Gelareh Sadigh1, Kimberly E Applegate2, Deborah A Baumgarten3. 1. Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322. Electronic address: gsadigh@emory.edu. 2. Department of Radiology, Children's Hospital of Atlanta and Emory University School of Medicine, Atlanta, Georgia. 3. Division of Abdominal Imaging, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia.
Abstract
RATIONAL AND OBJECTIVES: To evaluate whether addition of nonenhanced computed tomography (NECT) to intravenous contrast-enhanced (CE) abdominal CT improves detection or characterization of hypervascular liver masses. Patients were referred for initial staging or follow-up with known breast, melanoma, neuroendocrine, or thyroid cancer. MATERIAL AND METHODS: The literature was searched using the patient, intervention, comparison, and outcome (PICO) method. Retrieved articles were critically appraised and assigned a level of evidence based on the Oxford University Centre for Evidence-based Medicine hierarchy of validity for diagnostic studies. RESULTS: One thousand one hundred studies were reviewed; only 11 studies matched the PICO of our study and were appraised. Most of the appraised articles were published in the 1990s using older technology and contrast delivery. The retrieved diagnostic performance for characterization of liver metastases showed sensitivity/specificity of 97%/76% for NECT, 97%/75% for arterial CT, and 98%/76% for portal venous phase CT in patients with breast cancer; sensitivity of 96% (arterial and portal CT) versus 100% (NECT, arterial and portal CT) in patients with melanoma; and sensitivity of 43% (portal CT) versus 17% (NECT) in patients with neuroendocrine tumor. No primary study was found for performance of different CT protocols in patients with thyroid cancer. Available evidence showed radiologists reported more conspicuous liver masses on CECT compared to NECT in patients with breast or neuroendocrine cancer. CONCLUSIONS: Based on existing evidence, NECT only adds a small incremental value to CECT for detection/characterization of hypervascular liver metastases. Addition of NECT increases patient's exposure to radiation and the number of images available for interpretation.
RATIONAL AND OBJECTIVES: To evaluate whether addition of nonenhanced computed tomography (NECT) to intravenous contrast-enhanced (CE) abdominal CT improves detection or characterization of hypervascular liver masses. Patients were referred for initial staging or follow-up with known breast, melanoma, neuroendocrine, or thyroid cancer. MATERIAL AND METHODS: The literature was searched using the patient, intervention, comparison, and outcome (PICO) method. Retrieved articles were critically appraised and assigned a level of evidence based on the Oxford University Centre for Evidence-based Medicine hierarchy of validity for diagnostic studies. RESULTS: One thousand one hundred studies were reviewed; only 11 studies matched the PICO of our study and were appraised. Most of the appraised articles were published in the 1990s using older technology and contrast delivery. The retrieved diagnostic performance for characterization of liver metastases showed sensitivity/specificity of 97%/76% for NECT, 97%/75% for arterial CT, and 98%/76% for portal venous phase CT in patients with breast cancer; sensitivity of 96% (arterial and portal CT) versus 100% (NECT, arterial and portal CT) in patients with melanoma; and sensitivity of 43% (portal CT) versus 17% (NECT) in patients with neuroendocrine tumor. No primary study was found for performance of different CT protocols in patients with thyroid cancer. Available evidence showed radiologists reported more conspicuous liver masses on CECT compared to NECT in patients with breast or neuroendocrine cancer. CONCLUSIONS: Based on existing evidence, NECT only adds a small incremental value to CECT for detection/characterization of hypervascular liver metastases. Addition of NECT increases patient's exposure to radiation and the number of images available for interpretation.
Authors: Gelareh Sadigh; Sadhna B Nandwana; Courtney Moreno; Kelly L Cox; Deborah A Baumgarten; Jeffrey Switchenko; Tiffany Easter; Kimberly E Applegate Journal: Curr Probl Diagn Radiol Date: 2016-05-25
Authors: Jacqueline Dinnes; Lavinia Ferrante di Ruffano; Yemisi Takwoingi; Seau Tak Cheung; Paul Nathan; Rubeta N Matin; Naomi Chuchu; Sue Ann Chan; Alana Durack; Susan E Bayliss; Abha Gulati; Lopa Patel; Clare Davenport; Kathie Godfrey; Manil Subesinghe; Zoe Traill; Jonathan J Deeks; Hywel C Williams Journal: Cochrane Database Syst Rev Date: 2019-07-01
Authors: R G Koleva-Kolarova; M J W Greuter; M van Kruchten; K M Vermeulen; T Feenstra; E Buskens; A W J M Glaudemans; E F J de Vries; E G E de Vries; G A P Hospers; G H de Bock Journal: Br J Cancer Date: 2015-04-16 Impact factor: 7.640
Authors: Brian Flemming; Mark D Kovacs; Andrew Hardie; Melissa Picard; Philip F Burchett; Heather Collins; Douglas H Sheafor Journal: Acta Radiol Open Date: 2021-02-27