Perfusion CT in cirrhotic patients with early stage hepatocellular carcinoma: Assessment of tumor-related vascularization

Abstract

Purpose To assess the value of CT-perfusion in determining the quantitative vascularization features of early hepatocellular carcinoma (HCC) in cirrhotic patients. Materials and methods A total of 35 cirrhotic patients with single histologically proven HCC not exceeding 3 cm in diameter underwent conventional triple-phase multidetector computed tomography (MDCT) examination. All patients were also examined with CT-perfusion (CTp) technique after i.v. injection of 50 mL of iodinated contrast. Data were analyzed using a dedicated software which generated a quantitative map of liver parenchyma perfusion. The following parameters were assessed: hepatic perfusion (HP); blood volume (BV); arterial perfusion (AP); time to peak (TTP) and hepatic perfusion index (HPI). Univariate Wilcoxon signed rank test was used for statistical analysis. Results In the 35 HCCs evaluated, the following quantitative data were obtained: HP (mL/s/100 g): median = 47.0 (1 stqt = 35.5; 3 stqt = 61.2); BV (mL/100 mg): median = 22.5 (1 stqt = 18.4; 3 stqt = 27.7); AP (mL/min): median = 42.9 (1 stqt = 35.8; 3 stqt = 55.6); HPI(%): median = 75.3 (1 stqt = 63.1; 3 stqt = 100); TTP(s): median = 18.7 (1 stqt = 16.8; 3 stqt = 24.5). Perfusion values calculated in cirrhotic liver parenchyma were HP: median = 10.3 (1 stqt = 9.1; 3 stqt = 13.2); BV: median = 11.7 (1 stqt = 9.6; 3 stqt = 15.5); AP: median = 10.4 (1 stqt = 8.6; 3 stqt = 11.3); HPI: median = 17.5 (1 stqt = 14.3; 3 stqt = 19.7); TTP: median = 44.6 (1 stqt = 40.3; 3 stqt = 50.1). HP, BV, HPI and AP were found to be significantly higher in HCC lesion than in liver parenchyma ( p < 0.001), while TTP was significantly lower ( p < 0.001). Conclusion CT-perfusion technique allows obtaining quantitative information about tumor-related vascularization of early HCC, in patients with liver cirrhosis.