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European Radiology
Published in: European Radiology 11/2015

01-11-2015 | Computed Tomography

Perfusion computed tomography for detection of hepatocellular carcinoma in patients with liver cirrhosis

Authors: Michael A. Fischer, Nikolaos Kartalis, Aristeidis Grigoriadis, Louiza Loizou, Per Stål, Bertil Leidner, Peter Aspelin, Torkel B. Brismar

Published in: European Radiology | Issue 11/2015

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Abstract

Purpose

To evaluate the diagnostic performance of dynamic perfusion CT (P-CT) for detection of hepatocellular carcinoma (HCC) in the cirrhotic liver.

Materials and methods

Twenty-six cirrhotic patients (19 men, aged 69 ± 10 years) with suspicion of HCC prospectively underwent P-CT of the liver using the 4D spiral-mode (100/80 kV; 150/175mAs/rot) of a dual-source system. Two readers assessed: (1) arterial liver-perfusion (ALP), portal-venous liver-perfusion (PLP) and hepatic perfusion-index (HPI) maps alone; and (2) side-by-side with maximum-intensity-projections of arterial time-points (art-MIP) for detection of HCC using histopathology and imaging follow-up as standard of reference. Another reader quantitatively assessed perfusion maps of detected lesions.

Results

A total of 48 HCCs in 21/26 (81 %) patients with a mean size of 20 ± 10 mm were detected by histopathology (9/48, 19 %) or imaging follow-up (39/48, 81 %). Detection rates (Reader1/Reader2) of HPI maps and side-by-side analysis of HPI combined with arterial MIP were 92/88 % and 98/96 %, respectively. Positive-predictive values were 63/63 % and 68/71 %, respectively. A cut-off value of ≥85 % HPI and ≥99 % HPI yielded a sensitivity and specificity of 100 %, respectively, for detection of HCC.

Conclusion

P-CT shows a high sensitivity for detection of HCC in the cirrhotic liver. Quantitative assessment has the potential to reduce false-positive findings improving the specificity of HCC diagnosis.

Key points

• Visual analysis of perfusion maps shows good sensitivity for detection of HCC.
• Additional assessment of anatomical arterial MIPs further improves detection rates of HCC.
• Quantitative perfusion analysis has the potential to reduce false-positive findings.
• In cirrhotic livers, a hepatic-perfusion-index ≥ 9 9 % might be specific for HCC.
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Metadata
Title
Perfusion computed tomography for detection of hepatocellular carcinoma in patients with liver cirrhosis
Authors
Michael A. Fischer
Nikolaos Kartalis
Aristeidis Grigoriadis
Louiza Loizou
Per Stål
Bertil Leidner
Peter Aspelin
Torkel B. Brismar
Publication date
01-11-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3732-1

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