title: Same-day computed tomography during arterial portography and delayed high-dose iodine computed tomography: an efficient approach to imaging potentially resectable liver tumours.
abstract: Preoperative imaging in patients with potentially resectable liver tumours has traditionally been performed in specialized hepatobiliary centres. To assess the feasibility and value of establishing a same-day, pre-resectional hepatic imaging service, computed tomography during arterial portography (CTAP) and delayed high-dose iodine computed tomography (DICT) were used to examine patients considered suitable for curative hepatic resection. The study group comprised 27 patients (14 from hospitals not affiliated with a university and 13 from two university-affiliated hospitals) for whom pre-referral imaging showed tumour distribution amenable to resection. Among the patients from centres not affiliated with a university, seven had undergone ultrasonography (US) and equilibrium-phase CT, four had undergone US and unenhanced CT, two had undergone equilibrium-phase CT only and one had undergone bolus dynamic incremented CT (BDCT) only. For 12 of the patients coming from the university-affiliated centres, the pre-referral imaging had consisted of US and BDCT; the other had undergone US only. After CTAP and DICT, 20 (74%) of the 27 patients were reclassified as having unresectable disease: 7 (54%) of the 13 patients who had undergone BDCT before CTAP and DICT and 12 (92%) of the 13 patients who had undergone unenhanced or equilibrium-phase CT, as well as the patient who had undergone US only. By averting laparotomy in 20 of the patients, CTAP and DICT resulted in short-term health care savings of about $160,000. These findings suggest that BDCT was underused in the hospitals not affiliated with university centres.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, Ont.
authors.forename: F P
authors.initials: FP
authors.lastname: McGrath
authors.forename: D E
authors.initials: DE
authors.lastname: Malone
authors.forename: J
authors.initials: J
authors.lastname: Dobranowski
authors.forename: G J
authors.initials: GJ
authors.lastname: Gill
authors.forename: S
authors.initials: S
authors.lastname: Somers
authors.forename: G W
authors.initials: GW
authors.lastname: Stevenson
mesh_terms: D000792:Angiography; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006761:Hospitals; D006785:Hospitals, University; D006801:Humans; D007455:Iodine; D008113:Liver Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D008297:Male; D011172:Portography / Q000379:methods*; D011856:Radiographic Image Enhancement; D012017:Referral and Consultation; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007455:Iodine