Diagnostic value of spiral CT arterial enhancement fraction in colorectal cancer staging / 肿瘤研究与临床

Objective:To explore the diagnostic value of spiral CT arterial enhancement fraction (AEF) in clinicopathological staging of colorectal cancer.Methods:The clinical data of 151 newly diagnosed colorectal cancer patients (colorectal cancer group) and 86 patients who underwent physical examination with no history of colorectal disease (the control group) admitted to Shanxi Province Cancer Hospital from September 2019 to May 2021 were retrospectively analyzed. All research subjects received whole abdominal spiral CT plain scan and three-phase enhanced scan, and the obtained images were transferred to the Siemens Syngo.via post-processing workstation for post-processing to obtain the AEF color map and its quantitative parameter AEF value. The correlation of AEF value with colorectal cancer stage and Ki-67 was analyzed, and its diagnostic performance for clinicopathological staging of colorectal cancer was evaluated by using receiver operating characteristic curve.Results:The AEF values ??of patients at stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ colorectal cancer were (72±9)%, (65±11)%, (60±12)%, and (52±10)%, respectively, and the difference was statistically significant ( F = 22.15, P < 0.001). The AEF values ??of the control group and the colorectal cancer group were (85±6)% and (62±12)%, respectively, and the difference in AEF value of both groups was statistically significant ( t = 18.66, P < 0.001). The clinicopathological stage of colorectal cancer was negatively correlated with AEF value ( r = -0.548, P < 0.05). Taking the control group as the standard, the area under the curve (AUC) of AEF value for the diagnosis of colorectal cancer stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 0.866 (the sensitivity was 62.50%, the specificity was 96.51%) and 0.928 (the sensitivity was 76.74%, the specificity was 98.84%), 0.981 (the sensitivity was 92.68%, the specificity was 91.86%) and 1.000 (the sensitivity was 100.00%, the specificity was 98.84%), and the difference in diagnostic efficiency was statistically significant ( P < 0.05). The AEF value of colorectal cancer was negatively correlated with Ki-67 ( r = -0.537, P < 0.05). The Ki-67 positive index of patients at stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ colorectal cancer was (55±12)%, (67±10)%, (73±12)%, and (79±11)%, respectively, and the difference was statistically significant ( F = 11.94, P < 0.001); the Ki-67 positive index of patients at stage Ⅳ was higher than those at stage Ⅰ+Ⅱ ( t = 3.45, P = 0.001); the clinicopathological stage of colorectal cancer was positively correlated with Ki-67 ( r = 0.393, P < 0.001). Conclusions:AEF quantitative color map and AEF value can reflect the characteristics of arterial and venous blood supply in colorectal cancer lesions. AEF value analysis before surgery is helpful for the clinicopathological staging of colorectal cancer.

Identification of Arterial Hyperenhancement in CT and MRI in Patients with Hepatocellular Carcinoma: Value of Unenhanced Images

OBJECTIVE: According to the current guidelines, arterial hyperenhancement for diagnosis of hepatocellular carcinoma (HCC) is determined using the arterial phase only. We investigated the optimal definition of arterial hyperenhancement in patients with HCC using computed tomography (CT) and magnetic resonance imaging (MRI). MATERIALS AND METHODS: The Institutional Review Board approved this retrospective study. The requirement for informed consent was waived. Between January 2011 and September 2013, 147 consecutive patients with surgically proven HCCs with both pre-operative CT and MRI were included. Identification rates of arterial hyperenhancement on CT and magnetic resonance (MR) images using arterial phase only, dual phase (unenhanced and arterial phases), and also subtraction MR images were assessed qualitatively. RESULTS: The identification rates for arterial hyperenhancement on CT were significantly different between arterial phase and dual phase (72.8% vs. 90.5%; p < 0.001), whereas the rates were similar on MRI (91.8% vs. 93.9%; p = 0.257). The identification rate of arterial hyperenhancement in MRI increased to 98.6% using subtraction MR images. CONCLUSION: Visual comparison of arterial and unenhanced phases could be recommended instead of conventional qualitative arterial phase alone assessment to determine arterial hyperenhancement of HCCs, especially when using CT.

Detection of Recurrent Hepatocellular Carcinoma in Cirrhotic Liver after Transcatheter Arterial Chemoembolization: Value of Quantitative Color Mapping of the Arterial Enhancement Fraction of the Liver

OBJECTIVE: To investigate the additional diagnostic value of color mapping of the hepatic arterial enhancement fraction (AEF) for detecting recurrent or residual hepatocellular carcinoma (HCC) in patients treated with transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS: Seventy-six patients with 126 HCCs, all of whom had undergone previous TACE, and subsequently, underwent follow-up multiphasic liver CT scans, were included in this study. Quantitative color maps of the AEF of the whole liver were created, by using prototype software with non-rigid registration. The AEF was defined as the ratio of the attenuation increment during the arterial phase to the attenuation increment during the portal phase. Two radiologists independently analyzed the two image sets at a two-week interval, i.e., the multiphasic CT image set and the second image set of the AEF color maps and the CT images. The additional diagnostic value of the AEF color mapping was determined, by the use of the jackknife-alternative free-response receiver-operating-characteristic analysis. The sensitivity and positive predictive values for detecting HCCs of each image set were also evaluated and compared. RESULTS: The reader-averaged figures of merit were 0.699 on the initial interpretation of the MDCT image set, and 0.831 on the second interpretation of the combined image set; the difference between the two interpretations was significant (p value < 0.001). The mean sensitivity for residual or recurrent HCC detection increased from 62.7% on the initial analysis to 82.1% on the second analysis using the AEF color maps (p value < 0.001). The mean positive predictive value for HCC detection was 74.5% on the initial analysis using MDCT, and 71.6% on the second analysis using AEF color mapping. CONCLUSION: Quantitative color mapping of the hepatic AEF may have the possibility to increase the diagnostic performance of MDCT for the detection of recurrent or residual HCC without the potential risk of radiation-related hazards.