Davide Ippolito MD, Presenter: Nothing to Disclose

Pietro Andrea Bonaffini MD, Abstract Co-Author: Nothing to Disclose

Davide Leni, Abstract Co-Author: Nothing to Disclose

Cristina Capraro MD, Abstract Co-Author: Nothing to Disclose

Rocco Corso MD, Abstract Co-Author: Nothing to Disclose

Sandro Sironi MD, Abstract Co-Author: Nothing to Disclose

To prospectively investigate the role of CT-perfusion (CT-p) technique in evaluation of perfusion changes in hepatocellular carcinomas (HCC) before and after transarterial chemoembolization (TACE) treatment.

Twenty-seven patients with cirrhotic liver disease and histologically proved HCC were prospectively enrolled in our study. CT-p study was performed on 16 multidetectorCT (Brilliance 16, Philips, NL)¸dose exposure was 120 Kv, 80mAs. In all cases the bolus injection of 50 ml of non ionic contrast agent (350 mgI/ml ) at a flow rate of 6 ml/sec was performed. Forty dynamic scans were acquired at a fixed table position in all patients. A dedicated perfusion software which generated a quantitative map of arterial and portal perfusion by means of colour scale was employed. The following perfusion parameters for the whole liver and HCC lesions were assessed before and after TACE: Hepatic perfusion (HP), Arterial perfusion (AP), Blood Volume (BV), Hepatic perfusion Index (HPI).

A complete HCC filling by lipiodol was found in 18 cases and partial filling in the 9 remaining cases. The following perfusion data were obtained in partially treated lesions: HP 32,7 ± 15,1 ml/sec/100gr; AP:38,4 ± 8,8 ml/min; BV 17,6 ± 9,5 ml/100mg; HPI 96,2 ± 7,5 %. The corresponding value calculated in patients without residual tumor were: HP 13,6 ± 6,3 ml/sec/100gr; AP 13,1 ± 7 ml/min; BV 6,8 ± 4,8 ml/100mg; HPI 13,6 ± 9,2 %.While in normal liver the found parameters were: HP 11,04 ± 4 ml/sec/100gr;AP 10,3 ± 3 ml/min,4;BV 14,9 ± 2,8 ml/100mgand HPI 16,2 ± 9,8 %.A significant difference(p<0,001) was found for all parameters between residual viable tumor tissue(p<0,001) compared to successfully treated lesion, due to the presence of residual arterial vascular structure in viable portion of treated HCC

On the basis of the small patient population, this feasibility study shows that quantitative analysis of perfusion could provide an in vivo early biomarker for prediciting the treatment response in patients with HCC lesions.

Our results suggest that CT-p adds quantitative data of vascularization,related to the presence of residual neoplastic arterial structures,useful in monitoring the therapeutic response of treated HCC.

Ippolito, D, Bonaffini, P, Leni, D, Capraro, C, Corso, R, Sironi, S, Evaluation of Quantitative Perfusion Map with CT-Perfusion Technique as an Early Predictor for Tumor Response to Transarterial Chemoembolization in Patients with HCC Lesions: Preliminary Results.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11006906.html