Project details

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Is dynamic multi-phase CT imaging in cancer patients useful?

Keywords:
Multi-phase CT liver metastases diagnostic importance

Researchers:
Dr. D. Yakar
Dr. T. Kwee

Nature of the research:
Retrospective evaluation

Fields of study:
surgery radiology internal medicine

Background / introduction
Knowledge of anatomic disease spread (staging) is crucial for appropriate treatment planning and prognostication of patients with cancer. Computed tomography (CT) is an important imaging modality that is routinely used for the evaluation of cancer patients. A CT scan is usually performed after intravenous contrast medium administration to improve the visibility of cancer relative to surrounding normal anatomical structures. After administration of contrast medium, CT scanning can be done in one phase (i.e. a single time point after contrast administration) or in different phases (multi-phasic CT). Multi-phasic CT thus provides a dynamic picture of the human body and diseases. The potential advantage of multi-phasic CT is better visualization of cancer, but the disadvantage is the use of a higher dose of radiation compared to single-phase CT. Currently, there are no clear guidelines for CT-based imaging follow-up of metastatic disease. Nevertheless, multi-phasic CT of the liver has been advocated for the optimal detection of liver metastases that have a high arterial vascularity. Examples of such tumours are breast cancer, melanoma, renal cell carcinoma, thyroid cancer, and neuroendocrine tumours. However, there is limited evidence/information on the extra diagnostic yield of these multi-phase scans compared to standard single-phase CT. The purpose of this study is to investigate the utility of multi-phase CT in the evaluation of cancer patients and to propose a new guideline for CT follow-up in metastatic disease.
Research question / problem definition
1. To evaluate the clinical utility of multi-phase CT for tumour detection in cancer patients.
2. To investigate if the optimal detectability is different for e.g. breast cancer, melanoma, renal cell carcinoma, thyroid cancer, and neuroendocrine tumours.
Workplan
This project is suited for a medical student in his/her senior Bachelor (2nd or 3rd year) or Master phase for a period of 3 (minimum) to 6 months. The final product will be a co-authored scientific article. Time schedule: part 1: familiarisation with the topic; part 2: data collection; part 3: data analysis and manuscript writing. During this research internship, there is also the possibility to accompany the radiologist/nuclear medicine physician with daily clinical activities and attend clinical meetings with other medical specialists.
References
1.Utility of dual phase liver CT for metastatic melanoma staging and surveillance.
Winkler N, Rezvani M, Heilbrun M, Shaaban A. Eur J Radiol. 2013
2. Liver metastases from melanoma: detection with multiphasic contrast-enhanced CT. Blake SP, Weisinger K, Atkins MB, Raptopoulos V. Radiology. 1999.
3. Hepatic metastases from breast carcinoma: comparison of non-contrast, arterial-dominant, and portal-dominant phase spiral CT. Zimmerman P, Lu DS, Yang LY, Chen S, Sayre J, Kadell B. J Comput Assist Tomogr. 2000
4. Comparison of unenhanced, hepatic arterial-dominant, and portal venous-dominant phase helical CT for the detection of liver metastases in women with breast carcinoma. Sheafor DH, Frederick MG, Paulson EK, Keogan MT, DeLong DM, Nelson RC. AJR Am J Roentgenol. 1999.
5. Multiphase contrast-enhanced helical CT of liver metastases from renal cell carcinoma. Raptopoulos VD, Blake SP, Weisinger K, Atkins MB, Keogan MT, Kruskal JB. Eur Radiol. 2001
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