Liver lesion detection and characterization with sequential use of hepatobiliary contrast agent mangafodipir trisodium and gadolinium-DTPA in a single imaging protocol.
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Adult↗
Biomedical subjects
Peter F Hahn
Publications and source records attributed to Peter F Hahn.
Characterizing liver hemangiomas on ferumoxides-enhanced dynamic TI-weighted imaging: preliminary experience.
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Contrast Media↗
US-guided fine-needle aspiration biopsy of thyroid nodules: adequacy of cytologic material and procedure time with and without immediate cytologic analysis.
PURPOSE: To compare the adequacy of aspirated material and procedure time when performing ultrasonography-guided fine-needle aspiration biopsy of thyroid nodules with and without immediate cytologic analysis of the aspirated sample. MATERIALS AND METHODS: One hundred twenty-one thyroid nodules were sampled for biopsy in 109 patients. In group A, results of 50 biopsies in which immediate cytologic analysis was performed were retrospectively reviewed for cytologic adequacy. In group B, 50 biopsies were performed without immediate cytologic analysis, and the procedure time was recorded. In group C, 21 biopsies were performed with immediate cytologic analysis, and the procedure time was recorded. Cytologic adequacy rates were compared by using the proportional odds model, and procedure times were compared by using linear regression to adjust for differences in the character of the nodules. RESULTS: For groups A and C (immediate cytologic analysis performed), the adequacy categories included the following results: 39 (55%) satisfactory, 15 (21%) limited, and 17 (24%) unsatisfactory. For group B (immediate cytologic analysis not performed), the adequacy categories included the following results: 25 (50%) satisfactory, 15 (30%) limited, and 10 (20%) unsatisfactory (Wald test, P =.815). The average procedure time was 12.5 minutes for group B and 44.4 minutes for group C (P <.001). CONCLUSION: There was no significant difference in cytologic adequacy whether immediate cytologic analysis of aspirated material was performed or not. The procedure time was significantly shorter when immediate cytologic analysis was not performed.
Adult↗
Percutaneous abscess drainage in Crohn disease: technical success and short- and long-term outcomes during 14 years.
PURPOSE: To determine technical success with percutaneous abscess drainage (PAD) in patients with Crohn disease during 14 years. MATERIALS AND METHODS: Medical records of 32 patients with Crohn disease who underwent PAD from 1985 to 1999 were reviewed. Results of abscess drainage and nature of subsequent surgical procedures were recorded. Factors assessed included postoperative or spontaneous nature of the abscess, documentation of a proved fistula, history of occurrence of prior abscesses, duration of Crohn disease, and use of steroid treatment. Technical success was defined as complete abscess drainage. Short-term success was defined as avoidance of surgery within 60 days of drainage. Long-term success was defined as avoidance of surgery beyond the initial 60-day period. Short-term avoidance of surgery was assessed as a predictor of the need for surgery in the long term. Statistical analysis was performed with the chi(2) test to evaluate predictors of short-term success and to assess short-term success as a predictor of long-term success. RESULTS: The technical success rate was 96%. In 16 (50%) of 32 patients, the need for surgery in the short term was avoided, and surgery was more likely to be avoided in patients with postoperative abscesses than in those with spontaneous abscesses (P =.07). At long-term follow-up, short-term avoidance of surgery did not significantly increase the likelihood of need for surgery in the long term, which occurred in nine of 16 short-term successes versus five of 15 short-term failures (P =.55). Recurrent abscesses occurred in seven (22%) patients, a rate comparable to that with surgical abscess drainage; four (44%) of nine cases of re-drainage were successful. CONCLUSION: PAD has a high technical success rate of 96%. Half of patients may avoid surgery in the short term.
Abdominal Abscess↗
CT tumor measurement for therapeutic response assessment: comparison of unidimensional, bidimensional, and volumetric techniques initial observations.
