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Evaluation of perfusion CT and dual-energy CT for predicting microvascular invasion of hepatocellular carcinoma

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Abstract

Purpose

Evaluation of perfusion CT and dual-energy CT (DECT) quantitative parameters for predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC) prior to surgery.

Methods

This prospective single-center study included fifty-six patients (44 men; median age 67; range 31–84) who provided written informed consent. Inclusion criteria were (1) treatment-naïve patients with a diagnosis of HCC, (2) an indication for hepatic resection, and (3) available arterial DECT phase and perfusion CT (GE revolution HD-GSI). Iodine concentrations (IC), arterial density (AD), and 9 quantitative perfusion parameters for HCC were correlated to pathological results. Radiological parameters based principal component analysis (PCA), corroborated by unsupervised heatmap classification, was meant to deliver a model for predicting MVI in HCC. Survival analysis was performed using univariable log-rank test and multivariable Cox model, both censored at time of relapse.

Results

58 HCC lesions were analyzed (median size 42.3 mm; range of 20–140). PCA showed that the radiological model was predictive of tumor grade (p = 0.01), intratumoral MVI (p = 0.004), peritumoral MVI (p = 0.04), MTM (macrotrabecular-massive) subtype (p = 0.02), and capsular invasion (p = 0.02) in HCC. Heatmap classification of HCC showed tumor heterogeneity, stratified into three main clusters according to the risk of relapse. Survival analysis confirmed that permeability surface-area product (PS) was the only significant independent parameter, among all quantitative tumoral CT parameters, for predicting a risk of relapse (Cox p value = 0.004).

Conclusion

A perfusion CT and DECT-based quantitative imaging profile can provide a diagnosis of histological MVI in HCC. PS is an independent parameter for relapse.

Clinical trials

ClinicalTrials.gov: NCT03754192.

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Abbreviations

DECT:

Dual-energy CT

DLP:

Dose Length Product

HCC:

Hepatocellular carcinoma

MVI:

Microvascular invasion

MTM:

Macrotrabecular-massive

PCA:

Principal component analysis

HaBF:

Hepatic arterial Blood Flow

HAF:

Hepatic arterial flow

BF:

Blood flow

BV:

Blood volume

MSI:

Mean slope of increase

TTP:

Time to peak

MTT:

Mean Transit Time

PS:

Permeability surface-area produce

WHO:

World Health Organization

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Acknowledgements

The sponsor was Assistance Publique-Hôpitaux de Paris (Direction de la Recherche Clinique et de l’Innovation). The authors thank Eddy ROUAG and Magali COQUERY for their support.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Service de Radiologie, AP-HP-Université Paris Saclay Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94800, Villejuif, France

    Maïté Lewin, Adina Radu, Joëlle Ann Feghali & Jad Farah

  2. Faculté de Médecine, Université Paris Saclay, 94270, Le Kremlin-Bicêtre, France

    Maïté Lewin, Astrid Laurent-Bellue, Christophe Desterke, Eric Vibert & Catherine Guettier

  3. Service d’Anatomopathologie, AP-HP-Université Paris Saclay Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France

    Astrid Laurent-Bellue & Catherine Guettier

  4. Service de Bio-informatique, INSERM UA9, Hôpital Paul Brousse, 94800, Villejuif, France

    Christophe Desterke

  5. Service d’Epidémiologie et de Santé Publique, AP-HP-Université Paris Saclay Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France

    Hélène Agostini

  6. Service d’Hépatologie, AP-HP, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Hôpital Avicenne, 93000, Bobigny, France

    Jean-Charles Nault

  7. Functional Genomics of Solid Tumors Laboratory, Centre de Recherche Des Cordeliers, Sorbonne Université, Inserm, USPC, Université Paris Descartes, Université Paris Diderot, Université Paris 13, 75006, Paris, France

    Jean-Charles Nault

  8. Université Paris 13, Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, 93000, Bobigny, France

    Jean-Charles Nault

  9. AP-HP-Université Paris Saclay, Hôpital Paul Brousse, 94800, Villejuif, France

    Eric Vibert

  10. Centre Hépato-Biliaire, INSERM U1193 Hôpital Paul Brousse, 94800, Villejuif, France

    Eric Vibert & Catherine Guettier

Authors
  1. Maïté Lewin
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  2. Astrid Laurent-Bellue
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  3. Christophe Desterke
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  10. Catherine Guettier
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Contributions

The scientific guarantor of this publication is Maïté Lewin. The study conception and design were performed by ML and CG; Formal analysis and investigation were performed by AL-B, AR, JAF, JF; Statistic was performed by CD; Methodology was performed by HA; Writing review and editing were performed by ML, CG, J-CN, EV. All authors read and approved the final manuscript. All authors agree the article to be published.

Corresponding author

Correspondence to Maïté Lewin.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was approved by our institutional review board (C.P.P Ouest V, 18/074-2).

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Informed consent was obtained from all individual participants included in the study.

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Consent to publish de-identified images and data were included in the informed consent process.

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Lewin, M., Laurent-Bellue, A., Desterke, C. et al. Evaluation of perfusion CT and dual-energy CT for predicting microvascular invasion of hepatocellular carcinoma. Abdom Radiol 47, 2115–2127 (2022). https://doi.org/10.1007/s00261-022-03511-7

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  • DOI: https://doi.org/10.1007/s00261-022-03511-7

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