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CT-perfusion technique, with evaluation of quantitative perfusion map, as an early predictor for tumour response to transarterial chemoembolization in patients with HCC lesions

Abstract
Philips CT Clinical Science Philips Healthcare • USA

PA Bonaffini, D Ippolito, C Talei Franzesi, C Capraro, R Corso, S Sironi, Monza/IT. 

Purpose
The purpose of this study was to prospectively investigate the role of CT-perfusion (CT-p) technique in evaluation of perfusion changes in HCCs before and after transarterial chemoembolization (TACE) therapy.

Material and Methods
Twenty-seven patients with cirrhotic liver disease and histologically proved HCC were prospectively enrolled in our study. CT-p study was performed on 16 multidetector CT (Brilliance CT 16-slice, Philips, NL), dose exposure was 120 V, 80 mAs. In all cases, bolus injection of 50 ml of nonionic contrast agent (350 mgI/ml) at a flow rate of 6 ml/sec was performed and forty dynamic scans were acquired at a fixed table position. A dedicated perfusion software which generated a quantitative map of arterial and portal perfusion by means of colour scale was employed. The following perfusion parameters were assessed before and after TACE:
  • Hepatic perfusion (HP)
  • Arterial perfusion (AP)
  • Blood volume (BV)
  • Hepatic perfusion index (HPI)

Results
A complete HCC filling by lipiodol was found in 18 cases with following perfusion parameters: HP 32.7±15.1 ml/sec/100 gr; AP 38.4±8.8 ml/min; BV 17.6±9.5 ml/100 mg; HPI 96.2 ±7.5%. Corresponding value calculated in patients without residual tumor were: HP 13.6±6.3; AP 13.1±7; BV 6.8±4.8; HPI 13.6±9.2. A significant difference (p<0.001) was found for all parameters between residual viable tumor tissue (p<0.001) compared to successfully treated lesion, due to the presence of residual arterial vascular structure in viable portion of treated HCC.

Conclusion
On the basis of the small patient population, this feasibility study shows that quantitative analysis of perfusion could provide an in vivo early biomarker for predicting treatment response in patients with HCC lesions.


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Abstract
Brilliance 16-slice
abdomen, Body, bolus tracking, contrast, lesion, liver, liver perfusion, Perfusion, tumor
 

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