Characterization of hepatocellular carcinoma and colorectal liver metastasis by means of perfusion MRI

Abstract

Purpose: To characterize and compare hepatocellular carcinoma and liver metastases of colorectal metastatic cancer (CMC) by means of quantitative liver perfusion MRI. Materials and Methods:Liver perfusion was assessed in 26 HCC and CMC patients (50 nodules) by means of contrast-enhanced MRI. Six perfusion parameters-hepatic perfusion index (HPI), mean transit time (MTT), distribution volume (DV), total blood flow (F T ), arterial blood flow (F A ), and portal blood flow (F P )-were calculated in tumor nodules and the adjacent hepatic parenchyma. Results:The values of F T , F A , F P , and DV were significantly higher in the HCC than in the CMC group, whereas MTT was significantly higher in the CMC group. There was no significant difference in HPI. Arterial blood flow was higher than portal blood flow in the CMC group, while portal blood flow was slightly higher than arterial blood flow in the HCC group. Conclusion:The present work describes the use of dynamic MRI to quantitatively assess liver perfusion, which in the future may help studying liver cancers on the basis of their microvascular characteristics. BLOOD REACHES THE LIVER by two pathways: first, by the hepatic artery, which carries between 25% and 30% of the total hepatic blood flow; and second, by the portal vein carrying between 70% and 75%.The proportion between hepatic artery and portal perfusion varies according to the pathologic status of the liver. Liver cancers differ in their type of vascularization. In general, hepatocellular carcinoma (HCC), the most frequent primary malignant liver tumor (1), is hypervascular and vascularized initially by the hepatic artery. In contrast, colorectal metastatic cancer (CMC) is hypovascular. Also, the vascular architecture of the intra-cancerous mass differs from that of the surrounding liver parenchyma according to the size and differentiation grade: the cancer mass is fed by both the portal vein and the hepatic artery in the early stages, while the hepatic artery is the only source for end-stage HCC and CMC (2-9). In clinical practice, the ability to quantitatively assess liver perfusion parameters has considerable potential (10). Indeed, quantification of hepatic and portal blood flow may prove useful to study liver cancer and metastases and to assess delivery of drugs in health and diseases. For example, obtaining information about the degree of the arterial and portal contribution in the tumors vascularization may play a role in determining when to use some kinds of therapy like arterial chemoembolization and antiangiogenic therapy. Time-intensity curve analysis of MR imaging of the liver after contrast agent injection enables perfusion parameters to be estimated (11)(12)(13)(14). The aim of the present prospective study was to noninvasively quantify the differences in liver perfusion in the two most frequent groups of liver cancer, i.e., HCC and CMC, using firstpass dynamic MRI. To the best of our knowledge, this is the first quantitative comparison of perfusion parameters in these cancers to use multisli...

CT Perfusion of the Liver: Principles and Applications in Oncology

“…In contrast, CT perfusion imaging has not been evaluated for earlier detection of HCC in a surveillance program. This is likely due to the high higher in HCC than in hypovascular metastases (64).…”

Hepatocellular Carcinoma: Perfusion Quantification With Dynamic Contrast-Enhanced MRI

“…Tracer kinetic modeling based on DCE-MRI has been used to detect liver fibrosis and cirrhosis and to assess tumor angiogenesis [12–17]. Recent studies using perfusion CT [18–20] and DCE-MRI [16, 21–24] showed potential for quantifying perfusion of malignant liver lesions and for monitoring treatment response to antiangiogenic drugs in liver metastases. However, perfusion CT [18–20, 25] and DCE-MRI [16, 22, 26–28] data assessing HCC lesions and cirrhosis are limited.…”

“…Recent studies using perfusion CT [18–20] and DCE-MRI [16, 21–24] showed potential for quantifying perfusion of malignant liver lesions and for monitoring treatment response to antiangiogenic drugs in liver metastases. However, perfusion CT [18–20, 25] and DCE-MRI [16, 22, 26–28] data assessing HCC lesions and cirrhosis are limited. Some studies have shown differences in perfusion parameters between HCC tumors and background liver using perfusion CT [18–20] or a 2D gradient-recalled echo sequence for DCE-MRI [16].…”

Model Matters: Differences in Orthotopic Rat Hepatocellular Carcinoma Physiology Determine Therapy Response to Sorafenib

“…Mechanical stress from increased intratumoral pressure, resulting in vessel compression may in part explain the observed difference (36). Furthermore, lower perfusion values in McA tumors may indicate a vascular supply similar to that of liver metastases rather than HCC (12). Also growth kinetics in McA tumors on average, are higher compared with DEN tumors possibly related to a less mature vascular phenotype in McA tumors.…”

“…The marker enzymes of liver damage, aspartate aminotransferase (ASAT) alanine aminotransferase (12), cholinesterase (ChE), and gamma-glutamyl transpeptidase (GGT) were analyzed in serum samples of all rats (Diasys) following the manufacturer's instructions.…”