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Can dual-energy CT replace perfusion CT for the functional evaluation of advanced hepatocellular carcinoma?



To determine the degree of relationship between iodine concentrations derived from dual-energy CT (DECT) and perfusion CT parameters in patients with advanced HCC under treatment.


In this single-centre IRB approved study, 16 patients with advanced HCC treated with sorafenib or radioembolization who underwent concurrent dynamic perfusion CT and multiphase DECT using a single source, fast kV switching DECT scanner were included. Written informed consent was obtained for all patients. HCC late-arterial and portal iodine concentrations, blood flow (BF)-related and blood volume (BV)-related perfusion parameters maps were calculated. Mixed-effects models of the relationship between iodine concentrations and perfusion parameters were computed. An adjusted p value (Bonferroni method) < 0.05 was considered significant.


Mean HCC late-arterial and portal iodine concentrations were 22.7±12.7 mg/mL and 18.7±8.3 mg/mL, respectively. Late-arterial iodine concentration was significantly related to BV (mixed-effects model F statistic (F)=28.52, p<0.0001), arterial BF (aBF, F=17.62, p<0.0001), hepatic perfusion index (F=28.24, p<0.0001), positive enhancement integral (PEI, F=66.75, p<0.0001) and mean slope of increase (F=32.96, p<0.0001), while portal-venous iodine concentration was mainly related to BV (F=29.68, p<0.0001) and PEI (F=66.75, p<0.0001).


In advanced HCC lesions, DECT-derived late-arterial iodine concentration is strongly related to both aBF and BV, while portal iodine concentration mainly reflects BV, offering DECT the ability to evaluate both morphological and perfusion changes.

Key points

• Late-arterial iodine concentration is highly related to arterial BF and BV.

• Portal iodine concentration mainly reflects tumour blood volume.

• Dual-energy CT offers significantly decreased radiation dose compared with perfusion CT.

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Fig. 1
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Fig. 3



Dual-energy CT


Blood flow


Blood volume


Arterial blood flow


Portal blood flow


Hepatic perfusion index


Mean transit time


Mean slope of increase


Capillary permeability surface product


Time to peak


Positive enhancement integral


American Association for the Study of Liver Diseases


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This work was an ancillary study to the SARAH multicentric trial ( identifier NCT01482442).


The authors state that this work has not received any funding.

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Corresponding author

Correspondence to Sébastien Mulé.

Ethics declarations


The scientific guarantor of this publication is Pr. Alain Luciani.

Conflict of interest

Two authors of this manuscript (R.Q. and P.R.) are employees of GE Healthcare. All other authors retained full control of all data and were responsible for all analyses performed in the study.

Statistics and biometry

Revised statistical analysis was performed by A.T., a PhD statistician with 11 years of experience.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• cross sectional study

• performed at one institution

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Mulé, S., Pigneur, F., Quelever, R. et al. Can dual-energy CT replace perfusion CT for the functional evaluation of advanced hepatocellular carcinoma?. Eur Radiol 28, 1977–1985 (2018).

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  • Multidetector computed tomography
  • Perfusion imaging
  • Iodine
  • Hepatocellular carcinoma
  • Contrast media