The Contribution of Contrast Enhanced CT to FDG PET on Characterization of Liver Lesions and It’s Quantitative Effects

Year 2023, , 548 - 554, 31.12.2023

Mutlay Keskin , Şeyda Türkölmez , Elif Özdemir , Nilüfer Yıldırım , Zuhal Kandemir

https://doi.org/10.35440/hutfd.1380745

Abstract

Background: The goals of this study was to evaluate the diagnostic capability of enhanced/unenhanced 18F-FDG-PET/CT scans for identifying primary-secondary liver malignancies in terms of size and localization, to decide the quantitative impact of contrast agent on the SUVmax values of liver lesions and normal liver tissue, and to assess the impact in SUVmax metrics following contrast substance administration.
Materials and Methods: This was a prospective research that included patients with suspicious primary and secondary hepatic cancers. Patients had non-enhanced & enhanced regional PET/CT examinations. The dimen-sion, position, densities (HU), visually assessment outcome, and SUVmax values for all pathological lesions were recorded, as well as the HU and SUVmax data of normal hepatic tissue.
Results: There were 97 liver lesions in total. Visually assessment outcome of lesions, the introduction of a contrast substance considerably enhanced the HU and SUVmax measurements for normal hepatic tissue. The HU measurements for lesions bigger than 1cm increased statistically significantly, as did the SUVmax levels of centralized lesions bigger than 1cm. The attenuation adjustment procedures, resulted in an average inaccuracy in computed SUVmax values at the ratio of %5 for normal liver tissue and %6 for all hepatic pathologies follow-ing the contrast substance delivery.
Conclusions: The inclusion of contrast substance increases the identification, localization, and characterization of the liver lesions with PET/CT substantially.

Keywords

Contrast material, PET/CT, liver lesion

Project Number

B.30.2.YBÜ.006.06.01/125

Kontrastlı BT'nin Karaciğer Lezyonlarının Karakterizasyonunda FDG PET'e Katkısı ve Kantitatif Etkileri

Abstract

Amaç: Çalışmadaki amaçlarımız, primer-sekonder karaciğer malignitelerinin boyut, lokalizasyon açısından saptanması için kontrastlı/kontrastsız 18F-FDG-PET/BT taramalarının tanısal etkinliğini karşılaştırmak, kontrast maddenin karaciğer lezyonlarının ve normal karaciğer dokusunun SUVmaks değerlerindeki kantitatif etkilerini araştırmak, kontrast madde uygulamasından sonra SUVmaks ölçümlerindeki hata düzeyini belirlemekti.
Materyal ve Metod: Bu çalışma, primer-sekonder karaciğer malignitesi şüphesi olan bireyleri içeren prospektif çalışmadır. Hastalara bölgesel kontrastsız ve kontrastlı PET/BT taramaları yapılmıştır. Malign kabul edilen lezyonların boyutu, lokalizasyonu, dansitesi, görsel derecelendirme skoru, SUVmaks değerleri ile normal karaciğer dokusunun HU, SUVmaks değerleri kaydedilmiştir.
Bulgular: Toplam 97 karaciğer lezyonu tespit edildi. Lezyonların görsel derecelendirme skorları, normal karaciğer dokusu için HU ve SUVmaks değerleri kontrast madde verilmesiyle anlamlı olarak arttı. 1cm'den büyük lezyonların HU değerlerinde ve 1cm'den büyük santral yerleşimli lezyonların SUVmaks değerlerinde istatistiksel anlamlı artış vardı. Atenüasyon düzeltme algoritmaları ile kontrast madde uygulamasından sonra hesaplanan SUVmaks değerlerinde normal karaciğer dokusu için ortalama %5 ve karaciğer lezyonları için %6 hatalı artış vardı.
Sonuç: Kontrast madde kullanımı, PET/BT ile hepatik lezyonların saptanmasını, lokalizasyonunu ve karakterizasyonunu önemli ölçüde iyileştirmektedir.

Keywords

Kontrast madde, PET/BT, karaciğer lezyonu

Ethical Statement

Çalışma Tıpta Uzmanlık Tezinden üretilmiş olup, Ankara Atatürk Eğitim ve Araştırma Hastanesi Etik Kurulu tarafından onaylanmıştır (İlaç Dışı Klinik Araştırmalar Etik Kurul Koordinatörlüğü/26.12.2012/B.30.2.YBÜ.006.06.01/125).

