Liver cancer
4D-CT imaging with synchronized intravenous contrast injection to improve delineation of liver tumors for treatment planning

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Abstract

We have developed a tumor-specific protocol for the 4D-CT imaging of liver tumors using synchronized intravenous (IV) contrast injection to improve the accuracy of tumor delineation for treatment planning. Most liver metastases and cholangiocarcinomas can be imaged in the portal venous phase, while hepatocellular carcinomas are most visible in the delayed phase. Combined 4D-CT imaging with synchronized IV contrast allows for both enhancement of tumor contrast and coverage over the entire breathing cycle.

Section snippets

4D-CT procedure

As part of the standard treatment for patients with liver tumors, we use the GE Discovery ST PET/CT scanner (General Electric Co., Waukesha, WI) for 4D-CT image acquisition. The CT scanner in this unit is used to acquire a maximum of eight 2.5-mm slices per couch position. The respiration of the patient is tracked using the Real-Time Position Management (RPM) System (Varian Medical Systems, Palo Alto, CA) [5], [9]. Normal helical scouts for patient positioning and isocenter localization are

Results and discussion

More than 80 patients have been simulated following this protocol since November 2004. Representative images from patients with each of the three common liver tumor types (colorectal liver metastases, cholangiocarcinoma, and hepatocellular carcinoma) are provided in Fig. 1, and data for these three patients are shown in Table 1. For two of the patients, one with liver metastases and the other with intrahepatic cholangiocarcinoma, the liver was imaged during the portal venous phase with a 45-s

Conclusions

Combined 4D-CT imaging with synchronized IV contrast allows for both enhancement of tumor contrast and coverage over the entire breathing cycle. The 4D-CT scans are acquired in the same position and immobilization device as that used for treatment, and thus may improve on the accuracy of tumor contouring and localization. Finally, the resulting tumor contours can be fused with the scans to be used for treatment planning.

Further studies are required, and additional experience from the

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