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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

Juan José Arenas-Jiménez
Juan José Arenas-Jiménez
, 
Elena García-Garrigós
Elena García-Garrigós
 y 
Mariana Cecilia Planells-Alduvín
Mariana Cecilia Planells-Alduvín
   | 19 nov 2021
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Article Category: Research Article
Publicado en línea: 19 nov 2021
Páginas: 418 - 425
Recibido: 13 feb 2021
Aceptado: 01 may 2021
DOI: https://doi.org/10.2478/raon-2021-0029
© 2021 Juan José Arenas-Jiménez, Elena García-Garrigós, Mariana Cecilia Planells-Alduvín, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

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.
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.

Figure 2

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.
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.

Figure 3

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.
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
eISSN:
1581-3207
Idioma:
Inglés
Calendario de la edición:
4 veces al año
Temas de la revista:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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