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Renal versus splenic maximum slope based perfusion CT modelling in patients with portal-hypertension

  • Computed Tomography
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Abstract

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

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Acknowledgements

The scientific guarantor of this publication is Prof. Peter Aspelin. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The first author was financially supported by the Swiss Radiological Society. No other authors have received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board.

In total 7/24 patients have been previously reported in Fischer MA, et al. Eur Radiol 24(1):151-61 and Fischer MA, et al. Eur Radiol 25(11): 3123-3132.

Methodology: retrospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Zurich, CH-8091, Zurich, Switzerland

    Michael A. Fischer

  2. Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden

    Michael A. Fischer, Anders Svensson, Peter Aspelin & Torkel B. Brismar

  3. Department of Radiology, Karolinska University Hospital Huddinge, SE-14186, Stockholm, Sweden

    Katharina Brehmer, Anders Svensson, Peter Aspelin & Torkel B. Brismar

Authors
  1. Michael A. Fischer
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  2. Katharina Brehmer
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  3. Anders Svensson
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  4. Peter Aspelin
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  5. Torkel B. Brismar
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Correspondence to Michael A. Fischer.

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Fischer, M.A., Brehmer, K., Svensson, A. et al. Renal versus splenic maximum slope based perfusion CT modelling in patients with portal-hypertension. Eur Radiol 26, 4030–4036 (2016). https://doi.org/10.1007/s00330-016-4277-7

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  • DOI: https://doi.org/10.1007/s00330-016-4277-7

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