The role of unenhanced phase of the liver in the scanning protocol of metastatic breast cancer: implications for sensitivity, response evaluation and size measurement Cover

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The role of unenhanced phase of the liver in the scanning protocol of metastatic breast cancer: implications for sensitivity, response evaluation and size measurement

Radiology and Oncology

Volume 55 (2021): Issue 4 (December 2021)

By: Juan José Arenas-Jiménez, Elena García-Garrigós and Mariana Cecilia Planells-Alduvín

Open Access

|Nov 2021

Figures & Tables

Flowchart of the reading protocol. There were four steps: sort of phases from best to worst, sensitivity study based only on the reading of examinations having ≤5 metastases, measurement of one target lesion in each examination and evaluation of phases for comparing metastases in 2 consecutive follow-up scans.

48-year-old woman with hepatic metastases from breast cancer. Upper row corresponds to previous study and lower row is follow-up. Previous unenhanced phase (A) show more lesions than either the arterial (B) and portal (C) phases. At follow-up 6 weeks later, worsening seen in unenhanced phase (D) cannot be confidently confirmed only by arterial (E) and portal (F) phases.

56-year-old woman with hepatic metastases from breast cancer. Measurement of target lesion in unenhanced phase (A) is 33 mm and in the portal phase (B) is 18 mm, that represent a 45% difference. A part of the metastatic lesion posteriorly is scarcely seen as a subtle increase attenuation in the portal phase, but both readers failed to consider that area as part of the lesion, and measured only the hypoattenuating component. Note how unenhanced phase also shows other small lesions not seen in the portal phase.

Measurements of target lesions by phase

	Unenhanced	Arterial	Portal
Reader 1	27.6 ± 18.7	23.9 ± 18.9	24.2 ± 18.2
Reader 2	27.4 ± 18.6	24.0 ± 18.7	24.1 ± 18.0

Distribution of scores of each phase for comparing metastatic lesions in two consecutive scans by both readers in 149 examinations

		Reader 1
					UNENHANCED
				1	2	3
			1	35	6	1
	1	ARTERIAL	2	42	20	0
			3	2	0	0
PORTAL			1	3	0	1
	2	ARTERIAL	2	23	0	0
			3	2	0	0
	3	ARTERIAL	2	1	0	0
			3	13	0	0

Distribution of scores of each phase by both readers in 153 examinations

			Reader 1
					UNENHANCED
				1	2	3	4
			1	32	2	2	0
	1	ARTERIAL	2	16	20	10	1
			3	9	10	0	0
			4	4	0	0	0
			1	1	0	2	0
PORTAL	2	ARTERIAL	2	6	0	0	0
			3	15	0	0	1
					0	0	0
			1	0	1	0	0
	3	ARTERIAL	2	4	0	0	0
			3	4	0	0	0
			4	0	0	0	0
			2	1	0	0	0
	4	ARTERIAL	4	9	0	0	0

DOI: https://doi.org/10.2478/raon-2021-0029 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

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Language: English

Page range: 418 - 425

Submitted on: Feb 13, 2021

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Accepted on: May 1, 2021

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Published on: Nov 19, 2021

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

computed tomography,

Related subjects:

Clinical medicine,

Internal medicine,

Haematology, oncology,

© 2021 Juan José Arenas-Jiménez, Elena García-Garrigós, Mariana Cecilia Planells-Alduvín, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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