Project Number

B.30.2.YBÜ.006.06.01/125

References

• 1. Nakamura S, Suzuki S, Baba S. Resection of liver metastases of colorectal carcinoma. World J Surg. 1997 Sep;21(7):741-7.
• 2. Tsili AC, Alexiou G, Naka C, Argyropoulou MI. Imaging of colorectal cancer liver metastases using contrast-enhanced US, multidetector CT, MRI, and FDG PET/CT: a meta-analysis. Acta Radiol. 2021 Mar;62(3):302-312.
• 3. Refaat R, Basha MAA, Hassan MS, Hussein RS, El Sammak AA, El Sammak DAEA, et al., Efficacy of contrast-enhanced FDG PET/CT in patients awaiting liver transplantation with rising alpha-fetoprotein after bridge therapy of hepatocel-lular carcinoma. Eur Radiol. 2018 Dec;28(12):5356-5367.
• 4. Awai K, Hori S. Effect of contrast injection protocol with dose tailored to patient weight and fixed injection duration on aortic and hepatic enhancement at multidetector-row helical CT. Eur Radiol. 2003 Sep;13(9):2155-60.
• 5. Numminen K, Isoniemi H, Halavaara J, Tervahartiala P, Makisalo H, Laasonen L, et al., Preoperative assessment of focal liver lesions: multidetector computed tomography challenges magnetic resonance imaging. Acta Radiol. 2005 Feb;46(1):9-15.
• 6. Furuhata T, Okita K, Tsuruma T, Hata F, Kimura Y, Katsura-maki T, et al., Efficacy of SPIO-MR imaging in the diagnosis of liver metastases from colorectal carcinomas. Dig Surg. 2003;20(4):321-5.
• 7. Bar-Shalom R, Yefremov N, Guralnik L, Gaitini D, Frenkel A, Kuten A, et al., Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and pa-tient management. J Nucl Med. 2003 Aug;44(8):1200-9.
• 8. Cohade C, Osman M, Leal J, Wahl RL. Direct comparison of (18)F-FDG PET and PET/CT in patients with colorectal carci-noma. J Nucl Med. 2003 Nov;44(11):1797-803.
• 9. Pfannenberg AC, Aschoff P, Brechtel K, Müller M, Klein M, Bares R, et al., Value of contrast-enhanced multiphase CT in combined PET/CT protocols for oncological imaging. Br J Ra-diol. 2007 Jun;80(954):437-45.
• 10. Pfannenberg AC, Aschoff P, Brechtel K, Müller M, Bares R, Paulsen F, et al., Low dose non-enhanced CT versus stand-ard dose contrast-enhanced CT in combined PET/CT proto-cols for staging and therapy planning in non-small cell lung cancer. Eur J Nucl Med Mol Imaging. 2007 Jan;34(1):36-44.
• 11. Cantwell CP, Setty BN, Holalkere N, Sahani DV, Fischman AJ, Blake MA. Liver lesion detection and characterization in pa-tients with colorectal cancer: a comparison of low radiation dose non-enhanced PET/CT, contrast-enhanced PET/CT, and liver MRI. J Comput Assist Tomogr. 2008 Sep-Oct;32(5):738-44.
• 12. Dizendorf E, Hany TF, Buck A, von Schulthess GK, Burger C. Cause and magnitude of the error induced by oral CT con-trast agent in CT-based attenuation correction of PET emis-sion studies. J Nucl Med. 2003 May;44(5):732-8.
• 13. Glover C, Douse P, Kane P, Karani J, Meire H, Mohammad-taghi S, et al., Accuracy of investigations for asymptomatic colorectal liver metastases. Dis Colon Rectum. 2002 Apr;45(4):476-84.
• 14. Dodd GD 3rd, Soulen MC, Kane RA, Livraghi T, Lees WR, Yamashita Y, et al., Minimally invasive treatment of malig-nant hepatic tumors: at the threshold of a major break-through. Radiographics. 2000 Jan-Feb;20(1):9-27.
• 15. Ruers T, Bleichrodt RP. Treatment of liver metastases, an update on the possibilities and results. Eur J Cancer. 2002 May;38(7):1023-33.
• 16. Ward J, Robinson PJ, Guthrie JA, Downing S, Wilson D, Lodge JP, et al., Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium- and SPIO-enhanced MR imaging. Radiology. 2005 Oct;237(1):170-80.
• 17. Vogl TJ, Schwarz W, Blume S, Pietsch M, Shamsi K, Franz M, et al., Preoperative evaluation of malignant liver tumors: comparison of unenhanced and SPIO (Resovist)-enhanced MR imaging with biphasic CTAP and intraoperative US. Eur Radiol. 2003 Feb;13(2):262-72.
• 18. Kinkel K, Lu Y, Both M, Warren RS, Thoeni RF. Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology. 2002 Sep;224(3):748-56.
• 19. Bipat S, van Leeuwen MS, Comans EF, Pijl ME, Bossuyt PM, Zwinderman AH, et al., Colorectal liver metastases: CT, MR imaging, and PET for diagnosis--meta-analysis. Radiology. 2005 Oct;237(1):123-31.
• 20. Badiee S, Franc BL, Webb EM, Chu B, Hawkins RA, Coakley F, et al., Role of IV iodinated contrast material in 18F-FDG PET/CT of liver metastases. AJR Am J Roentgenol. 2008 Nov;191(5):1436-9.
• 21. Berthelsen AK, Holm S, Loft A, Klausen TL, Andersen F, Højgaard L. PET/CT with intravenous contrast can be used for PET attenuation correction in cancer patients. Eur J Nucl Med Mol Imaging. 2005 Oct;32(10):1167-75.
• 22. Bunyaviroch T, Turkington TG, Wong TZ, Wilson JW, Colsher JG, Coleman RE. Quantitative effects of contrast enhanced CT attenuation correction on PET SUV measurements. Mol Imaging Biol. 2008 Mar-Apr;10(2):107-13.
• 23. Murakami T, Kim T, Takamura M, Hori M, Takahashi S, Federle MP, et al., Hypervascular hepatocellular carcinoma: detection with double arterial phase multi-detector row helical CT. Radiology. 2001 Mar;218(3):763-7.
• 24. Zhang M, Kono M. Solitary pulmonary nodules: evaluation of blood flow patterns with dynamic CT. Radiology. 1997 Nov;205(2):471-8.
• 25. Kinahan PE, Hasegawa BH, Beyer T. X-ray-based attenua-tion correction for positron emission tomogra-phy/computed tomography scanners. Semin Nucl Med. 2003 Jul;33(3):166-79.