Dissertation
Dissertation > Medicine, health > Oncology > Gastrointestinal Cancer > Liver tumors

Hepatic Enhancement at Multidetector CT: Effects of Patient Factors

Author ZhuJianBing
Tutor WuHaoRong; GongJianPing
School Suzhou University
Course General Surgery
Keywords multidetector CT hepatic enhancement sex age weightliver low attenuation fat liver enhancement multidetector CTcirrhosis schistosomias
CLC R735.7
Type PhD thesis
Year 2012
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Part Ⅰ Studies of hepatic enhancement at multidetector CT:effects of sex, age, body mass index, height, weight, abdomencircumference, heart rate and blood pressurePurpose1. To evaluate and compare relationship of sex, age, height, weight, abdomen circumference, heartrate and blood pressure for contrast material-enhanced multidetector computed tomography (CT) ofliver under the condition of the adjustment of the iodine dose by weight.2. To evaluate and compare effects of sex, age, height, weight, abdomen circumference, heart rateand blood pressure for contrast material-enhanced multidetector computed tomography (CT) of liverunder the condition of the adjustment of the iodine dose by weight.MATERIALS AND METHODSInstitutional review committee approval of the second affiliated hospital of Soochow universitywas obtained.785patients (416men,369women) who underwent multidetector CT of the abdomenwere collected in this study in a period of5months, from Jan to May2010,all patients scan with64-MSCT (LightSpeed VCT; GE Healthcare), height, weight, abdomen circumference, heart rate andblood pressure were collected before examination, All patients were administered nonionic iodinatedcontrast material(iohexol) containing300mg of iodine per milliliter, contrast dose decided byweight(0.5mgI/Kg), Injection duration fixed as30s, and saline flush before and after contrast injection.A bolus-tracking software program (SmartPrep; GE Healthcare) was used to determine the time ofinitiation of diagnostic scanning following contrast material injection. as hepatic arterial phase weredecided manual initiation of diagnostic scanning10s after the CT number in the aorta reached a threshold level increase of150HU, Hepatic venous phase and delay phase were decided by add40s,120s after completion of the last series scan. Reformations were done on the workstation ofADW4.2, all measurement were done on the PACS.Result1. The age, height, weight varied wildly in the group, but the mean added enhancement of theabdominal aorta arrived250HU in the arterial phase, the mean added enhancement of liver arrived50HU in the portal phase, which satisfied clinic demanding. The plain scan and enhancement of thedifferent lobe of liver has significant differences.2. A mild inverse correlation was noted between liver attenuation and age in the arterial phase, theregression formula (hepatic attenuation [H]=24.77–0.097age [years])(p <0.001), a positivecorrelation was noted between age and the abdominal aorta enhancement of the arterial phase, portalphase and delay phase. Young group has significant differences with other age groups.3. Although contrast dose decided by weight, but weight still has positive correlation with hepaticenhancement in the portal phase and delay phase, abdominal aorta enhancement of the arterial phaseand the portal vein enhancement in the portal phase and delay phase.4. A positive correlation was noted between liver attenuation and height in the portal phase anddelay phase, with the increase of the height, the added hepatic enhancement of the portal phase anddelay phase also increased, a mild inverse correlation was noted between height and abdominal aortaenhancement of the portal phase and delay phase.5. A mild inverse correlation was noted between liver attenuation and body mass index(BMI) in thearterial phase, suggests that, with the increase the BMI, hepatic enhancement of the arterial phasedecreased, the regression formula (hepatic attenuation [H]=24.39–0.226BMI [Kg/m~2])(p <0.05), Apositive correlation was noted between BMI and the hepatic enhancement, portal vein of the portalphase and delay phase and the abdominal aorta enhancement of the arterial phase, the portal phase anddelay phase. The group was divided into thin group and no-thin group by the BMI, suggests that, thereis no significant difference between thin and no-thin group(P>0.05) on hepatic enhancement of thearterial phase, but thin group has lower hepatic enhancement than no-thin group in the portal phase anddelay phase(P<0.05). 