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Computed tomographic perfusion imaging for the prediction of response and survival to transarterial chemoembolization of hepatocellular carcinoma Cover

Computed tomographic perfusion imaging for the prediction of response and survival to transarterial chemoembolization of hepatocellular carcinoma

Radiology and Oncology
Volume 52 (2018): Issue 1 (March 2018)
By: Peter Popovic,  Ana Leban,  Klara Kregar,  Manca Garbajs,  Rok Dezman and  Matjaz Bunc  
Open Access
|Dec 2017

Figures & Tables

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.
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.

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.
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.

CTPI Parameters of target lesions before treatment with TACE

Complete response (n = 9)Partial response (n = 10)P
BF [ml/100ml/min]36.3 ± 23.251 ± 31.60.271
BV[ml/100ml]11.6 ± 514.4 ± 4.80.240
TTP [s]26.3 ± 8.324 ± 7.80.551
PMB [ml/100ml/min]37.3 ± 19.333.6 ± 10.90.616
ALP [ml/100ml/min]38.7 ± 22.249 ± 28.90.400
PVP [ml/100ml/min]20.8 ± 22.713 ± 170.404
HPI [%]65.1 ± 30.778.6 ± 27.40.322

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 valueGroup 1 mean survival [months]Group 2 mean survival [months]P
BF50.4 ml/100ml/min35.6 ± 518.8 ± 2.70.033
BV13.3 ml/100ml35.2 ± 4.318.8 ± 4.10.028
TTP19 s16.4 ± 0.833.2 ± 4.70.015
PMB40.2 ml/100ml/min33.8 ± 4.215.9 ± 5.40.079
ALP33.1 ml/100ml/min30.2 ± 6.627.1 ± 3.80.691
PVP1.8 ml/100ml/min23.5 ± 5.530.8 ± 4.70.400
HPI82.7 %32.8 ± 624 ± 3.80.244

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 [%]
Alcohol7 [43.8]
HBV3 [18.8]
HCV1 [6.3]
Other5 [31.3]
Albumin [g/l]38.3 ± 5.1
INR1.2 ± 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, n56
Average number of nodules per patient3.1 ± 2.1
Average of HCC nodule diameters [cm]4.4 ± 1.8
DOI: https://doi.org/10.1515/raon-2017-0052 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
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Language: English
Page range: 14 - 22
Submitted on: Sep 11, 2017
|
Accepted on: Oct 15, 2017
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Published on: Dec 7, 2017
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
hepatocellular carcinoma,
computed tomography perfusion imaging,
drug-eluting beads transarterial chemoembolization,
response to treatment,
survival
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2017 Peter Popovic, Ana Leban, Klara Kregar, Manca Garbajs, Rok Dezman, Matjaz Bunc, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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