Background: s/Aims: The status of portal lymph nodes is a critical factor in determining eligibility for hepatic artery infusion pump (HAIP) therapy. However, methods for detecting occult positive nodes and understanding their clinical implications remain inadequately defined. Methods: We conducted a retrospective evaluation of a cohort of patients with metastatic colorectal cancer who underwent HAIP.An independent, blinded radiologist reviewed pre-operative imaging to identify predictors for nodal positivity. We performed Kaplan-Meier survival analyses to explore the relationship between hepatic nodal staging and patient survival. Results: The study comprised 33 patients, with a median follow-up of 23.5 months (range 2–56 months). The imaging review did not accurately identify patients with hepatic nodal disease. Patients without hepatic nodal metastases (n = 23) had a significantly longer median overall survival (OS) of 27 months compared to those with hepatic nodal metastases, who had a median OS of 11 months (hazard ratio = 4.8, p ≤ 0.01). Hepatic nodal positivity (hLN+) was associated with primary nodal positivity (pLN+, p = 0.036), and all patients with hLN+ were also pLN+. Conclusions Hepatic nodal metastases are a predictor of survival in patients receiving HAIP therapy for colorectal liver metastases.Primary nodal positivity may aid in the selection of HAIP candidates by increasing the suspicion of hepatic nodal positivity.

OBJECTIVE: This study was designed to investigate the effect of administration of warmed contrast material (CM) on the bolus geometry and enhancement as depicted on coronary CT angiography. MATERIALS AND METHODS: A total of 64 patients (42 men, 22 women; mean age, 56 years) were randomly divided into two groups. Group 1 included 32 patients administered CM (Omnipaque [Iohexol] 350 mg I/ mL; Nycomed, Princeton, NJ) saline solutions kept in an incubator at a constant temperature (37degrees C). Group 2 included 32 patients administered the CM saline solutions kept at constant room temperature (24degrees C). Cardiac CT scans were performed with a dual source computed tomography (DSCT) scanner. For each group, region of interest curves were plotted inside the ascending aorta, main pulmonary artery and descending aorta on test bolus images. Using enhancement values, time/enhancement diagrams were produced for each vessel. On diagrams, basal Hounsfield unit (HU) values were subtracted from sequentially obtained values. A value of 100 HU was accepted as a cut-off value for the beginning of opacification. The time to peak, the time required to reach 100 HU opacification, maximum enhancement and duration of enhancement above 100 HU were noted. DSCT angiography studies were evaluated for coronary vessel enhancement. RESULTS: Maximum enhancement values in the ascending aorta, descending aorta and main pulmonary artery were significantly higher in group 1 subjects. In the ascending aorta, the median time required to reach 100 HU opacification during the test bolus analysis was significantly shorter for group 2 subjects than for group 1 subjects. In the ascending aorta, the descending aorta and main pulmonary artery, for group 1 subjects, the bolus geometry curve shifted to the left and upwards as compared with the bolus geometry curve for group 2 subjects. CONCLUSION: The use of warmed CM yields higher enhancement values and a shorter time to reach maximum enhancement duration, resulting in a shift of the bolus geometry curve to the left that may provide optimized image quality.
Adult ; Aged ; Contrast Media/*administration & dosage ; *Coronary Angiography ; Female ; Humans ; Image Enhancement ; Image Processing, Computer-Assisted ; Injections, Intravenous ; Iohexol/*administration & dosage ; Male ; Middle Aged ; Prospective Studies ; *Temperature ; Tomography, X-Ray Computed