Abstract
Computed Tomography (CT) Perfusion is an evolving method to visualize perfusion in organs and tissue. With the introduction of multidetector CT scanners, it is now possible to cover up to 16 cm in one rotation, and thereby making it possible to scan entire organs such as the liver with a fixed table position. Advances in reconstruction algorithms make it possible to reduce the radiation dose for each examination to acceptable levels. Regarding abdominal imaging, CT perfusion is still considered a research tool, but several studies have proven it as a reliable non-invasive technique for assessment of vascularity. CT perfusion has also been used for tumor characterization, staging of disease, response evaluation of newer drugs targeted towards angiogenesis and as a method for early detection of recurrence after radiation and embolization. There are several software solutions available on the market today based on different perfusion algorithms. However, there is no consensus on which protocol and algorithm to use for specific organs. In this article, the authors give an introduction to CT perfusion in abdominal imaging introducing technical aspects for calculation of perfusion parameters, and considerations on patient preparation. This article also contains clinical cases to illustrate the use of CT perfusion in abdominal imaging.
Highlights
Recent advances in oncological treatment, with increasing focus on individualized treatment, calls for more advanced imaging modalities to stage diseases and evaluate treatment response
It has been previously reported that a Computed Tomography (CT) perfusion protocol uses 1.5 times the radiation dose of a normal CT scan [7], but with wider coverage this number is probably higher and it varies depending on the selected protocol
For some patients it can be difficult to suspend their breathing during a CT perfusion examination, and either taking a deep breath or slowly exhaling, both causing more movement distortion compared to shallow breathing [24]
Summary
Recent advances in oncological treatment, with increasing focus on individualized treatment, calls for more advanced imaging modalities to stage diseases and evaluate treatment response. Computed Tomography (CT) Perfusion is a functional imaging modality to evaluate tissue vascularity [1,2]. It measures changes in tissue enhancement after contrast injection and tissue perfusion can be estimated with different kinetic models. CT perfusion is already well established in stroke evaluation [4], but is still considered a research tool regarding abdominal imaging. Perfusion imaging could be added to already standardized CT protocols for various applications, such as diagnosis, staging, prognostic evaluation, and monitoring response to therapies. This article presents clinical cases and gives a brief overview of the application of CT perfusion in abdominal cancer
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