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Erschienen in:
01.11.2015 | Computed Tomography
Perfusion computed tomography for detection of hepatocellular carcinoma in patients with liver cirrhosis
Erschienen in: European Radiology | Ausgabe 11/2015
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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.