Abdominal Radiology

, Volume 42, Issue 6, pp 1679–1684 | Cite as

Extra-hepatic sarcoma metastasis surveillance in the liver: is arterial phase imaging necessary?

  • Peter A. HarriEmail author
  • Alex Chung
  • Srini Tridandapani
  • Sadhna Nandwana
  • Oluwayemisi O. Ibraheem
  • Kelly Cox
  • Fredrick Murphy
  • Pardeep Mittal
  • William Small



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.


Sarcoma Liver metastases Surveillance Computed tomography 


Compliance with ethical standards


No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Peter A. Harri
    • 1
    Email author
  • Alex Chung
    • 2
  • Srini Tridandapani
    • 1
  • Sadhna Nandwana
    • 1
  • Oluwayemisi O. Ibraheem
    • 1
  • Kelly Cox
    • 1
  • Fredrick Murphy
    • 1
  • Pardeep Mittal
    • 1
  • William Small
    • 1
  1. 1.Department of Radiology and Imaging SciencesEmory University School of MedicineAtlantaUSA
  2. 2.Emory University School of MedicineAtlantaUSA

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