Dataset Information

Feasibility of 4D CT simulation with synchronized intravenous contrast injection in hepatocellular carcinoma.

ABSTRACT:

Background

Delivering Stereotactic Body Radiotherapy (SBRT) for Hepatocellular Carcinoma (HCC) is challenging mainly for two reasons: first, motion of the liver occurs in six degrees of freedom and, second, delineation of the tumor is difficult owing to a similar density of HCC to that of the adjoining healthy liver tissue in a non-contrast CT scan. To overcome both these challenges simultaneously, we performed a feasibility study to synchronize intravenous contrast to obtain an arterial and a delayed phase 4D CT.

Materials and methods

We included seven HCC patients of planned for SBRT. 4D CT simulation was performed with synchronized intravenous contrast based on the formula T_{SCAN DELAY} = T _peak - (L₀/Detector Coverage × Cine Duration in Seconds). This was followed by a delayed 4D CT scan.

Results

We found that, with our protocol, it is feasible to obtain a 4DCT with an arterial and a delayed phase making it comparable to a diagnostic multi-phase CT. The peak HU of the 4D scan and diagnostic CT were similar (mean peak HU 134.2 vs 143.1, p value = 0.58 N.S). Whereas in comparison with a non-contrast CT a significant rise in the peak HU was seen (mean peak 134.2 vs 61.4 p value = .00003).

Conclusion

A synchronized contrast 4D CT simulation for HCC is safe and feasible. It results in good contrast enhancement comparable to a diagnostic 3D contrast CT scan.

SUBMITTER: Gupta A

PROVIDER: S-EPMC7078516 | biostudies-literature | 2020 Mar-Apr

REPOSITORIES: biostudies-literature

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Publications

Feasibility of 4D CT simulation with synchronized intravenous contrast injection in hepatocellular carcinoma.

Gupta Anil A Kumar Rishabh R Yadav Hanuman Prasad HP Sharma Manik M Kamal Rose R Thaper Deepak D Banik Prabir P Gupta Shipra S Saroha Kartik K Singh Sandeep S Kumar Sarin Shiv S

Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology 20191213 2

<h4>Background</h4>Delivering Stereotactic Body Radiotherapy (SBRT) for Hepatocellular Carcinoma (HCC) is challenging mainly for two reasons: first, motion of the liver occurs in six degrees of freedom and, second, delineation of the tumor is difficult owing to a similar density of HCC to that of the adjoining healthy liver tissue in a non-contrast CT scan. To overcome both these challenges simultaneously, we performed a feasibility study to synchronize intravenous contrast to obtain an arterial ...[more]

PMID: 32194348

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Project description:Arterial peak enhancement on contrast-enhanced CT (CECT) images is thought to be higher in patients with low cardiac function. Using computer simulations, we tested the hypothesis that the relationship between the cardiac index and the aortic peak CT number (PCTN) is affected by the contrast material (CM) injection duration. We created computer simulation software for the contrast enhancement of various organs and vessels based on the Bae pharmacokinetics model and implemented models for CM transmission within organs and CM diffusion in blood plasma based on the osmotic pressure. Aortic contrast enhancement at coronary- and abdominal CT angiographs (CTA) was simulated for a representative 60-year-old Japanese male 166 cm in height and 65.0 kg in weight. The injection protocol for coronary CTA was: CM dose 45.5 ml, iodine dose, 245 mg/kg body weight (BW); injection duration 8-20 sec in 2-sec increments. For abdominal CTA it was CM dose 74.3 ml; iodine dose 400 mg/kg BW; injection duration 10-40 sec in 5-sec increments. In both protocols the iodine concentration was 350 mgI/ml, osmotic pressure was 590 mOsm/kgH2O, and the cardiac index ranged from 0.1-6.0 l/min/m2. Under all protocols, the aortic PCTN increased as the injection duration decreased and as the cardiac index rose to the cardiac index value. It then decreased as it exceeded the cardiac index value. At coronary CTA, at an injection duration of 8 or 10 sec, the PCTN exceeded 350 Hounsfield units (HU) at a cardiac index from 0.9-5.6 l/min/m2. At an HU value greater than 350, the range of the cardiac index narrowed when the injection duration was 12 sec or longer. On abdominal CTA scans performed with an injection duration of 10-, 15-, or 20 sec, the PCTN exceeded 350 HU at a cardiac index ranging from 0.4-5.3 l/min/m2. When the injection duration ranged from 25-40 sec, there was narrowing of the range of the cardiac index at which the PCTN exceeded 350 HU. For coronary and abdominal CTA, contrast enhancement protocols with shorter injection durations yield a diagnostically adequate aortic PCTN at a wide range of cardiac indices.

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Dataset Information

Feasibility of 4D CT simulation with synchronized intravenous contrast injection in hepatocellular carcinoma.

Background

Materials and methods

Results

Conclusion

Publications

Feasibility of 4D CT simulation with synchronized intravenous contrast injection in hepatocellular carcinoma.

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