PURPOSE: To compare unidimensional, bidimensional, and volumetric techniques for evaluation of treatment response in patients with liver metastases from breast cancer in a phase III clinical trial. MATERIALS AND METHODS: Helical computed tomographic (CT) studies in 38 patients with liver metastases from breast cancer who were enrolled in a phase III clinical trial were evaluated before treatment and at 6 months after treatment. Two subspecialty radiologists measured all lesions on transverse CT scans with use of electronic calipers according to both unidimensional and bidimensional criteria. Volumetric measurements were made by tracing individual lesions. Measurements of individual lesions were summed to obtain patient response, which was categorized as complete response, disappearance of lesions; partial response, greater than 30% decrease in tumor diameter (unidimensional), greater than 50% reduction in tumor area (bidimensional), or greater than 65% reduction in tumor volume (volumetric); disease progression, greater than 20% increase in tumor diameter, greater than 25% increase in tumor area, or greater than 73% increase in tumor volume: or stable disease (size response other than that of complete response, partial response, or disease progression). RESULTS: In 37 patients, there was concordant treatment response with use of unidimensional and bidimensional techniques. Volumetric measurement produced results different from those of the unidimensional and bidimensional techniques in 12 and 13 patients, respectively. In six patients with partial response per unidimensional and bidimensional criteria, the response based on the volumetric technique was stable disease. In two patients with stable disease per bidimensional and unidimensional criteria, the response was partial response by volumetric measurement. In four patients with disease progression per bidimensional and unidimensional criteria, the response was stable disease per volumetric criteria. CONCLUSION: Volumetric measurement of tumor burden gives different results for treatment response compared with that of the unidimensional or bidimensional technique in a considerable proportion of patients.
Antineoplastic Combined Chemotherapy Protocols↗
Cystic lymph node metastases in papillary thyroid carcinoma.
OBJECTIVE: The aim of this study was to illustrate and discuss the sonographic spectrum of surgically proven cystic nodal metastases from papillary thyroid carcinoma. By correlative evaluation of the sonographic imaging findings to gross pathology and histology, our purpose was to provide useful hints to differentiate cystic lymph node metastases from other benign cystic neck lesions such as branchial cysts. MATERIALS AND METHODS: Sonographic examinations of 74 patients (47 women, 27 men; mean age, 49 years) with 97 histologically confirmed cystic lymph nodes metastases from papillary thyroid carcinoma were included in the study. The anatomic relationship of the nodes relative to the primary tumor was recorded, and all cystic nodes were qualitatively categorized as either simple (purely cystic) or complex (thickened outer wall, internal nodules, internal septations, and calcifications). All imaging findings were compared with gross pathologic specimens. RESULTS: Most of the cystic metastases were ipsilateral to the primary tumor (87.8%) and located in the mid or lower jugular chain (73.2%). In 14.9% of all patients, cystic lymph node metastases were the initial manifestation of disease. Only 6.2% of all lymph node metastases were purely cystic (all of these occurred in patients less than 35 years old). Of the 91 complex metastases, a thickened outer wall was present in 35.2% of patients, internal nodules in 42.9%, and internal septations in 57.1%. No calcifications were seen in the 91 complex metastases, and two or more findings were seen in 23.1%. All sonographic findings were verified by surgery. CONCLUSION: In most of the patients, cystic lymph node metastases are characterized sonographically by the presence of a thickened outer wall, internal echoes, internal nodularity, and septations. However, in younger patients, the lymph nodes might appear purely cystic, thereby mimicking branchial cysts and thus requiring biopsy for final diagnosis and therapy planning.
Adult↗
Using multidetector CT for preoperative vascular evaluation of liver neoplasms: technique and results.
OBJECTIVE: The purpose of our study was to evaluate the performance of CT angiography using multidetector CT (MDCT) for preoperative vascular evaluation in candidates who were scheduled for liver neoplasm resection. SUBJECTS AND METHODS: Forty-two consecutive subjects with malignant liver tumors scheduled for resection were studied with multiphase MDCT. The first 22 subjects underwent both multiphase MDCT angiography and catheter angiography before surgery. The subsequent 20 subjects underwent only preoperative CT angiography. Postprocessing was performed, and the images were analyzed for the depiction of arterial, portal vein, and hepatic vein anatomy and for the identification of important vascular variants. The postprocessing findings were compared and correlated with the findings from catheter angiography (22/42) or intraoperative sonography (42/42) and surgery (42/42). RESULTS: Arterial anomalies were detected on the images of 17 of 42 patients, including a replaced right hepatic artery in five, replaced left hepatic artery in six, accessory right and left hepatic arteries in two, common trunk for the celiac and superior mesenteric arteries in one, and early bifurcation of the celiac artery in one. In 22 patients in whom catheter angiography confirmation was available, the number of arteries and almost all the significant anomalies were correctly identified on CT angiography (accuracy, 97%; sensitivity, 94%; specificity, 100%). In the subset of 20 patients who underwent MDCT angiography without catheter angiography confirmation, all clinically relevant information was provided by CT angiography. The portal and hepatic vein anatomy and the relationships of the liver tumors to the neighboring venous structures were shown on CT. CONCLUSION: Multidetector CT provides valuable preoperative information about hepatic vascular architecture and can be used as a noninvasive alternative to catheter angiography before oncologic liver surgery.
