Assessment of small hepatocellular carcinoma: perfusion quantification and time-concentration curve evaluation using color-coded and quantitative digital subtraction angiography

Abstract

To explore the role of quantitative digital subtraction angiography (QDSA) in the diagnosis of small hepatocellular carcinoma (HCC).Between November 2015 and November 2017, all patients who underwent chemoembolization for HCC were retrospectively reviewed. Patients with tumors measuring more than 5 cm or evident post-processing imaging artifacts were excluded. Images were post-processed using the QDSA technique. Regions of interest were manually drawn on proper hepatic artery (as a reference), target HCC and peritumoral liver. Time-concentration curves and flow parameters of the peak ratio, subtracted time-to-peak (TTP), and area under the curve (AUC) ratio was obtained and analyzed.A total of 146 HCCs (mean diameter, 1.6 cm) of 71 cirrhotic patients (54 men, 17 women; mean age, 67.7 years) were enrolled. Compared with liver parenchyma, HCCs showed an increased and more rapid flow (peak ratio, AUC ratio, subtracted TTP, and wash-in slope; all P <.001). Compared with untreated HCCs, chemoembolized HCCs showed a slower flow (subtracted TTP and wash-in slope, P = .004 and .002, respectively). HCCs with a typical enhancement pattern on computed tomography (CT) or magnetic resonance imaging (MRI) had a trend toward Type III (washout pattern) time-concentration curves (P <.001). Chemoembolized HCCs had a trend toward Type II (plateau pattern) time-concentration curves (P = .005).QDSA technology can be used to quantify perfusion measurements of HCC and hepatic parenchyma and to assess perfusion changes after HCC chemoembolization.

A Quantitative Digital Subtraction Angiography Technique for Characterizing Reduction in Hepatic Arterial Blood Flow During Transarterial Embolization

“…Other attempts have been made to develop an objective embolization endpoint using volumetric imaging. One, quantitative 4D transcatheter intra-arterial perfusion MRI, showed promise, however, lacks feasibility as it requires a complex and costly hybrid angiography/MR suite only available at selected institutions [18,19]. A recent study demonstrated the feasibility of using quantitative 4D-DSA to depict changes in hepatic arterial blood velocity during transarterial embolization in a swine model, but the method requires lengthy data acquisition times and greater amounts of iodinated contrast [20,21].…”

Advances in gross tumor target volume determination in radiotherapy for patients with hepatocellular carcinoma

“…Low spatial resolution, long scanning time, and patient respiratory motion cause images to form artifacts easily. QDSA Accurately measure arterial blood flow and improve the detection rate of HCC in the background of cirrhosis (33).…”