Perfusion Study of Hypervascular Hepatocellular Carcinoma with SPIO

Abstract

We evaluated whether a perfusion study with Resovist is useful to assess blood flow in tumors in patients with hypervascular hepatocellular carcinoma (HCC). The subjects were 28 patients; the lesions consisted of 68 hypervascular HCC, 14 post-treatment nodules, and 7 hepatocellular hypovascular nodules. After rapid intravenous injection of Resovist, 7-phase imaging was performed using the single-shot echo-planar method. Diagnostic accuracy and tumor vascularity were evaluated by 3 radiologists using the alternative free response receiver operating characteristic method. Sensitivity, Az values, and positive predictive values were calculated. To assess interobserver variability, we evaluated the kappa static to measure the degree of agreement. The 3 observers indicated no significant difference in Az value related to the presence or absence of a perfusion study, and only one remarked a significant difference in sensitivity. However, kappa values were better in the presence than in the absence of a perfusion study. Blood flow assessment was poor in less than 1 cm. The 3 observers showed a positive predictive value of 90% or more. A perfusion study may facilitate the diagnosis of hypervascular HCC, improving the diagnostic accuracy.