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Keywords:
Radiographers, Liver, CT, Efficacy studies, Diagnostic procedure, Metastases
Authors:
S. Tomé García1, J. G. García Calonge1, E. Ramón Botella1, M. Monteiro2; 1Madrid/ES, 2COIMBRA/PT
DOI:
10.1594/ecr2017/C-2759
Conclusion
For all scientific data mentioned so far and although our study reveals that in the Arterial phase in some cases all injuries are not valued,
we want to emphasize its importance and its inclusiveness in the routine diagnostic protocol for the scientific evidence that we have found at respect regarding differentiation thereof in the case of being hypervascular metastases (7).
As well as differentiation in the case of very small lesions,
as indicated by Honda et al,
in their article that shows that by adding a HAP (hepatic arterial phase) improved detectability of liver metastases,
especially in the case of injuries smaller than 10 mm (8) (9).
Similar studies of other authors such as MD Hollet in which it is determined that arterial phase scans improve detection of small (Ø <1.5 cm) hepatic malignancies when compared with portal venous explorations alone website (10) (11) .
Even some authors are committed to the realization of 3 phases,
including a late stage (12) (13).
In relation to our research line,
we would have to make many more studies to take a firm decision at the time of removing the arterial phase of the protocol,
despite our results,
where in the portal phase all these lesions are observed (100 %) and,
on the contrary,
in the arterial phase do not appear,
what puts into question his effectiveness.
In addition,
locations in the arterial phase coincide in the portal phase,
which makes not undermined the efficacy of the study in these cases.
It seems that these results are not conditioned by the variable gender dependent,
as our sample shows a ratio compensated at 50%,
but the results could only be generalized to an older age profile (Table 1),
which may necessitate further research in patients of younger age (<54.83 years).
The scientific evidence than we currently have does not support us in the decision to eliminate this phase,
so we wanted to reference other data that covered scientifically would contribute to decrease the radiation dose and image quality performance of thoracoabdominal tests when performing the CT scan,
almost all related to the use of dual-source CT with automated voltage adaptation in intraindividual comparison to 120 kV tests with modulation of the tube,
with a special focus on clinically relevant liver lesions (14),
using adaptative iterative dose reduction algorithms (AIDR 3D) in detectability of focal liver lesions with low contrast (FLLS) and repeatability of the radiation dose of automatic tube current modulation (ATCM) in abdominal CT (15) Dual Source Computed Tomography with high pitch and SAFIRE iterative reconstruction can shorten the scan time and reduce the radiation dose while preserving image quality in abdominal study (16),
the effect of using dual energy CT monochrome image late hepatic arterial phase for improving the detection of focal lesions and visibility of hypervascular lesions (17),
to evaluate the usefulness of the slope of the spectral curve of dual energy CT (DECT) for differentiating between hepatocellular carcinoma (HCC),
liver metastases,
hemangioma (HH) and cysts (18) to determine the impact of noise gradual increases in CT images in detecting hypodense hepatic lesions with low contrast it can be increased to 21.2 NI (noise index) with a reduction of 50% in patient radiation dose without substantial reduction in sensitivity (19).
Based on the results obtained,
we can conclude:
- The Arterial phase has lower reliability than the Portal phase.
- The liver lesions that appear on the Portal and Arterial phase coincide in their location in all cases.
- With the extracted data we would recommend at first suppress the Arterial phase to reduce the exposure dose of patients and therefore,
the health costs of revisions of cancer patients,
provided that the diagnostic quality is not altered.
What happens is that there is not enough scientific evidence to support that,
especially when they are very small lesions in which is necessary the realization of both phases.
- Although the results seem to follow a clear line,
we suggest reproduce similar studies with sample calculation using the data of our sample and classifying it by years of cancer progression,
weight,
height,
to infer the entire population.