Brief Article
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World J Gastroenterol. Dec 21, 2010; 16(47): 5993-6000
Published online Dec 21, 2010. doi: 10.3748/wjg.v16.i47.5993
Hepatocellular carcinoma treated with transarterial chemoembolization: Dynamic perfusion-CT in the assessment of residual tumor
Davide Ippolito, Pietro Andrea Bonaffini, Laura Ratti, Laura Antolini, Rocco Corso, Ferruccio Fazio, Sandro Sironi
Davide Ippolito, Pietro Andrea Bonaffini, Laura Antolini, Ferruccio Fazio, Sandro Sironi, Department of Diagnostic Radiology, School of Medicine, University of Milano-Bicocca, H S. Gerardo, Via Pergolesi 33, 20052 Monza, Milan, Italy
Davide Ippolito, Pietro Andrea Bonaffini, Sandro Sironi, Department of Diagnostic Radiology, School of Medicine, University of Milano-Bicocca, H S. Gerardo, Via Pergolesi 33, 20052 Monza, Milan, Italy
Laura Ratti, Department of Clinical Medicine, School of Medicine, University of Milano-Bicocca, H S. Gerardo, Via Pergolesi 33, 20052 Monza, Milan, Italy
Laura Antolini, Department of Clinical Medicine Prevention and Biotechnology, Section of Medical Statistics, H S. Gerardo, Via Pergolesi 33, 20052 Monza, Milan, Italy
Rocco Corso, Department of Interventional Radiology, H S. Gerardo, Via Pergolesi 33, 20052 Monza, Milan, Italy
Author contributions: Ippolito D elaborated the study concepts, designed the protocol study; Ippolito D and Sironi S wrote the manuscript in collaboration; Ippolito D and Bonaffini PA provided data acquisition and analysis/interpretation; Ratti L performed the clinical studies; Corso R performed the interventional treatment; Antolini L performed the statistical analysis; Ippolito D and Fazio F were also the guarantor of the integrity of the entire study.
Correspondence to: Davide Ippolito, MD, Department of Diagnostic Radiology, School of Medicine, University of Milano-Bicocca, H S. Gerardo, Via Pergolesi 33, 20052 Monza, Milan, Italy. davide.atena@tiscalinet.it
Telephone: +39-39-2339536 Fax: +39-39-2333463
Received: March 30, 2010
Revised: June 25, 2010
Accepted: July 2, 2010
Published online: December 21, 2010
Abstract

AIM: To asses the value of computed tomography (CT)-perfusion in the detection of residual hepatocellular carcinoma (HCC) vascularization after transarterial chemoembolization (TACE).

METHODS: Thirty-two consecutive patients were prospectively included in this study. All patients had liver cirrhosis and a confirmed HCC lesion which was treated with TACE. One month after treatment, perfusion measurements of treated lesions were carried out. The CT-perfusion (CT-p) protocol was performed with 16 slice multidetector computed tomography which included the following parameters: 8 dynamic slices/scan per 40 scans after iv injection of 50 mL of iodinated contrast (350 mg/mL) at a flow rate of 6 mL/s. Treated lesions were evaluated using dedicated perfusion software, which generated a quantitative colour map of perfusion. The following parameters were considered: hepatic perfusion (HP), arterial perfusion (AP), blood volume (BV), hepatic perfusion index (HPI), and time to peak (TTP). Perfusion parameters were described with quartile values of their distribution and statistically analyzed.

RESULTS: Perfusion parameters of the treated lesions could be quantitatively assessed using CT-p analysis. The presence of residual tumor tissue was observed in 13 of the 32 patients. The values of the perfusion parameters measured within the relapse tissue were: HP (mL/100 g per minute): median = 44.4 (1stqt = 31.3, 3rdqt = 55.8); BV (mL/100 g): median = 18.7 (1stqt = 11.5, 3rdqt = 22.5); AP (mL/min): median = 39.0 (1stqt = 36.5, 3rdqt = 61.3); HPI (%): median = 34.0 (1stqt = 30.4, 3rdqt = 38.9); TTP (s): median = 17.3 (1stqt = 15.8, 3rdqt = 26.5). With the use of the univariate paired Wilcoxon signed rank test, HP, AP and HPI were shown to be significantly higher (P < 0.001) in the relapse site than in the primary lesion. The BV and TTP parameters showed a tendency to be greater and lower, respectively, in the relapse site than in the primary lesion.

CONCLUSION: In patients with HCC treated with TACE, CT-p provides measurement of flow parameters related to residual arterial structures in viable tumor, thus helping in the assessment of therapeutic response.

Keywords: Computed tomography-perfusion, Functional-computed tomography, Hepatocellular carcinoma, Trans-arterial chemoembolization, Tumour neo-angiogenesis