Figure 1
Computed Tomographic Perfusion Imaging of the liver. Image of a 65-year-old woman with hepatocellular carcinoma. (A) HCC in the segment VIII of the liver (1 – volume of interest in the the tumor, 2 – volume of interest in the normal liver parenchyma, 3 – volume of interest in the normal liver parenchyma). (B) Higher BF values in the tumor (84.50 ml/100ml/min) in comparison with normal liver parenchyma (18.60 and 16.66 ml/100ml/min). (C) Higher BV values in the tumor (16.39 ml/100ml) in comparison with the normal liver parenchyma (9.55 and 10.28 ml/100ml). (D) Lower TTP values in the the tumor (13.00 s) in comparison with the normal liver parenchyma (35.70 and 36.00 s). (E) Lower PMB values in the tumor (35.55 ml/100ml/min) in comparison with the normal liver parenchyma (39.18 and 39.46 ml/100ml/min). (F) Higher ALP in the tumor (47.12 ml/100ml/min) in comparison with the normal liver parenchyma (30.21 and 30.85 ml/100ml/min). (G) Lower PVP values in the tumor (0.02 ml/100ml/min) in comparison with the normal liver parenchyma (34.76 and 15.55 ml/100ml/min). (H) Higher HPI values in the tumor (99.95 %) in comparison with the normal liver parenchyma (47.67 and 69.36 %). (I) Calculation of perfusion parameters.
Table 1
Baseline characteristics of the patients
| Age [years] | 68.8 ± 5.8 |
|---|---|
| Sex (M/F), n [%] | 17/1 [94.4/5.6] |
| Cirrhosis (yes/no), n [%] | 16/2 [88.9/11.1] |
| Aetiology of cirrhosis, n [%] | |
| Alcohol | 7 [43.8] |
| HBV | 3 [18.8] |
| HCV | 1 [6.3] |
| Other | 5 [31.3] |
| Albumin [g/l] | 38.3 ± 5.1 |
| INR | 1.2 ± 0.3 |
| Total bilirubin [mmol/l] | 23.6 ± 18.8 |
| Child-Pugh score (points) | 5.7 ± 0.8 |
| A, n [%] | 14 [77.8] |
| B, n [%] | 4 [22.2] |
| Creatinine [µmol/l] | 87.8 ± 22.8 |
| AST [µkat/l] | 1.1 ± 0.9 |
| ALT [µkat/l] | 0.9 ± 0.8 |
| γGT [µkat/l] | 1.9 ± 1.1 |
| AFP [kIE/l] | 174.5 ± 279.3 |
| Portal vein thrombosis (yes/no), n [%] | 3/15 [16.7/83.3] |
| Bilobar disease, n [%] | 4 [22.2] |
| Unilobar disease, n [%] | 14 [77.8] |
| Right lobe, n [%] | 13 [92.9] |
| Left lobe, n [%] | 1 [7.1] |
| Overall number of lesions, n | 56 |
| Average number of nodules per patient | 3.1 ± 2.1 |
| Average of HCC nodule diameters [cm] | 4.4 ± 1.8 |
[i] AFP = alpha-fetoprotein; ALT = alanine aminotransferase; AST = aspartate aminotransferase; HBV = hepatitis B virus; HCV = hepatitis C virus; INR = International normalized ratio; γGT = gamma-glutamyltranspeptidase. Quantitative variables are expressed as means and standard deviations. Categorical variables are expressed as frequencies and percentages
Table 2
CTPI Parameters of target lesions before treatment with TACE
| Complete response (n = 9) | Partial response (n = 10) | P | |
|---|---|---|---|
| BF [ml/100ml/min] | 36.3 ± 23.2 | 51 ± 31.6 | 0.271 |
| BV[ml/100ml] | 11.6 ± 5 | 14.4 ± 4.8 | 0.240 |
| TTP [s] | 26.3 ± 8.3 | 24 ± 7.8 | 0.551 |
| PMB [ml/100ml/min] | 37.3 ± 19.3 | 33.6 ± 10.9 | 0.616 |
| ALP [ml/100ml/min] | 38.7 ± 22.2 | 49 ± 28.9 | 0.400 |
| PVP [ml/100ml/min] | 20.8 ± 22.7 | 13 ± 17 | 0.404 |
| HPI [%] | 65.1 ± 30.7 | 78.6 ± 27.4 | 0.322 |
[i] ALP = arterial liver perfusion; BF = hepatic blood flow; BV = hepatic blood volume; HPI = hepatic perfusion index; p = statistical significance; PMB = permeability; PVP = portal vein perfusion; TTP = time to peak. Quantitative variables are expressed as means with standard deviation.
Table 3
Patients’ survival. Group 1 – patients with the value of CTPI parameter lower than the threshold value, group 2 – patients with the value of CTPI parameter higher than the threshold value
| Threshold value | Group 1 mean survival [months] | Group 2 mean survival [months] | P | |
|---|---|---|---|---|
| BF | 50.4 ml/100ml/min | 35.6 ± 5 | 18.8 ± 2.7 | 0.033 |
| BV | 13.3 ml/100ml | 35.2 ± 4.3 | 18.8 ± 4.1 | 0.028 |
| TTP | 19 s | 16.4 ± 0.8 | 33.2 ± 4.7 | 0.015 |
| PMB | 40.2 ml/100ml/min | 33.8 ± 4.2 | 15.9 ± 5.4 | 0.079 |
| ALP | 33.1 ml/100ml/min | 30.2 ± 6.6 | 27.1 ± 3.8 | 0.691 |
| PVP | 1.8 ml/100ml/min | 23.5 ± 5.5 | 30.8 ± 4.7 | 0.400 |
| HPI | 82.7 % | 32.8 ± 6 | 24 ± 3.8 | 0.244 |
[i] ALP = arterial liver perfusion; BF = hepatic blood flow; BV = hepatic blood volume, HPI = hepatic perfusion index; p = statistical significance in mean survival between group 1 and group 2; PMB = permeability; PVP = portal vein perfusion, TTP = time to peak, Quantitative variables are expressed as means with standard deviation.
Figure 2
Kaplan-Meier survival curves. Patients with BF value lower than 50.4 ml/100ml/min, BV lower than 13.3 ml/100ml, TTP longer than 19 s have statistically significant longer survival (p = 0.033, p = 0.028, p = 0.015). Čas = Time in days. Blue line - Group 1, Green line - Group 2.