Adult↗
Percutaneous nonvascular splenic intervention: a 10-year review.
OBJECTIVE: We performed a retrospective review of our experiences with percutaneous splenic interventions to evaluate the safety and usefulness of these procedures. We examined both the success rate and the complication rate. MATERIALS AND METHODS: We used our electronic database to perform a retrospective analysis of patients treated from January 1990 to December 2000. Thirty-nine imaging-guided percutaneous splenic procedures were performed in 38 patients: 27 men and 11 women who ranged in age from 17 to 83 years (mean age, 56.5 years). For 28 procedures, sonographic guidance was used, and for 11, CT guidance was used. Procedures performed included splenic biopsy (n = 24), fluid aspiration (n = 8), and fluid drainage (n = 7). RESULTS: Splenic biopsy was successful in 91% of the procedures; fluid aspiration, in 100%; and fluid drainage, in 86%. The overall complication rate was 10.3%, with three patients requiring emergency splenectomy as a result of massive bleeding after the procedure. Two of these patients had previously unrecognized vascular tumors, and one had concomitant refractory thrombocytopenia. CONCLUSION: This study suggests that splenic biopsy can be performed safely and is of considerable value in diagnosis. Our findings also show that percutaneous catheter drainage of splenic abscesses is successful and that splenectomy should be reserved for failed percutaneous drainage. The complications that occur after procedures on vascular tumors emphasize the importance of requiring normal coagulation parameters before the procedure because the vascular nature of the lesion may be difficult to recognize on imaging before the procedure.
Adolescent↗
Intermediate cystic renal masses: radiology-pathology correlation.
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Biopsy↗
The difficult biopsy: let's make it easier.
Image-guided percutaneous biopsies of abdominal and pelvic organs are an integral part of the daily practice of many radiologists. Fortunately, most image-guided percutaneous biopsies are straightforward. At times, however, image-guided percutaneous biopsies can be technically challenging due to various factors, including proximity of surrounding vessels or organs, "moving targets" due to respiratory motion, or difficulties in detecting lesions with certain imaging modalities. The purpose of this manuscript is to discuss techniques that can be utilized to increase the successful biopsy of "difficult" lesions. Choices of imaging modality for guiding needle placement will be discussed, as will the use of alternative access routes such as transgluteal, transvaginal, and other transorgan approaches. Factors to improve the accessibility of lesions, including patient positioning and the timing of contrast injections that improve lesion detection, will be discussed.
Biopsy↗
Image-guided percutaneous biopsy of the adrenal gland: review of indications, technique, and complications.
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Adrenal Gland Diseases↗
Functioning acinar cell pancreatic carcinoma: diagnosis on mangafodipir trisodium (Mn-DPDP)-enhanced MRI.
We describe the imaging findings of a functional pancreatic acinar cell carcinoma in a patient who presented with weight loss, hyperlipasemia, and multiple foci of subcutaneous fat necrosis. The tumor invaded the adjacent splenic and portal vein, causing isolated left-sided portal hypertension. At MRI, the tumor showed marked enhancement following administration of the hepatobiliary-specific contrast agent mangafodipir trisodium (Mn-DPDP), thereby demonstrating the functional nature of the tumor. Avid uptake of Mn-DPDP by a functioning pancreatic tumor has not been reported in the radiology literature.
Aged↗
Contrast-enhanced MRI of the liver with mangafodipir trisodium: imaging technique and results.
Magnetic resonance (MR) contrast agents are now routinely used for detecting and characterizing focal liver lesions. Liver specific, hepatobiliary, MRI contrast agent mangafodipir trisodium (Mn-DPDP) is taken up by the functioning hepatocytes and excreted by the biliary system. Contrast uptake leads to persistent elevation of T1-weighted signal of normal liver parenchyma within 10 minutes of injection. Most tumors of non-hepatocellular origin typically are hypointense relative to enhanced liver parenchyma on T1 weighted images and are more conspicuous than on unenhanced images. Whereas, tumors of hepatocellular origin such as focal nodular hyperplasia (FNH), adenoma, and well-differentiated hepatocellular carcinomas (HCC) have been shown to accumulate Mn-DPDP, providing characterization information to discriminate hepatocellular from non-hepatocellular tumors. The purpose of this pictorial essay is to illustrate the appearance of various liver tumors on mangafodipir enhanced liver MR imaging.