6. Abdomen circumference has correlation with liver, portal vein and the abdominal aorta in thearterial phase, the portal phase and delay phase, the inverse correlation including hepatic enhancementof the arterial phase(P<0.05) and portal vein of the arterial phase(P<0.01),others have positivecorrelation.7. Systolic pressure has the inverse correlation with the abdominal aorta in the arterial phase, andnone correlation with others. The mild positive correlations were noted between heart rate and thehepatic enhancement of the arterial phase, the abdominal aorta enhancement of the portal phase anddelay phase.8. There is significant differences in hepatic plain scan between male and female(P<0.05),nosignificant differences in hepatic enhancement of the arterial phase(P>0.05), but significant differencesin hepatic enhancement of the portal phase and delay phase(P<0.05).Age of the female has morecorrelation with the hepatic enhancement of the arterial phase. With increased weight, male hepaticenhancement of the portal vein phase decreased slower than female.9. With absolute50HU of the hepatic enhancement of portal vein phase as standard, it has27%arrived the standard, the characters are more female, lighter weight, lower height, smaller abdomencircumference, and no differences in age, heart rate and blood pressure, but divided as age, advancedage group has more.Conclusion1. With the control of the weight, contrast injection and CT scan techniques, Individual factors ofthe patients (including sex, age, height, weight, BMI, BSA, abdomen circumference, heart rate andblood pressure) have different degree role in the enhancement of the liver; parts of the individual factorshave Interaction.2. There is sex difference in decided factors in an optimal contrast injection plan. Clinic applicationshould pay attention to it adjust contrast injection plan.3. With increased age, an optimal contrast injection plan should be applied foe hepaticenhancement in arterial phase. Age has no role in hepatic enhancement in the portal vein phase anddelay phase.4. Weight is not an only important factor that affects hepatic enhancement, the weighted patient, maybe have been injected more contrast dose than needed.5. With the increasing BMI, hepatic enhancement of arterial phase decreased, but has positivecorrelation with hepatic and portal vein enhancement of the portal vein phase, delay phase, theabdominal aorta of the arterial phase, delay phase. Thin group has more correlation with hepatic andvessel enhancement, but no for no-thin group, suggested that, existence of the fat twist the goodcorrelation between weight and contrast enhancement. No-thin group get more contrast than needed.6. Blood pressure and heart rate have complicated effect on enhancement, it has low correlationwith hepatic enhancement, should combined with other infectors in the judgment of the enhancement.7. BSA is a role in affect the hepatic enhancement in portal vein and delay phase, but no role inhepatic enhancement in the arterial phase.8. Statistical analysis indicated that factor of the type of build (including weight, height, BMI,BSA,abdomen circumference, contrast injection volume and injection rate) is a most important factor inaffecting hepatic enhancement of the portal vein phase and delay phase, but no role in hepaticenhancement in the arterial phase. Part Ⅱ Hepatic enhancement at multidetector CT: effects ofdiffused low hepatic attenuationPurposeWith the control of the contrast dose and contrast injection, characters of hepatic enhancement wasinvestigated in the patients with diffused low hepatic attenuation, and compare with normal livercontrast group, for investigating the characters of hepatic enhancement with different pathology anddifferent server degree.MATERIALS AND METHODSInstitutional review committee approval of the second affiliated hospital of Soochow universitywas obtained.92patients who underwent multidetector CT of the abdomen were collected in this studyin a period of5months, from Jan to May2010,at the same time, for contrast,92,94and72patinet werecollected with the method of random, in accordance with weight and BMI. all patients scan with 64-MSCT (LightSpeed VCT; GE Healthcare), height, weight, abdomen circumference, heart rate andblood pressure were collected before examination, All patients were administered nonionic iodinatedcontrast material(iohexol) containing300mg of iodine per milliliter, contrast dose decided byweight(0.5mgI/Kg), Injection duration fixed as30s, and saline flush before and after contrast injection.A bolus-tracking software program (SmartPrep; GE Healthcare) was used to determine the time ofinitiation of diagnostic scanning following contrast material injection. as hepatic arterial phase weredecided manual initiation of diagnostic scanning10s after the CT number in the aorta reached athreshold level increase of150HU, Hepatic venous phase and delay phase were decided by add40s,120s after completion of the last series scan. Reformations