Extra-hepatic sarcoma metastasis surveillance in the liver: is arterial phase imaging necessary?
To assess the value of arterial phase imaging (ART) in the detection of liver metastases on CT compared to portal venous phase imaging (PV) alone in patients with primary sarcomas.



Multiphasic abdominal computed tomography (CT) images of patients with tissue-proven sarcomas were reviewed by five abdominal radiologists in a staggered fashion. Up to three of the largest or most conspicuous liver lesions were characterized on a four-point confidence level for PV independently, followed by PV + ART. Inter-observer reliability was evaluated with kappa statistics. Change in characterization of lesions by the addition of ART was calculated. Follow-up imaging was used to determine if index lesion characterization was valid.



55 of 149 patients had 470 liver lesion characterizations by the five readers with follow-up. Inter-observer agreement was κ = 0.62 on PV and κ = 0.58 on PV + ART. The intra-observer agreement between PV and ART interpretations of the same lesion was κ = 0.93. 426 lesion characterizations were possible on both PV and ART. Only 6 characterizations were changed after the addition of ART; 4 of the 6 changes were incorrect when compared to follow-up. Only 6 lesion characterizations could be made on ART alone (missed by PV), with all the malignant lesions arising from primary leiomyosarcomas. For the lesions seen on PV alone, the sensitivity, specificity, PPV, NPV, and accuracy were 98.8%, 100%, 100%, 99.3%, and 99.6%, respectively. After the addition of ART, they were 98.8%, 98.7%, 97.5%, 99.4%, and 98.7%, respectively.



ART adds marginal value to PV for characterization of metastatic liver lesions in patients with primary sarcomas, except possibly in primary leiomyosarcomas.
Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road, AT634, Atlanta, GA, 30322, USA. pharri@emory.edu.
Peter A
PA
Harri
Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA, 30322, USA.
Alex
A
Chung
Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road, AT634, Atlanta, GA, 30322, USA.
Srini
S
Tridandapani
Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road, AT634, Atlanta, GA, 30322, USA.
Sadhna
S
Nandwana
Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road, AT634, Atlanta, GA, 30322, USA.
Oluwayemisi O
OO
Ibraheem
Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road, AT634, Atlanta, GA, 30322, USA.
Kelly
K
Cox
Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road, AT634, Atlanta, GA, 30322, USA.
Fredrick
F
Murphy
Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road, AT634, Atlanta, GA, 30322, USA.
Pardeep
P
Mittal
Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road, AT634, Atlanta, GA, 30322, USA.
William
W
Small
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging* / Q000473:pathology*; D012189:Retrospective Studies; D012509:Sarcoma / Q000000981:diagnostic imaging* / Q000556:secondary*; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D007472:Iohexol
Computed tomography; Liver metastases; Sarcoma; Surveillance