Advanced Hepatocellular Carcinoma: CT Perfusion of Liver and Tumor Tissue—Initial Experience<sup>1</sup>

Sahani, Dushyant V.; Holalkere, Nagaraj-Setty; Müeller, Peter R.

doi:10.1148/radiol.2433052020

Cited by 297 publications

(206 citation statements)

References 14 publications

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“…Some authors found that there was no significant difference in perfusion parameters between well to moderately differentiated and poorly differentiated HCC (22,28). However Sahani et al (24) observed that the perfusion of well-differentiated HCC was distinct from those of moderately and poorly differentiated HCC.…”

Section: Perfusion Imaging For Detection Of Hepatocellular Carcinomamentioning

confidence: 98%

“…The perfusion parameters of HCC are considerably different compared to the background liver parenchyma (Fig. 1 and Table 2) (24,25). Perfusion CT may better assess the therapeutic efficacy of interventional procedures by providing quantitative flow parameters relevant to residual arterial structures in viable tumors (22).…”

Section: Perfusion Imaging For Detection Of Hepatocellular Carcinomamentioning

confidence: 99%

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Perfusion CT imaging of the liver: review of clinical applications

Oğul

Kantarcı²,

Genç³

et al. 2014

Diagn Interv Radiol

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Perfusion computed tomography (CT) has a great potential for determining hepatic and portal blood flow; it offers the advantages of quantitative determination of lesion hemodynamics, distinguishing malignant and benign processes, as well as providing morphological data. Many studies have reported the use of this method in the assessment of hepatic tumors, hepatic fibrosis associated with chronic liver disease, treatment response following radiotherapy and chemotherapy, and hepatic perfusion changes after radiological or surgical interventions. The main goal of liver perfusion imaging is to improve the accuracy in the characterization of liver disorders. In this study, we reviewed the clinical application of perfusion CT in various hepatic diseases. The advent of multidetector CT has given rise to the acquisition of images with higher quality and accuracy. Multidetector CT has been developed as a noninvasive imaging modality for evaluation of vascular anatomy. It has also made it possible to perform CT angiography of the hepatic vessels. New generation CT systems with multidetector are capable of performing volumetric imaging. These systems provide a single rotational acquisition and almost the whole upper abdomen can be appraised by means of serial rotational acquisitions at a single location in the z-direction. Multidetector CT imaging is used extensively for the preoperative selection of living related liver donors, as well as evaluation of the vascular anatomy of the recipients (1). This imaging technique is also used for the initial evaluation and follow-up of most patients with hepatic metastases, providing valuable information about the number, size, and distribution of hepatic metastases and the presence and extent of extrahepatic disease (1).Perfusion CT imaging permits the qualitative and quantitative assessment of liver perfusion. In perfusion CT, a quantitative tissue perfusion map is obtained from dynamic CT data and displayed using a color scale permitting the quantification of tissue perfusion in absolute units at high spatial resolution (2). Perfusion CT efficiently locates abnormal tissue perfusion which is difficult to detect accurately with conventional CT (3). Functional assessment of the perfusion of normal and pathologic tissues is performed by means of quantitative or semiquantitative parameters, such as blood flow (BF), blood volume (BV), mean transit time (MTT), portal liver perfusion (PLP), arterial liver perfusion (ALP) and hepatic perfusion index (HPI). Perfusion CT measures the temporal changes in tissue density through a series of dynamically acquired CT images after intravenous injection of an iodinated contrast material (4, 5). Perfusion CT may be performed quickly and provide valuable data for diagnosis. However, there are some limitations of this method such as long breath-holding for portal flow measurement, separation of arterial and portal blood flow, additional radiation exposure, limited craniocaudal scan range, and standardization of analytic methods (2). In this a...

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Section: Perfusion Imaging For Detection Of Hepatocellular Carcinomamentioning

confidence: 98%

Section: Perfusion Imaging For Detection Of Hepatocellular Carcinomamentioning

confidence: 99%

Perfusion CT imaging of the liver: review of clinical applications

Oğul

Kantarcı²,

Genç³

et al. 2014

Diagn Interv Radiol

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“…Some more studies have been conducted with pCT: while Ippolito et al [38] did not report any significant correlation between pCT-derived parameters and pathological grade, Sahani et al [39] found that welldifferentiated HCCs had significantly higher perfusion values than less differentiated lesions. Yang et al [40] reported that pCT could quantitatively assess the blood supply and particularly its distribution during hepatocarcinogenesis, with statistically significant correlations between BF, hepatic arterial perfusion (HAP) and microvascular density (MVD).…”