Adult↗
CT characterization of "indeterminate" renal masses: targeted or comprehensive scanning?
PURPOSE: A comprehensive renal mass evaluation CT protocol is usually performed for simultaneous characterization and staging of incidentally discovered renal masses considered indeterminate on ultrasound (US). The purpose of the study was to determine if a comprehensive examination is appropriate in these patients. MATERIALS AND METHODS: The authors performed a retrospective review of 100 patients (mean age, 61 years) with 102 sonographically indeterminate renal masses and who were referred to undergo CT for lesion characterization. Lesions were classified according to surgical histology or imaging follow-up evaluation. Statistical analysis was performed. RESULTS: Thirteen lesions (12.7%) in 11 (11%) patients (mean age, 59 years) were malignant. Eighty-seven lesions (85.3%) in 87 patients (87%; mean age, 62 years) were benign. Two lesions (1.96%) in two patients (2%) remained indeterminate. CONCLUSION: Although comprehensive renal mass evaluation protocol provides a more thorough patient evaluation, only a small fraction of indeterminate renal masses seen on US are malignant. The authors' results suggest a targeted renal CT imaging protocol for evaluation of indeterminate renal masses incidentally discovered on US.
Adult↗
Rare benign and malignant appendiceal lesions: spectrum of computed tomography findings with pathologic correlation.
Although acute appendicitis is the most common disease of the appendix, the appendix can be involved by a wide range of diseases. Diseases other than acute appendicitis may produce signs and symptoms indistinguishable from those of acute appendicitis. Computed tomography (CT) can provide important information for diagnosis and evaluation of appendiceal diseases. The various CT and histologic features of appendiceal benign and neoplastic diseases are discussed, illustrated, and correlated in this article. Radiologists need to understand the full spectrum of appendiceal abnormalities, their underlying pathologic changes, and associated CT imaging findings.
Adult↗
Radiological measurement of breast cancer metastases to lung and liver: comparison between WHO (bidimensional) and RECIST (unidimensional) guidelines.
PURPOSE: Radiologic assessment of "response-to-treatment" during clinical trials of anticancer drugs has been conventionally based on bidirectional tumor measurement. Recently, the revised guidelines were published, which recommended unidirectional tumor measurements. The purpose of this study was to compare response to treatment between the two measurement techniques in breast cancer patients with lung and liver metastases. METHOD: Contrast-enhanced computed tomography studies of 86 breast cancer patients who had lung (n = 27) and liver (n = 59) metastases and who were enrolled in a phase-III oncology trial were evaluated before initiation of treatment and at 6 months after treatment. Lesions were measured by subspecialist radiologists on digitized images using electronic calipers. The largest diameter of the lesions was extracted from bidimensional measurements. Response to treatment was categorized into one of four categories: complete response indicating lesion disappearance, partial response indicating >30% decrease in tumor diameter, or >50% reduction in tumor area, disease progression indicating >20% increase in tumor diameter, or >25% increase in tumor area, and stable disease (neither complete response, partial response, nor disease progression). Response to treatment between the two measurement techniques was compared statistically using the chi2 test. RESULTS: Response to treatment was concordant in 76 patients between unidimensional and bidimensional measurement techniques. In 5 patients (2 lung and 3 liver metastases) the response assessment was improved using unidimensional criteria and in 5 patients (2 lung and 3 liver metastases) the response was worse using unidimensional guidelines. Thus, the overall response rate was 50% for both unidimensional and bidimensional measurement techniques. There was no statistical difference between the two techniques. CONCLUSION: Unidimensional measurements are appropriate for measuring the size of liver and lung metastases for determining response to treatment during clinical testing of oncologic drugs.
Antineoplastic Agents↗
Multidetector-row computed tomography angiography for planning intra-arterial chemotherapy pump placement in patients with colorectal metastases to the liver.
