Top

Published in:

01-05-2018 | Hepatobiliary-Pancreas

Can dual-energy CT replace perfusion CT for the functional evaluation of advanced hepatocellular carcinoma?

Authors: Sébastien Mulé, Frédéric Pigneur, Ronan Quelever, Arthur Tenenhaus, Laurence Baranes, Philippe Richard, Vania Tacher, Edouard Herin, Hugo Pasquier, Maxime Ronot, Alain Rahmouni, Valérie Vilgrain, Alain Luciani

Published in: European Radiology | Issue 5/2018

Abstract

Objectives

To determine the degree of relationship between iodine concentrations derived from dual-energy CT (DECT) and perfusion CT parameters in patients with advanced HCC under treatment.

Methods

In this single-centre IRB approved study, 16 patients with advanced HCC treated with sorafenib or radioembolization who underwent concurrent dynamic perfusion CT and multiphase DECT using a single source, fast kV switching DECT scanner were included. Written informed consent was obtained for all patients. HCC late-arterial and portal iodine concentrations, blood flow (BF)-related and blood volume (BV)-related perfusion parameters maps were calculated. Mixed-effects models of the relationship between iodine concentrations and perfusion parameters were computed. An adjusted p value (Bonferroni method) < 0.05 was considered significant.

Results

Mean HCC late-arterial and portal iodine concentrations were 22.7±12.7 mg/mL and 18.7±8.3 mg/mL, respectively. Late-arterial iodine concentration was significantly related to BV (mixed-effects model F statistic (F)=28.52, p<0.0001), arterial BF (aBF, F=17.62, p<0.0001), hepatic perfusion index (F=28.24, p<0.0001), positive enhancement integral (PEI, F=66.75, p<0.0001) and mean slope of increase (F=32.96, p<0.0001), while portal-venous iodine concentration was mainly related to BV (F=29.68, p<0.0001) and PEI (F=66.75, p<0.0001).

Conclusions

In advanced HCC lesions, DECT-derived late-arterial iodine concentration is strongly related to both aBF and BV, while portal iodine concentration mainly reflects BV, offering DECT the ability to evaluate both morphological and perfusion changes.

Key points

• Late-arterial iodine concentration is highly related to arterial BF and BV.

• Portal iodine concentration mainly reflects tumour blood volume.

• Dual-energy CT offers significantly decreased radiation dose compared with perfusion CT.

Miles KA (2003) Functional CT imaging in oncology. Eur Radiol 13:M134–M138CrossRefPubMed

Sahani DV, Holalkere NS, Mueller PR, Zhu AX (2007) Advanced hepatocellular carcinoma: CT perfusion of liver and tumor tissue--initial experience. Radiology 243:736–743CrossRefPubMed

Ippolito D, Capraro C, Casiraghi A, Cestari C, Sironi S (2012) Quantitative assessment of tumour associated neovascularisation in patients with liver cirrhosis and hepatocellular carcinoma: role of dynamic-CT perfusion imaging. Eur Radiol 22:803–811CrossRefPubMed

Jiang T, Kambadakone A, Kulkarni NM, Zhu AX, Sahani DV (2012) Monitoring response to antiangiogenic treatment and predicting outcomes in advanced hepatocellular carcinoma using image biomarkers, CT perfusion, tumor density, and tumor size (RECIST). Invest Radiol 47:11–17CrossRefPubMed

Ippolito D, Fior D, Bonaffini PA et al (2014) Quantitative evaluation of CT-perfusion map as indicator of tumor response to transarterial chemoembolization and radiofrequency ablation in HCC patients. Eur J Radiol 83:1665–1671CrossRefPubMed

Dai X, Schlemmer HP, Schmidt B et al (2013) Quantitative therapy response assessment by volumetric iodine-uptake measurement: initial experience in patients with advanced hepatocellular carcinoma treated with sorafenib. Eur J Radiol 82:327–334CrossRefPubMed

Kim SH, Kamaya A, Willmann JK (2014) CT perfusion of the liver: principles and applications in oncology. Radiology 272:322–344CrossRefPubMedPubMedCentral

Marin D, Boll DT, Mileto A, Nelson RC (2014) State of the art: dual-energy CT of the abdomen. Radiology 271:327–342CrossRefPubMed

Matsumoto K, Jinzaki M, Tanami Y, Ueno A, Yamada M, Kuribayashi S (2011) Virtual monochromatic spectral imaging with fast kilovoltage switching: improved image quality as compared with that obtained with conventional 120-kVp CT. Radiology 259:257–262CrossRefPubMed

10.

Stiller W, Skornitzke S, Fritz F et al (2015) Correlation of quantitative dual-energy computed tomography iodine maps and abdominal computed tomography perfusion measurements: are single-acquisition dual-energy computed tomography iodine maps more than a reduced-dose surrogate of conventional computed tomography perfusion? Invest Radiol 50:703–708CrossRefPubMed

11.

Lv P, Liu J, Yan X et al (2017) CT spectral imaging for monitoring the therapeutic efficacy of VEGF receptor kinase inhibitor AG-013736 in rabbit VX2 liver tumours. Eur Radiol 27:918–926CrossRefPubMed

12.