were done on the workstation ofADW4.2, all measurement were done on the PACS.Results1. Diffused low hepatic attenuation group compare with random contrast group, suggest that, thereare no significant differences on initial arterial scan time, age, sex, height and heart rate, but there aresignificant differences on weight, abdomen circumference, BMI, and blood pressure. There aresignificant differences on hepatic plain scan and hepatic enhancement of the arterial phase,demonstrated that diffused low hepatic attenuation group has lower enhancement than contrast group,but there are no significant differences hepatic enhancement of the portal vein phase and delay phase.2. Diffused low hepatic attenuation group compare with control group with same weight level,there is sex difference on distribution, lower heigh(tP<0.05),higher BMI(P<0.05). Diffused low hepaticattenuation group has lower hepatic enhancement of the arterial phase (P<0.05),but no significantdifferences on hepatic enhancement of the portal vein phase and delay phase.3. Diffused low hepatic attenuation group compare with control group with same BMI level, thereis significant difference on hepatic plain scan, but no significant differences on hepatic and vesselenhancement of the arterial phase, the portal vein phase and delay phase.4. The medium and server degree diffused low hepatic attenuation group compared with milddegree, there is significant differences on hepatic enhancement of the arterial phase, the portal veinphase and delay phas(eP<0.05),demonstrated that, hepatic enhancement of the arterial phase, the portalvein phase and delay phase of the medium and server degree diffused low hepatic attenuation groups are lower than group of mild.5. post-operation of tumors group compare with no post-operation of tumors group, there issignificant differences on hepatic attenuation of plain scan, with (36.19±16.09HU)and (42.71±10.41HU)respective. there is significant differences on hepatic enhancement of the arterial phase(P<0.05),with post-operation of tumors group (14.06±5.98HU) lower than no post-operation oftumors group (17.49±8.70HU),there are no significant differences on others.ConclusionWith the control of the weight, contrast injection and CT scan techniques, we can conclude1. Diffused low hepatic attenuation group compare with random contrast group, suggest that, it ishigher on weight, abdomen circumference, BMI, and blood pressure, diffused low hepatic attenuationgroup has lower hepatic enhancement of the arterial phase than contrast group, but no significantdifferences on hepatic enhancement of the portal vein phase and delay phase.2. Diffused low hepatic attenuation group compare with control group with same weight level,which with lower height, higher BMI and faster heart rate, lower hepatic enhancement of the arterialphase, but no significant differences on hepatic enhancement of the portal vein phase and delay phase.3. Diffused low hepatic attenuation group compare with control group with same BMI level, nosignificant differences on hepatic and vessel enhancement of the arterial phase, the portal vein phaseand delay phase and patients factors were noted, suggested that BMI is an important factor in hepaticenhancement of the arterial phase in this study.4. Compare within different degree diffused low hepatic attenuation group, suggested that moreserver the low hepatic attenuation, lower hepatic enhancement, so CT enhancement can be an index ofthe hepatic injury.5. In the study of different pathology on diffused low hepatic attenuation, post-operation of tumorsgroup is server than other group in the hepatic injury, which dammed hepatic enhancement of thearterial phase, but no significant differences on hepatic enhancement of the portal vein phase and delayphase. Part Ⅲ Hepatic enhancement at multidetector CT: effects ofcirrhosisPurpose1. under the control of the contrast volume and injection, to investigate the characters of hepaticenhancement of the cirrhosis, and compare with the normal control group.2. To compare hepatic enhancement of different cirrhosis.MATERIALS AND METHODSInstitutional review committee approval of the second affiliated hospital of Soochow universitywas obtained.50patients of cirrhosis who underwent multidetector CT of the abdomen were collectedin this study in a period of5months, from Jan to May2010,at the same time, for contrast,50patientswere collected with random as control group. all patients scan with64-MSCT (LightSpeed VCT; GEHealthcare), height, weight, abdomen circumference, heart rate and blood pressure were collectedbefore examination, All patients were administered nonionic iodinated contrast material(iohexol)containing300mg of iodine per milliliter, contrast dose decided by