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Erschienen in:
25.02.2016 | Computed Tomography
Renal versus splenic maximum slope based perfusion CT modelling in patients with portal-hypertension
Erschienen in: European Radiology | Ausgabe 11/2016
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Purpose
To assess liver perfusion-CT (P-CT) parameters derived from peak-splenic (PSE) versus peak-renal enhancement (PRE) maximum slope-based modelling in different levels of portal-venous hypertension (PVH).
Material and methods
Twenty-four patients (16 men; mean age 68 ± 10 years) who underwent dynamic P-CT for detection of hepatocellular carcinoma (HCC) were retrospectively divided into three groups: (1) without PVH (n = 8), (2) with PVH (n = 8), (3) with PVH and thrombosis (n = 8). Time to PSE and PRE and arterial liver perfusion (ALP), portal-venous liver perfusion (PLP) and hepatic perfusion-index (HPI) of the liver and HCC derived from PSE- versus PRE-based modelling were compared between the groups.
Results
Time to PSE was significantly longer in PVH groups 2 and 3 (P = 0.02), whereas PRE was similar in groups 1, 2 and 3 (P > 0.05). In group 1, liver and HCC perfusion parameters were similar for PSE- and PRE-based modelling (all P > 0.05), whereas significant differences were seen for PLP and HPI (liver only) in group 2 and ALP in group 3 (all P < 0.05).
Conclusion
PSE is delayed in patients with PVH, resulting in a miscalculation of PSE-based P-CT parameters. Maximum slope-based P-CT might be improved by replacing PSE with PRE-modelling, whereas the difference between PSE and PRE might serve as a non-invasive biomarker of PVH.
Key Points
• Peak-splenic enhancement is decreased and delayed in patients with portal-venous hypertension
• The maximum-slope method uses PSE to calculate arterial and portal-venous liver perfusion
• Peak-renal enhancement (PRE) is insensitive to PVH and might improve perfusion modelling
• The difference between PSE and PRE might serve as a non-invasive PVH biomarker