Gordic S, Puippe GD, Krauss B et al (2016) Correlation between Dual-Energy and Perfusion CT in Patients with Hepatocellular Carcinoma. Radiology 280:78–87CrossRefPubMed

13.

Thaiss WM, Haberland U, Kaufmann S et al (2016) Iodine concentration as a perfusion surrogate marker in oncology: Further elucidation of the underlying mechanisms using Volume Perfusion CT with 80 kVp. Eur Radiol 26:2929–2936CrossRefPubMed

14.

Kagawa Y, Okada M, Yagyu Y et al (2013) Optimal scan timing of hepatic arterial-phase imaging of hypervascular hepatocellular carcinoma determined by multiphasic fast CT imaging technique. Acta Radiol 54:843–850CrossRefPubMed

15.

Hammerstingl RM, Vogl TJ (2005) Abdominal MDCT: protocols and contrast considerations. Eur Radiol 15:E78–E90CrossRefPubMed

16.

Vilgrain V, Abdel-Rehim M, Sibert A et al (2014) Radioembolisation with yttrium90 microspheres versus sorafenib for treatment of advanced hepatocellular carcinoma (SARAH): study protocol for a randomised controlled trial. Trials 15:474CrossRefPubMedPubMedCentral

17.

Bruix J, Sherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022CrossRefPubMedPubMedCentral

18.

American College of Radiology. Liver Imaging Reporting and Data System version 2014. Available via http://www.acr.org/Quality-Safety/Resources/LIRADS. Accessed April 2016

19.

St Lawrence KS, Lee TY (1998) An adiabatic approximation to the tissue homogeneity model for water exchange in the brain: I. Theoretical derivation. J Cereb Blood Flow Metab 18:1365–1377CrossRefPubMed

20.

Kaufmann S, Horger T, Oelker A et al (2015) Characterization of hepatocellular carcinoma (HCC) lesions using a novel CT-based volume perfusion (VPCT) technique. Eur J Radiol 84:1029–1035CrossRefPubMed

21.

Miles KA (2003) Perfusion CT for the assessment of tumour vascularity: which protocol? Br J Radiol 76:S36–S42CrossRefPubMed

22.

Ng CS, Hobbs BP, Wei W et al (2015) Effect on perfusion values of sampling interval of computed tomographic perfusion acquisitions in neuroendocrine liver metastases and normal liver. J Comput Assist Tomogr 39:373–382PubMedPubMedCentral

23.

Miles KA, Lee TY, Goh V et al (2012) Current status and guidelines for the assessment of tumour vascular support with dynamic contrast-enhanced computed tomography. Eur Radiol 22:1430–1441CrossRefPubMed

24.

Djuric-Stefanovic A, Saranovic D, Masulovic D, Ivanovic A, Pesko P (2013) Comparison between the deconvolution and maximum slope 64-MDCT perfusion analysis of the esophageal cancer: is conversion possible? Eur J Radiol 82:1716–1723CrossRefPubMed

25.

Ng CS, Hobbs BP, Chandler AG et al (2013) Metastases to the liver from neuroendocrine tumors: effect of duration of scan acquisition on CT perfusion values. Radiology 269:758–767CrossRefPubMedPubMedCentral

26.

NCD Risk Factor Collaboration (2016) Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 387:1377–1396CrossRef

27.

Ng CS, Chandler AG, Wei W et al (2012) Effect of dual vascular input functions on CT perfusion parameter values and reproducibility in liver tumors and normal liver. J Comput Assist Tomogr 36:388–393CrossRefPubMedPubMedCentral

28.

Chen BB, Hsu CY, Yu CW et al (2017) Early perfusion changes within 1 week of systemic treatment measured by dynamic contrast-enhanced MRI may predict survival in patients with advanced hepatocellular carcinoma. Eur Radiol 27:3069–3079CrossRefPubMed

Title: Can dual-energy CT replace perfusion CT for the functional evaluation of advanced hepatocellular carcinoma?
Authors: Sébastien Mulé
Frédéric Pigneur
Ronan Quelever
Arthur Tenenhaus
Laurence Baranes
Philippe Richard
Vania Tacher
Edouard Herin
Hugo Pasquier
Maxime Ronot
Alain Rahmouni
Valérie Vilgrain
Alain Luciani
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 5/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-5151-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Can dual-energy CT replace perfusion CT for the functional evaluation of advanced hepatocellular carcinoma?

Abstract

Objectives

Methods

Results

Conclusions

Key points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key points

Please log in to get access to this content

Other articles of this Issue 5/2018

Can We Perform CT of the Appendix with Less Than 1 mSv? A De-escalating Dose-simulation Study

Anatomical Road Mapping Using CT and MR Enterography for Ultrasound Molecular Imaging of Small Bowel Inflammation in Swine

Accuracy of computed tomography for selecting the revascularization method based on SYNTAX score II

Intravoxel incoherent motion MR imaging of early cervical carcinoma: correlation between imaging parameters and tumor-stroma ratio

Metal artifact reduction MRI of total ankle arthroplasty implants

The efficacy of real-time colour Doppler flow imaging on endoscopic ultrasonography for differential diagnosis between neoplastic and non-neoplastic gallbladder polyps