Clinical study
Correlation between Tumor Perfusion and Lipiodol Deposition in Hepatocellular Carcinoma after Transarterial Chemoembolization

https://doi.org/10.1016/j.jvir.2010.08.015Get rights and content

Purpose

To study the correlation of tumor perfusion with lipiodol deposition in hepatocellular carcinoma (HCC) after transarterial chemoembolization with multidetector computed tomography (MDCT) perfusion imaging.

Materials and Methods

MDCT perfusion imaging was performed in 24 patients with HCC 1 to 7 days before chemoembolization. The computed tomography (CT) perfusion parameters, such as hepatic arterial perfusion (HAP), hepatic portal perfusion (HPP), total liver perfusion (TLP), and hepatic arterial perfusion index (HAPI), were calculated with the slope method. The follow-up CT scans (noncontrast) were performed 4 weeks after chemoembolization to analyze lipiodol deposition. The lipiodol deposition in the tumor was classified into three grades and compared with CT perfusion parameters before chemoembolization.

Results

The HAP and TLP of tumors before chemoembolization were correlated with the grades of lipiodol deposition in tumors after chemoembolization (r = 0.768, P < .0001 and r = 0.616, P = .001, respectively). However, the HPP and HAPI of the tumors were not related to the grades of iodized oil deposition (r = 0.227, P = .286 and r = 0.111, P = .607, respectively). Higher HAP was correlated with better lipiodol deposition, and lower HAP was correlated with poorer lipiodol deposition.

Conclusions

MDCT perfusion imaging has the potential to help select more appropriate patients with HCC for chemoembolization.

Section snippets

Patients

This prospective study was approved by our Institutional Review Board, and patient informed consent was waived. From June 2006 to May 2008, 24 patients with unresectable HCC proven by biopsy were admitted to our hospital. Of the 24 patients, 20 were men and 4 were women, with an average age of 51.6 ± 10.2 years (range, 28–70 years). All of the 24 patients had chronic viral hepatitis B infection and liver cirrhosis. The mean value of the Child-Pugh score of the 24 patients was 6.2 ± 1.6 points.

Results

All of the analyzed tumors have the typical arterial enhancement and portal venous washout characteristics on multiphase CT imaging.

Before chemoembolization, the CT perfusion parameters of the tumors were calculated (Table 2), and quantitative maps were created in all 24 patients. All patients had good ratings of perfusion acquisition. Four weeks after chemoembolization, the diameter of the tumors on the CT images was 9.0 ± 5.4 cm, which did not significantly change when compared with that

Discussion

CT perfusion imaging is a new application for the quantification of tissue perfusion using dynamic CT scanning, which is performed after intravenous bolus administration of an iodinated contrast agent. This technique can quantify perfusion in absolute units and at high spatial resolution (7, 8, 15).

In this study, we studied liver tumor perfusion with CT perfusion imaging, and we investigated the correlation between tumor perfusion and lipiodol deposition in the tumor tissue after

References (20)

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    Of these 73 patients, 52 (71.23%) had cirrhosis caused by hepatitis B virus (HBV) infection. The lipiodol deposition in the tumour after chemoembolization was divided into three grades.22 Grade I was defined as the iodized oil remaining and dispersing throughout the tumour or the area of iodized oil deposition was ≥60% of the tumour (n = 25).

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    An accurate non-invasive in vivo method for the evaluation of tumor angiogenesis would be highly desirable. Perfusion CT allows for the quantitative assessment of tumor angiogenesis according to multiple functionally relevant parameters including hepatic blood flow (HBF), hepatic blood volume (HBV), and permeability of capillary vessel surface (PS); each of these parameters have shown strong correlation with tumor angiogenesis reflected by MVD measurements in experimental and clinical studies [4,5]. However, perfusion CT of the liver has been of only limited use in clinical practice owing to increased radiation exposure and poor image quality caused by the use of low tube voltage [5,6].

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None of the authors have identified a conflict of interest.

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