and HCC-to-liver contrast.The 80-kVp protocol showed a 38.3% reduction in iodine dose compared with the 120-kVp protocol.
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Affiliation(s)
- Shintaro Ichikawa
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.,Department of Diagnostic Radiology, Kofu Kyoritsu Hospital, 1-9-1 Takara, Kofu, Yamanashi, Japan
| | - Tatsuya Shimizu
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Marie Luise Kromrey
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.,Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Domstraße 11, Greifswald, Germany
| | - Yoshihito Aikawa
- Division of Radiology, University of Yamanashi Hospital, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Daiki Tamada
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
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2018 Korean Liver Cancer Association-National Cancer Center Korea Practice Guidelines for the Management of Hepatocellular Carcinoma. Korean J Radiol 2019; 20:1042-1113. [PMID: 31270974 PMCID: PMC6609431 DOI: 10.3348/kjr.2019.0140] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 01/10/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer globally and the fourth most common cancer in men in Korea, where the prevalence of chronic hepatitis B infection is high in middle-aged and elderly patients. These practice guidelines will provide useful and constructive advice for the clinical management of patients with HCC. A total of 44 experts in hepatology, oncology, surgery, radiology, and radiation oncology in the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2014 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions.
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2018 Korean Liver Cancer Association-National Cancer Center Korea Practice Guidelines for the Management of Hepatocellular Carcinoma. Gut Liver 2019; 13:227-299. [PMID: 31060120 PMCID: PMC6529163 DOI: 10.5009/gnl19024] [Citation(s) in RCA: 224] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 01/24/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer globally and the fourth most common cancer in men in Korea, where the prevalence of chronic hepatitis B infection is high in middle-aged and elderly patients. These practice guidelines will provide useful and constructive advice for the clinical management of patients with HCC. A total of 44 experts in hepatology, oncology, surgery, radiology and radiation oncology in the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2014 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions.
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