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Split-Bolus Multidetector-Row Computed Tomography Technique for Characterization of Focal Liver Lesions in Oncologic Patients

View Article: PubMed Central - PubMed

ABSTRACT

Background: In oncologic patients, the liver is the most common target for metastases. An accurate detection and characterization of focal liver lesions in patients with known primary extrahepatic malignancy are essential to define management and prognosis.

Objectives: To assess the diagnostic accuracy of the split-bolus multidetector-row computed tomography (MDCT) protocol in the characterization of focal liver lesions in oncologic patients.

Patients and methods: We retrospectively analyzed the follow-up split-bolus 64-detector row CT protocol in 36 oncologic patients to characterize focal liver lesions. The split-bolus MDCT protocol by intravenous injection of two boluses of contrast medium combines the hepatic arterial phase (HAP) and hepatic enhancement during the portal venous phase (PVP) in a single-pass.

Results: The split-bolus MDCT protocol detected 208 lesions and characterized 186 (89.4%) of them: typical hemangiomas (n = 9), atypical hemangiomas (n = 3), cysts (n = 78), hypovascular (n = 93) and hypervascular (n = 3) metastases. Twenty two (10.6%) hypodense lesions were categorized as indeterminate (≤5 mm). The mean radiation dose was 24.5±6.5 millisieverts (mSv).

Conclusion: The designed split-bolus MDCT technique can be proposed alternatively to triphasic MDCT and in a single-pass to PVP in the initial staging and in the follow-up respectively in oncologic patients.

No MeSH data available.


Schematic view of split-bolus 64-detector row CT technique of the chest and abdomen in a 70 Kg patient. At start of bolus injection (or time zero), first bolus of CM (84 mL at 2.0 mL/sec), followed by 20 mL of saline at the same flow rate is injected (hepatic enhancement during the PVP); second bolus of CM (56 mL at 3.5 mL/sec, followed by 20 mL of saline at the same flow rate (HAP). Approximately at the end of the second bolus injection of CM, the scan started cranio-caudally after a delay of at least 6 seconds from the arrival of the CM in the aorta. An acquisition from the pulmonary apex to the pubic symphysis was performed resulting in a simultaneous contrast enhancement of the arterial and venous systems. CM: contrast medium. PVP: portal venous phase. HAP: hepatic arterial phase. *Arrival time of contrast medium in the aorta (Tarr).
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fig30163: Schematic view of split-bolus 64-detector row CT technique of the chest and abdomen in a 70 Kg patient. At start of bolus injection (or time zero), first bolus of CM (84 mL at 2.0 mL/sec), followed by 20 mL of saline at the same flow rate is injected (hepatic enhancement during the PVP); second bolus of CM (56 mL at 3.5 mL/sec, followed by 20 mL of saline at the same flow rate (HAP). Approximately at the end of the second bolus injection of CM, the scan started cranio-caudally after a delay of at least 6 seconds from the arrival of the CM in the aorta. An acquisition from the pulmonary apex to the pubic symphysis was performed resulting in a simultaneous contrast enhancement of the arterial and venous systems. CM: contrast medium. PVP: portal venous phase. HAP: hepatic arterial phase. *Arrival time of contrast medium in the aorta (Tarr).

Mentions: All patients were scanned with a 64-detector row scanner (Philips Healthcare, Best, The Netherlands). Our protocol consisted of unenhanced low-milliampere scans of the upper abdomen and a single scan of the CAP, after an iv injection of the of a maximum of 150 mL of contrast medium, Iopamiro 370 mgI/mL (Bracco, Milano, Italy) and Iopromide Ultravist 370 mgI/mL (Schering AG, Berlin, Germany), splitted by an automatic power injector (Medrad Stellant CT, Indianola, PA, USA) into two boli (Figure 1).


Split-Bolus Multidetector-Row Computed Tomography Technique for Characterization of Focal Liver Lesions in Oncologic Patients
Schematic view of split-bolus 64-detector row CT technique of the chest and abdomen in a 70 Kg patient. At start of bolus injection (or time zero), first bolus of CM (84 mL at 2.0 mL/sec), followed by 20 mL of saline at the same flow rate is injected (hepatic enhancement during the PVP); second bolus of CM (56 mL at 3.5 mL/sec, followed by 20 mL of saline at the same flow rate (HAP). Approximately at the end of the second bolus injection of CM, the scan started cranio-caudally after a delay of at least 6 seconds from the arrival of the CM in the aorta. An acquisition from the pulmonary apex to the pubic symphysis was performed resulting in a simultaneous contrast enhancement of the arterial and venous systems. CM: contrast medium. PVP: portal venous phase. HAP: hepatic arterial phase. *Arrival time of contrast medium in the aorta (Tarr).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036402&req=5

fig30163: Schematic view of split-bolus 64-detector row CT technique of the chest and abdomen in a 70 Kg patient. At start of bolus injection (or time zero), first bolus of CM (84 mL at 2.0 mL/sec), followed by 20 mL of saline at the same flow rate is injected (hepatic enhancement during the PVP); second bolus of CM (56 mL at 3.5 mL/sec, followed by 20 mL of saline at the same flow rate (HAP). Approximately at the end of the second bolus injection of CM, the scan started cranio-caudally after a delay of at least 6 seconds from the arrival of the CM in the aorta. An acquisition from the pulmonary apex to the pubic symphysis was performed resulting in a simultaneous contrast enhancement of the arterial and venous systems. CM: contrast medium. PVP: portal venous phase. HAP: hepatic arterial phase. *Arrival time of contrast medium in the aorta (Tarr).
Mentions: All patients were scanned with a 64-detector row scanner (Philips Healthcare, Best, The Netherlands). Our protocol consisted of unenhanced low-milliampere scans of the upper abdomen and a single scan of the CAP, after an iv injection of the of a maximum of 150 mL of contrast medium, Iopamiro 370 mgI/mL (Bracco, Milano, Italy) and Iopromide Ultravist 370 mgI/mL (Schering AG, Berlin, Germany), splitted by an automatic power injector (Medrad Stellant CT, Indianola, PA, USA) into two boli (Figure 1).

View Article: PubMed Central - PubMed

ABSTRACT

Background: In oncologic patients, the liver is the most common target for metastases. An accurate detection and characterization of focal liver lesions in patients with known primary extrahepatic malignancy are essential to define management and prognosis.

Objectives: To assess the diagnostic accuracy of the split-bolus multidetector-row computed tomography (MDCT) protocol in the characterization of focal liver lesions in oncologic patients.

Patients and methods: We retrospectively analyzed the follow-up split-bolus 64-detector row CT protocol in 36 oncologic patients to characterize focal liver lesions. The split-bolus MDCT protocol by intravenous injection of two boluses of contrast medium combines the hepatic arterial phase (HAP) and hepatic enhancement during the portal venous phase (PVP) in a single-pass.

Results: The split-bolus MDCT protocol detected 208 lesions and characterized 186 (89.4%) of them: typical hemangiomas (n = 9), atypical hemangiomas (n = 3), cysts (n = 78), hypovascular (n = 93) and hypervascular (n = 3) metastases. Twenty two (10.6%) hypodense lesions were categorized as indeterminate (≤5 mm). The mean radiation dose was 24.5±6.5 millisieverts (mSv).

Conclusion: The designed split-bolus MDCT technique can be proposed alternatively to triphasic MDCT and in a single-pass to PVP in the initial staging and in the follow-up respectively in oncologic patients.

No MeSH data available.