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

Peter Popovic
Peter Popovic
, 
Ana Leban
Ana Leban
, 
Klara Kregar
Klara Kregar
, 
Manca Garbajs
Manca Garbajs
, 
Rok Dezman
Rok Dezman
 and 
Matjaz Bunc
Matjaz Bunc
   | Dec 07, 2017
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Article Category: Research Article
Published Online: Dec 07, 2017
Page range: 14 - 22
Received: Sep 11, 2017
Accepted: Oct 15, 2017
DOI: https://doi.org/10.1515/raon-2017-0052
© 2018 Peter Popovic, Ana Leban, Klara Kregar, Manca Garbajs, Rok Dezman, Matjaz Bunc
This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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
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