PURPOSE: The purpose of this study was to evaluate the use of multidetector computed tomography (MDCT) in the preoperative arterial evaluation of patients scheduled to undergo intra-arterial chemotherapy pump placement. METHODS: Computed tomography scans of 30 patients with hepatic malignancies who were imaged with multiphase MDCT angiography for intra-arterial chemotherapy pump placement were retrospectively analyzed. Dual-phase helical CT was performed, and the arterial phase images were processed to depict the arterial anatomy and to identify pertinent anomalies. All findings were compared and correlated with surgical findings or catheter angiography if surgery was contraindicated. RESULTS: Arterial anomalies identified on CT angiography in 20 of 30 patients included a replaced right hepatic artery (RHA; n = 6) or left hepatic artery (LHA; n = 8), a replaced common hepatic artery (n = 1), an accessory RHA (n = 2) or LHA (n = 6), a replaced gastroduodenal artery (GDA; n = 2), an extrahepatic connection between the accessory RHA and the replaced RHA (n = 1), and a common origin composed of the GDA and RHA and LHA (n = 2). There were no additional arteries or anomalies identified by catheter angiography, when available, or during surgery. Only 1 variant, an accessory hepatic artery, was not located during surgery. In 2 patients, the surgical team decided that pump placement was not feasible because of overly complex anatomy as determined by CT angiography. Computed tomography angiography showed an overall sensitivity of 100% and specificity of 97%. CONCLUSIONS: Multidetector computed tomography angiography is accurate for the preoperative evaluation of normal and aberrant hepatic vasculature in patients under consideration for intra-arterial chemotherapy pump placement. Axial images alone permit recognition of vascular anomalies, including complex anatomy. Nevertheless, 3-dimensional rendering is useful to evaluate complex vascular anatomy and does not require catheter angiographic confirmation. In addition to aiding in selecting patients ideal for pump placement, MDCT permits noninvasive planning of their surgical approach.
Aged↗
Using the K-edge to improve contrast conspicuity and to lower radiation dose with a 16-MDCT: a phantom and human study.
PURPOSE: To study the effect of tube current (milliamperes; mA) and potential (peak kilovolt; kVp) on the attenuation values and contrast-to-noise ratios of iodine- and gadolinium-based contrast media (CM) for computed tomography angiography (CTA). MATERIALS AND METHODS: Phantom Study: A water-filled phantom with five 20-mL syringes filled with 1:20 dilution of 282, 300, 370, and 400 milligrams of iodine per milliliter concentration CM and gadopentetate dimeglumine (Magnevist, Berlex Laboratories, Wayne, NJ, 0.5 mol/L) was scanned with a 16-multidetector CT using 80, 100, 120, and 140 kVp and 500-millisecond gantry rotation time. The milliampere was either fixed at 100, 200, 300, and 380 or automatically adjusted with noise indices of 15, 20, and 25 or manually adjusted to maintain a constant image noise. The attenuation value (Hounsfield unit; HU) and its standard deviation of CM in each syringe and of the water phantom were obtained. Statistical analysis was performed to determine difference between attenuation values and contrast medium-to-water contrast-to-noise ratios at various kVp and mA selection. Human Study: Three groups of patients had CTA for abdominal aortic aneurysm with similar computed tomography parameters, varying only in kVp selection of either 100 (group A), 120 (group B), or 140 (group C). Another group (group D) had CTA at 100 kVp but with the CM volume reduced to 60%. The CTA studies were evaluated for the quality of axial and 3D images; attenuation values in the aorta, superior mesenteric artery, and iliac arteries; image noise; and scanner-estimated radiation dose. Statistical analysis was performed to determine the difference in image quality and radiation dose among the groups. RESULTS: Phantom Study: In comparison with 140 kVp, regardless of selected milliampere or noise indices, images acquired at 80, 100, and 120 kVp showed 90.8% to 94.2%, 47% to 49.7%, and 18.9% to 20.7% (P<0.0001) increase in HU of iodine-based CM, respectively, and 62.9%, 39.6%, and 16.8% (P<0.0001) increase in HU of gadolinium-based CM, respectively. Human Study: The axial images in all the groups were diagnostically acceptable. There was significantly inferior quality of axial images associated with greater image noise in group A and group D (P<0.01) in comparison with group C, but there was no difference in the quality of 3D images among the 4 groups. In comparison with group C, there was significantly higher attenuation of the aorta, superior mesenteric artery, and iliac arteries in group A (P<0.01), group B (P<0.05), and group D (P<0.01). The radiation dose (CT dose index volume) decreased to 12+/-4 in groups A and D compared with 17+/-4 in group B and 24+/-5 in group C. CONCLUSIONS: Lower kVp increases the attenuation of iodinated and gadolinium CM. CTA of the abdominal aorta performed at low kVp results in higher attenuation in aorta with reduced radiation dose and without degrading the diagnostic image quality. The iodinated CM volume can be reduced by reducing kVp during CTA.
Adolescent↗