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Perfusions-CT bei diffusen Lebererkrankungen

Perfusion computed tomography for diffuse liver diseases

Der Radiologe volume 52, pages 717–721 (2012)Cite this article

Zusammenfassung

Klinisches/methodisches Problem

Die Perfusions-CT hat ihren hauptsächlichen Stellenwert bislang in der klinischen Routinediagnostik bei neuroradiologische Fragestellungen.

Radiologische Standardverfahren

In der Leberdiagnostik kommt v. a. die mehrphasige Multidetektor-Spiral-CT-Untersuchung zum Einsatz.

Methodische Innovationen

Die Anwendung der Perfusions-CT ist auch bei der Diagnostik und Differenzierung diffuser Lebererkrankungen möglich.

Leistungsfähigkeit

Die Unterscheidung zwischen einer Leberzirrhose und zirrhoseähnlichen Parenchymveränderungen ist mit der Perfusions-CT möglich. Ebenso liefert sie einen wertvollen Beitrag zur Diagnostik bei der Früherkennung entstehender maligner Herdbefunde.

Bewertung

Diesen Vorteilen stehen jedoch auch einige negative Aspekte gegenüber, insbesondere die relativ hohe Strahlenexposition.

Empfehlung für die Praxis

Die vorliegende Arbeit soll einen Überblick über die technischen Grundlagen und die Anwendungsmöglichkeiten der Perfusions-CT bei diffusen Lebererkrankungen geben sowie die Vor- und Nachteile der Untersuchung gegeneinander abwägen.

Abstract

Clinical/methodical issue

Perfusion computed tomography (CT) has its main application in the clinical routine diagnosis of neuroradiological problems.

Standard radiological methods

Polyphase multi-detector spiral computed tomography is primarily used in liver diagnostics.

Methodical innovations

The use of perfusion CT is also possible for the diagnostics and differentiation of diffuse hepatic diseases.

Performance

The differentiation between cirrhosis and cirrhosis-like parenchymal changes is possible. It also helps to detect early stages of malignant tumors.

Achievements

However, there are some negative aspects, particularly that of radiation exposure.

Practical recommendations

This paper summarizes the technical basics and possible applications of perfusion CT in cases of diffuse liver disease and weighs up the advantages and disadvantages of the examinations.

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Literatur

  1. Axel L (1980) Cerebral blood flow determination by rapid-sequence computed tomography: theoretical analysis. Radiology 137:679–686

    PubMed  CAS  Google Scholar 

  2. Axel L (1983) Tissue mean transit time from dynamic computed tomography by a simple deconvolution technique. Invest Radiol 18:94–99

    PubMed  Article  CAS  Google Scholar 

  3. Bader TR, Grabenwoger F, Prokesch RW et al (2000) Measurement of hepatic perfusion with dynamic computed tomography: assessment of normal values and comparison of two methods to compensate for motion artifacts. Invest Radiol 35:539–547

    PubMed  Article  CAS  Google Scholar 

  4. Blomley MJ, Coulden R, Dawson P et al (1995) Liver perfusion studied with ultrafast CT. J Comput Assist Tomogr 19:424–433

    PubMed  Article  CAS  Google Scholar 

  5. Chiandussi L, Greco F, Sardi G et al (1968) Estimation of hepatic arterial and portal venous blood flow by direct catheterization of the vena porta through the umbilical cord in man. Preliminary results. Acta Hepatosplenol 15:166–171

    PubMed  CAS  Google Scholar 

  6. Gobbel GT, Fike JR (1994) A deconvolution method for evaluating indicator-dilution curves. Phys Med Biol 39:1833–1854

    PubMed  Article  CAS  Google Scholar 

  7. Goetti R, Leschka S, Desbiolles L et al (2010) Quantitative computed tomography liver perfusion imaging using dynamic spiral scanning with variable pitch: feasibility and initial results in patients with cancer metastases. Invest Radiol 45:419–426

    PubMed  Google Scholar 

  8. Guan S, Zhao WD, Zhou KR et al (2005) CT perfusion at early stage of hepatic diffuse disease. World J Gastroenterol 11:3465–3467

    PubMed  Google Scholar 

  9. Hashimoto K, Murakami T, Dono K et al (2006) Assessment of the severity of liver disease and fibrotic change: the usefulness of hepatic CT perfusion imaging. Oncol Rep 16:677–683

    PubMed  Google Scholar 

  10. Ippolito D, Capraro C, Casiraghi A et al (2012) Quantitative assessment of tumour associated neovascularisation in patients with liver cirrhosis and hepatocellular carcinoma: role of dynamic-CT perfusion imaging. Eur Radiol 22:803–811

    PubMed  Article  Google Scholar 

  11. Ippolito D, Sironi S, Pozzi M et al (2010) Perfusion CT in cirrhotic patients with early stage hepatocellular carcinoma: assessment of tumor-related vascularization. Eur J Radiol 73:148–152