weight(0.5mgI/Kg), Injectionduration fixed as30s, and saline flush before and after contrast injection. A bolus-tracking softwareprogram (SmartPrep; GE Healthcare) was used to determine the time of initiation of diagnostic scanningfollowing contrast material injection. as hepatic arterial phase were decided manual initiation ofdiagnostic scanning10s after the CT number in the aorta reached a threshold level increase of150HU,Hepatic venous phase and delay phase were decided by add40s,120s after completion of the last seriesscan. Reformations were done on the workstation of ADW4.2, all measurement were done on the PACS.Result1. Compare with control group, the height cirrhosis group (158.64±7.49cm)is shorter thancontrol group(163.82±7.89cm)with significant difference, but it has no significant differences withother patient factors. Cirrhosis group has higher hepatic enhancement in delay phase, and lower hepaticand vessel plain scan and enhancement of other phase, but has no significant differences. Comparedeferent lobe of liver within two groups, only hepatic enhancement of left lobe of arterial phase hassignificant difference, which with lower enhancement.2. Compare with cirrhosis of schistosomias, except no-cirrhosis of schistosomias (25.31± 3.53Kg/m~2)has higher BMI than cirrhosis of schistosomias(23.17±3.49Kg/m~2),other patients factorshave no significant differences. Except plain scan of abdominal aorta having significant difference, theleft hepatic and vessel plain scan and enhancement have no significant differences between two groups.ConclusionWith the contrast injection plan of this study and result, we can conclude that:1. Compare with control group, Cirrhosis group has no significant differences in hepaticenhancement.2. Different lobe of the liver has difference in hepatic enhancement, especially in the left lobe ofthe liver, suggested that, the left lobe can be an antecedents index for cirrhosis in CT diagnosis.3. Except plain scan of abdominal aorta having significant difference, the left hepatic and vesselplain scan and enhancement have no significant differences between cirrhosis of schistosomias andno-cirrhosis of schistosomias. Part Ⅳ Hepatic enhancement at multidetector CT: effects oftranscatheter hepatic arterial chemoembolizationPurposeTo collected patients with hepatic tumor, dividing into two groups with and without transcatheterhepatic arterial chemoembolization (TACE), and compares characters of hepatic enhancement betweentwo groups.MATERIALS AND METHODSInstitutional review committee approval of the second affiliated hospital of Soochow universitywas obtained.119patients with hepatic tumor who underwent multidetector CT of the abdomen werecollected in this study in a period of5months, from Jan to May2010, all patients scan with64-MSCT(LightSpeed VCT; GE Healthcare), height, weight, abdomen circumference, heart rate and bloodpressure were collected before examination, All patients were administered nonionic iodinated contrastmaterial(iohexol) containing300mg of iodine per milliliter, contrast dose decided by weight(0.5mgI/Kg), Injection duration fixed as30s, and saline flush before and after contrast injection. Abolus-tracking software program (SmartPrep; GE Healthcare) was used to determine the time of initiation of diagnostic scanning following contrast material injection. as hepatic arterial phase weredecided manual initiation of diagnostic scanning10s after the CT number in the aorta reached athreshold level increase of150HU, Hepatic venous phase and delay phase were decided by add40s,120s after completion of the last series scan. Reformations were done on the workstation ofADW4.2, all measurement were done on the PACS.Result1. comparing hepatic tumor with and without TACE: there is significant difference in age, heightand weight((P<0.05), other factors of patient has no significant difference.2. Hepatic tumor with TACE has lower hepatic enhancement of arterial phase and has significantdifference. There is no significant difference in the hepatic plain scan, hepatic enhancement of the portalvein phase and delay phase. The plain scan of the abdominal aorta and portal vein has significantdifference, but no significant differences were noted in the enhancement of the abdominal aorta andportal vein.3. Left lobe of the liver has significant difference in the hepatic enhancement of the arterial phase,others have none.ConclusionWith the contrast injection plan of this study and result, we can conclude that Hepatic tumor withTACE would lower hepatic enhancement of the arterial phase, but has no effort on hepatic enhancementof the portal vein phase and delay phase, and has no effort on the enhancement of the abdominal aortaand portal vein.

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