Section: Primary Liver Tumorsmentioning

confidence: 99%

Prognostication and response assessment in liver and pancreatic tumors: The new imaging

Robertis¹,

Martini²,

Demozzi³

et al. 2015

WJG

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Diffusion-weighted imaging (DWI), dynamic contrastenhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for posttreatment assessment, even at an early stage. or altered cellular membranes will present diffusion restriction, which is depicted as signal hyperintensity areas on high b-value DW images and hypointensity on the apparent diffusion coefficient (ADC) maps; ADC measurement can also quantify water molecules' diffusion. As dedifferentiation or therapies may induce microscopic changes in neoplastic tissues that could modify water molecules' diffusion, DWI can distinguish between different degrees of malignancy and can be also proposed for post-treatment monitoring. Moreover, DWI can be performed in a single session with DCE-MRI, thus providing a comprehensive "one-step" morphological and functional evaluation of hepatobilio-pancreatic tumors.Perfusion imaging techniques evaluate changes in signal intensity (DCE-MRI) or density (pCT) after contrast medium injection, being therefore able to assess microvascularization through the evaluation of the dynamics of contrast medium distribution from vessels to the neoplastic tissue. Perfusion parameters are therefore theoretically good candidates for the evaluation of microscopic vascular differences between lesions with different pathological grade and for the assessment of treatment response, especially after chemoembolization or during treatments with antiangiogenic drugs.This editorial analyzes up-to-date literature data regarding the application of functional imaging techniques, apart from molecular imaging, to hepatic and pancreatic tumors, with particular emphasis on correlations to pathological features, prognostic stratification and therapeutic response assessment. FUNCTIONAL IMAGING TECHNIQUES: TECHNICAL BASESIn 1965 Stejskal and Tanne...

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“…In progressive HCC and background liver tissue, HBF is higher in HCC tissue than in background liver tissue [22,23]. Additionally, the growth characteristics of HCC can be evaluated by analyzing portal vein perfusion at the tumor edge, allowing an estimated prognosis for patients with liver cancer.…”

Section: Ct Perfusion Imagingmentioning

confidence: 99%

The Role of Multimodality Imaging Techniques on Differential Diagnosis of Precancerous Nodules and Hepatocellular Carcinoma

Jiang¹,

Li²

2012

IJMPCERO

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In recent years, the incidence of hepatocellular carcinoma (HCC) has been increasing worldwide, and its high mortality seriously threatens public health. Early detection and treatment are crucial to improving the survival rate. Imaging examination widely used for the diagnosis of HCC and provides a non-invasive means of tumor visualization. The rapid development of medical imaging technology is expected to improve early-stage diagnosis rates for HCC. This article summarizes the methods for the differential diagnosis of pre-malignant dysplastic nodule (DN) and small hepatocellular carcinoma during the carcinogenesis of cirrhosis and reviews their application. In addition, a discussion on some recently patented medical imaging development was also presented.

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Advanced Hepatocellular Carcinoma: CT Perfusion of Liver and Tumor Tissue—Initial Experience¹

Abstract: Results suggest that CT perfusion is a feasible and, from the limited data, reproducible technique for quantifying tumor vascularity and angiogenesis in advanced HCC.

Cited by 297 publications

References 14 publications

Perfusion CT imaging of the liver: review of clinical applications

Perfusion CT imaging of the liver: review of clinical applications

Prognostication and response assessment in liver and pancreatic tumors: The new imaging

The Role of Multimodality Imaging Techniques on Differential Diagnosis of Precancerous Nodules and Hepatocellular Carcinoma

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Advanced Hepatocellular Carcinoma: CT Perfusion of Liver and Tumor Tissue—Initial Experience1

Abstract: Results suggest that CT perfusion is a feasible and, from the limited data, reproducible technique for quantifying tumor vascularity and angiogenesis in advanced HCC.

Cited by 297 publications

References 14 publications

Perfusion CT imaging of the liver: review of clinical applications

Perfusion CT imaging of the liver: review of clinical applications

Prognostication and response assessment in liver and pancreatic tumors: The new imaging

The Role of Multimodality Imaging Techniques on Differential Diagnosis of Precancerous Nodules and Hepatocellular Carcinoma

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Advanced Hepatocellular Carcinoma: CT Perfusion of Liver and Tumor Tissue—Initial Experience¹