Basic Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jul 28, 2016; 8(7): 683-692
Published online Jul 28, 2016. doi: 10.4329/wjr.v8.i7.683
Correlation of magnetic resonance signal characteristics and perfusion parameters assessed by volume perfusion computed tomography in hepatocellular carcinoma: Impact on lesion characterization
Gerd Grözinger, Michael Bitzer, Roland Syha, Dominik Ketelsen, Konstantin Nikolaou, Ulrich Lauer, Marius Horger
Gerd Grözinger, Roland Syha, Dominik Ketelsen, Konstantin Nikolaou, Marius Horger, Department of Diagnostic and Interventional Radiology, Eberhard Karls University, 72076 Tübingen, Germany
Michael Bitzer, Ulrich Lauer, Department of Hepatology and Gastroenterology, Eberhard Karls University, 72076 Tübingen, Germany
Author contributions: Grözinger G and Horger M contributed to the conception and design of the study, acquisition, analysis and interpretation of data, furthermore they drafted the article; Bitzer M, Syha R, Ketelsen D, Nikolaou K and Lauer U helped with data acquisition, drafted the article and made critical revisions related to the intellectual content of the manuscript and approved the final version of the article to be published.
Institutional review board statement: This retrospective evaluation was part of a prospective monitoring study in patients with HCC undergoing TACE which was approved by the local Institutional review board (IRB). For retrospective data evaluation approval was waived by the IRB.
Informed consent statement: All patients gave their written informed consent prior to the study. All data were treated in an anonymized manner.
Conflict-of-interest statement: To the best of our knowledge, no conflict of interest exists.
Data sharing statement: All participants gave informed consent for data sharing. However all presented data are anonymized and there is no risk of personal identification.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gerd Grözinger, MD, Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Hoppe Seyler Strasse 3, 72076 Tübingen, Germany. gerd.groezinger@med.uni-tuebingen.de
Telephone: +49-7071-2986676 Fax: +49-7071-294638
Received: January 21, 2016
Peer-review started: January 22, 2016
First decision: March 1, 2016
Revised: March 14, 2016
Accepted: May 10, 2016
Article in press: May 11, 2016
Published online: July 28, 2016
Abstract

AIM: To find out if magnetic resonance (MR)-signal characteristics of hepatocellular carcinomas (HCC) correlate with perfusion parameters assessed by volume perfusion computed tomography (VPCT).

METHODS: From October 2009 to January 2014, 26 (mean age, 69.3 years) patients with 36 HCC lesions who underwent both VPCT and MR liver imaging were analysed. We compared signal intensity in the T1w- and T2w-images and wash-in/wash-out kinetics on post-contrast MR images with mean values of blood flow (BF, mL/100 mL per minute), blood volume (BV, mL/100 mL), k-trans (mL/100 mL per minute), arterial liver perfusion (mL/100 mL per minute), portal venous perfusion and hepatic perfusion index (HPI, %) obtained by VPCT. Signal intensity on magnetic resonance imaging (MRI) was classified hyper/iso/hypointense compared with surrounding liver parenchyma.

RESULTS: Signal intensity on native T1w- and T2w-images was hyper/iso/hypo in 4/16/16 and 21/14/1 lesions, respectively. Wash-in and wash-out contrast kinetics were found on MRI in 33 of 36 lesions (91.7%) and 25 of 36 lesions (69.4%), respectively. The latter was observed significantly more often in higher graded lesions (P < 0.005). HPI was 94.7% ± 6.5%. There was no significant relationship between lesion’s MR-signal intensity, MR signal combinations, size and any of the VPCT-perfusion parameters. However HPI was constantly high in all HCC lesions.

CONCLUSION: VPCT parameters add limited value to MR-lesion characterization. However in HCC lesions with atypical MR signal characteristics HPI can add a parameter to ensure HCC diagnosis.

Keywords: Hepatocellular carcinoma, Volume perfusion computed tomography, Magnetic resonance imaging

Core tip: The study shows no correlation between hepatocellular carcinomas (HCC) perfusion parameters and any of the possible magnetic resonance (MR)-signal characteristics of HCC as displayed at MR imaging as well as tumor size. However hepatic perfusion index measured with help of volume perfusion computed tomography (VPCT) was very high in all HCC lesions and the arterial liver perfusion decreased with increasing tumor dedifferentiation. For this purpose, we advocate the additional use of perfusion-based liver tumor identification by VPCT for accurate HCC detection and characterisation in case of unclear MR signal characteristics.