    PubMed  Article  Google Scholar 

  12. Ippolito D, Sironi S, Pozzi M et al (2008) Hepatocellular carcinoma in cirrhotic liver disease: functional computed tomography with perfusion imaging in the assessment of tumor vascularization. Acad Radiol 15:919–927

    PubMed  Article  Google Scholar 

  13. Kambadakone AR, Sahani DV (2009) Body perfusion CT: technique, clinical applications, and advances. Radiol Clin North Am 47:161–178

    PubMed  Article  Google Scholar 

  14. Klauss M, Stiller W, Fritz F et al (2012) Computed tomography perfusion analysis of pancreatic carcinoma. J Comput Assist Tomogr 36:237–242

    PubMed  Article  Google Scholar 

  15. Lee TY, Purdie TG, Stewart E (2003) CT imaging of angiogenesis. Q J Nucl Med 47:171–187

    PubMed  Google Scholar 

  16. Lui YW, Tang ER, Allmendinger AM et al (2010) Evaluation of CT perfusion in the setting of cerebral ischemia: patterns and pitfalls. AJNR Am J Neuroradiol 31:1552–1563

    PubMed  Article  CAS  Google Scholar 

  17. Meier P, Zierler KL (1954) On the theory of the indicator-dilution method for measurement of blood flow and volume. J Appl Physiol 6:731–744

    PubMed  CAS  Google Scholar 

  18. Miles KA (2003) Perfusion CT for the assessment of tumour vascularity: which protocol? Br J Radiol 76 Spec No 1:36–42

    Article  Google Scholar 

  19. Miles KA, Charnsangavej C, Lee FT et al (2000) Application of CT in the investigation of angiogenesis in oncology. Acad Radiol 7:840–850

    PubMed  Article  CAS  Google Scholar 

  20. Miles KA, Hayball M, Dixon AK (1991) Colour perfusion imaging: a new application of computed tomography. Lancet 337:643–645

    PubMed  Article  CAS  Google Scholar 

  21. Miles KA, Hayball MP, Dixon AK (1993) Functional images of hepatic perfusion obtained with dynamic CT. Radiology 188:405–411

    PubMed  CAS  Google Scholar 

  22. Pandharipande PV, Krinsky GA, Rusinek H et al (2005) Perfusion imaging of the liver: current challenges and future goals. Radiology 234:661–673

    PubMed  Article  Google Scholar 

  23. Petralia G, Bonello L, Viotti S et al (2010) CT perfusion in oncology: how to do it. Cancer Imaging 10:8–19

    PubMed  Article  CAS  Google Scholar 

  24. Petralia G, Preda L, D’andrea G et al (2010) CT perfusion in solid-body tumours. Part I: Technical issues. Radiol Med 115:843–857

    PubMed  Article  CAS  Google Scholar 

  25. Schenk WG Jr., Mc DJ, Mc DK et al (1962) Direct measurement of hepatic blood flow in surgical patients: with related observations on hepatic flow dynamics in experimental animals. Ann Surg 156:463–471

    PubMed  Article  Google Scholar 

  26. Schreiner SA, Gorman B, Stephens DH (1998) Chemotherapy-related hepatotoxicity causing imaging findings resembling cirrhosis. Mayo Clin Proc 73:780–783

    PubMed  Article  CAS  Google Scholar 

  27. Spira D, Schulze M, Sauter A et al (2011) Volume perfusion-CT of the liver: Insights and applications. Eur J Radiol 81:1471–1478

    PubMed  Article  Google Scholar 

  28. Van Beers BE, Leconte I, Materne R et al (2001) Hepatic perfusion parameters in chronic liver disease: dynamic CT measurements correlated with disease severity. AJR Am J Roentgenol 176:667–673

    Google Scholar 

  29. Young ST, Paulson EK, Washington K et al (1994) CT of the liver in patients with metastatic breast carcinoma treated by chemotherapy: findings simulating cirrhosis. AJR Am J Roentgenol 163:1385–1388

    PubMed  CAS  Google Scholar 

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Affiliations

  1. Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland

    S.A. Schmidt & M.S. Juchems

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  1. S.A. Schmidt
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  2. M.S. Juchems
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Correspondence to S.A. Schmidt.

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Schmidt, S., Juchems, M. Perfusions-CT bei diffusen Lebererkrankungen. Radiologe 52, 717–721 (2012). https://doi.org/10.1007/s00117-012-2308-1

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  • DOI: https://doi.org/10.1007/s00117-012-2308-1

Schlüsselwörter

  • Diffuse Lebererkrankungen
  • Diagnostik
  • Differenzierung
  • Parenchymveränderungen
  • Strahlenexposition

Keywords

  • Diffuse liver disease
  • Diagnostics
  • Differentiation
  • Parenchymal changes
  • Radiation exposure