Estudio Dinamico Con Tem de Las Masas Hepaticas
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Transcript of Estudio Dinamico Con Tem de Las Masas Hepaticas
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AJR:180, May 2003
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OBJECTIVE.
Our aim was to determine which of three contrast-enhanced phases (early arterial, late arterial, or portal
venous) was optimal for achieving maximalenhancement of the celiac artery, portal vein, andhepatic parenchyma.
We also wanted to learn which phase provided themaximal tumor-to-parenchyma difference when usingmultidetector CT (MDCT) with fixed timing delays.
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Tcnica
In all patients, CT was performed using an MDCTscanner (Lightspeed QX/i; General Electric).
One hour before scanning, patients received 320 mL of dilute
barium orally(Scan C: 2.1% weight by weight bariumsulfate) for gastrointestinal tract opacification.
Via a power injector, 150 mL of Omnipaque 300 mg I/mL (iohexol300 mg I/mL) was injected IV at a rate of 4 mL/sec.
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Tcnica
The entire liver was scanned in a cephalad-to-caudad direction using a detector collimation of5 mm with a table speed per rotation of 15
mm/0.8 sec, a pitch of 3 in the scanners HQmode, and an image thickness of 5 mm.
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Material y mtodos
52 patients with suspected or known hepatic tumorsunderwent multiphasic contrast-enhanced MDCTI
Images were acquired at 20 sec for the early arterial phase, 35 sec for the late arterial phase, and
60 sec for the portal venous phase.
Attenuation measurements of the celiac artery, portalvein, normal hepatic parenchyma, and the hepatic
tumor were compared. Three reviewers independently and subjectively rated
tumor conspicuity for each of the three phases.
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Introduccin
The arterial phase in these studies, defined as occurring 18-35 secafter
initiation of IV contrast media administration, has beenfound to be most useful for maximizing enhancement
ofhypervascular tumors. In comparison, portal venous phase imaging, defined as occurring
50-70 sec after the initiation of IV contrast media
administration, has been found to be most useful for
obtaining maximal hepatic parenchymal enhancementand thus maximizing tumor-to-parenchyma differencesfor hypovascular tumors
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Hypovascular tumors: metastases from colon and pancreatic adenocarcinoma
Hypervascular tumors: hepatocellular carcinoma,
hepatic adenomas,
Focal nodular hyperplasia
hypervascular metastases choriocarcinoma,
renal cell carcinoma,
thyroid carcinoma, carcinoid tumor,
islet cell tumor
neuroendocrine tumors
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Resultados:
Celiac Axis Enhancement
The greatest average celiac axis attenuation wasobserved in the late arterial phase and wassignificantly superior (p
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Resultados:
Portal Vein Enhancement
The greatest average attenuation of the portalvein was observed on the portal venous phase
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Resultados:
Normal Hepatic ParenchymalEnhancement
Hepatic parenchymal attenuation was greatest in
the portal venous phase and was significantlyhigher (p < 0.0001) than that of each of theother phases. Although the hepatic attenuation
in the late arterial phase was significantly greaterthan that in the early arterial phase, thedifference was not as great.
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Resultados:
Quantitative Analysis: Tumor-to-Parenchyma
Differences
For the subgroup of hypervascular tumors, althoughmaximal tumor-to-parenchyma differences were greaterduring the late arterial and portal venous phases thanduring the early arterial phase, the differences were notstatistically significant.
In the subgroup of hypovascular tumors, maximaltumor-to-parenchyma differences were significantlygreater during the late arterial and portal venous phasesthan during the early arterial phase. However, nosignificant difference was found between the latearterial and portal venous phases.
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52-year-old man with metastases from
colon carcinoma. Metastases
hypovascular best seen in late arterial
and portal venous phase.
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57-year-old man with
hepatocellular carcinoma,best seen in late arterial
phase.
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76-year-old woman with hypervascular metastases
from primary extrahepatic neuroendocrine tumor.
Metastases hypervascular best seen in late arterial
phase.
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76-year-old woman with metastases
from colon carcinoma. Metastases
hypovascular best seen in portal venous
phase.
http://www.ajronline.org/cgi/content/full/183/2/443/FIG16http://www.ajronline.org/cgi/content/full/183/2/443/FIG13 -
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Utilidad de la fase arterial temprana en el carcinoma hepatocelular, permite estudiar sus arterias nutricias.
http://www.ajronline.org/cgi/content/full/183/2/443/FIG16http://www.ajronline.org/cgi/content/full/183/2/443/FIG13http://www.ajronline.org/content/vol183/issue2/images/large/AD1260_04B.jpeg -
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Focal nodular hyperplasia in
28-year-old woman, best seen
in early arterial phase.
http://www.ajronline.org/content/vol183/issue2/images/large/AD1260_05B.jpeghttp://www.ajronline.org/content/vol183/issue2/images/large/AD1260_05A.jpeghttp://www.ajronline.org/content/vol183/issue2/images/large/AD1260_04B.jpeghttp://www.ajronline.org/cgi/content/full/183/2/443/FIG2http://www.ajronline.org/cgi/content/full/183/2/443/FIG1 -
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Typical hemangioma in 72-year-old woman. Conventional axial CT image obtained in arterial phase
reveals lesion in right lobe of liver (arrow), with peripheral nodular enhancement. In portal venous phase
reveals gradual contrast filling of tumor.
http://www.ajronline.org/cgi/content/full/183/2/443/FIG2http://www.ajronline.org/cgi/content/full/183/2/443/FIG1 -
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Conclusiones
Although we found that late arterial and portal venousphase images had better MDCT results than earlyarterial phase images for hypervascular liver tumors,
this finding was not statistically significant. For hypovascular liver tumors, late arterial and portal
venous phase images had statistically significantsuperior maximal tumor-to-parenchyma differences
compared with early arterial phase images.
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Conclusiones
Because use of early arterial phase images doesnot contribute to tumor detection in mostpatients, we no longer routinely perform early
arterial phase imaging in patients with known orsuspected hepatic neoplasms.
At our institution, patients referred for CT withpossible or known hepatic tumors undergoMDCT using only late arterial and portal venousphase imaging.
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Conclusiones
The early arterial phase images are acquired onlyif CT angiography is required to depict hepaticarterial anatomy before surgery.
Although the arterial enhancement is superior inthe late arterial phase, some venouscontamination occurs, which makes the early
arterial phase more suitable for CT angiography.