Skip to main content
Log in

Dynamic contrast-enhanced CT imaging of hepatocellular carcinoma in cirrhosis: feasibility of a prolonged dual-phase imaging protocol with tracer kinetics modeling

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Dynamic contrast-enhanced (DCE) CT imaging of four patients with hepatocellular carcinoma (HCC) was performed using a dual-phase imaging protocol designed with initial rapid dynamic imaging to capture the initial increase in contrast medium enhancement in order to assess perfusion, followed by a delayed imaging phase with progressively longer intervals to monitor subsequent tissue enhancement behaviour in order to assess tissue permeability. The DCE CT images were analysed using a dual-input two-compartment distributed parameter model to yield separate estimates for blood flow and permeability, as well as fractional intravascular and extravascular volumes. The HCCs and surrounding cirrhotic liver tissues were found to exhibit enhancement curves that can be appropriately described by two distinct compartments separated by a semipermeable barrier. Early contrast arrival was also found for HCC as compared with background liver. These findings are consistent with the current understanding of sinusoidal capillarization and hepatocarcinogenesis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Park YN, Yang CP, Fernandez GJ, Cubukcu O, Thung SN, Theise ND (1998) Neoangiogenesis and sinusoidal “capillarization” in dysplastic nodules of the Liver. Am J Surg Pathol 22:656

    Article  PubMed  CAS  Google Scholar 

  2. Kojiro M (2005) Histopathology of liver cancers. Best Pract Res Clin Gastroenterol 19:39–62

    Article  PubMed  Google Scholar 

  3. Ueda K, Terada T, Nakanuma Y, Matsui O (1992) Vascular supply in adenomatous hyperplasia of the liver and hepatocellular carcinoma: a morphometric study. Human Pathol 23:619–626

    Article  CAS  Google Scholar 

  4. Willatt JM, Hussain HK, Adusumilli S, Marrero JA (2008) MR imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology 247:311–330

    Article  PubMed  Google Scholar 

  5. Jeong YY, Yim NY, Kang HK (2005) Hepatocellular carcinoma in the cirrhotic liver with helical CT and MRI: imaging spectrum and pitfalls of cirrhosis-related nodules. Am J Roentgenol 185:1024–1032

    Article  Google Scholar 

  6. Matsui O, Kadoya M, Kameyama T et al (1991) Benign and malignant nodules in cirrhotic livers: distinction based on blood supply. Radiology 178:493–497

    PubMed  CAS  Google Scholar 

  7. Villeneuve JP, Dagenais M, Huet PMI, Roy A, Lapointe R, Marleau D (1996) The hepatic microcirculation in the isolated perfused human liver. Blood 23:24–31

    CAS  Google Scholar 

  8. Koh TS, Thng CH, Lee PS et al (2008) Hepatic metastases: in vivo assessment of perfusion parameters at dynamic contrast-enhanced MR imaging with dual-input two-compartment tracer kinetics model. Radiology 249:307–320

    Article  PubMed  Google Scholar 

  9. Koh TS, Cheong LH, Hou Z, Soh YC (2003) A physiologic model of capillary-tissue exchange for dynamic contrast-enhanced imaging of tumor microcirculation. IEEE Trans Biomed Eng 50:159–167

    Article  PubMed  CAS  Google Scholar 

  10. Larson KB, Markham J, Raichle ME (1987) Tracer-kinetic models for measuring cerebral blood flow using externally detected radiotracers. J Cereb Blood Flow Metab 7:443–463

    PubMed  CAS  Google Scholar 

  11. Hart A (2001) Mann–Whitney test is not just a test of medians: differences in spread can be important. BMJ 323:391–393

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Materne R, Van Beers BE, Smith AM et al (2000) Non-invasive quantification of liver perfusion with dynamic computed tomography and a dual-input one-compartmental model. Clin Sci 99:517–525

    Article  PubMed  CAS  Google Scholar 

  14. Materne R, Annet L, Dechambre S et al (2002) Dynamic computed tomography with low-and high-molecular-mass contrast agents to assess microvascular permeability modifications in a model of liver fibrosis. Clin Sci 103:213–216

    Article  PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  16. Tsushima Y, Shintaro F, Jun A, Shigeru S, Keigo E (2004) Quantitative perfusion map of malignant liver tumors, created from dynamic computed tomography data. Acad Radiol 11:215–223

    Article  PubMed  Google Scholar 

  17. Nakanuma Y, Terada T, Terasaki S et al (1990) ‘Atypical adenomatous hyperplasia’ in liver cirrhosis: low-grade hepatocellular carcinoma or borderline lesion? Histopathology 17:27–35

    Article  PubMed  CAS  Google Scholar 

  18. Bosch J (2007) Vascular deterioration in cirrhosis: the big picture. J Clin Gastroenterol 41:S247

    Article  PubMed  Google Scholar 

  19. Hayashi M, Matsui O, Ueda K, Kawamori Y, Gabata T, Kadoya M (2002) Progression to hypervascular hepatocellular carcinoma: correlation with intranodular blood supply evaluated with CT during intra-arterial injection of contrast material. Radiology 225:143–149

    Article  PubMed  Google Scholar 

  20. Miles KA, Leggett DA, Kelley BB, Hayball MP, Sinnatamby R, Bunce I (1998) In vivo assessment of neovascularization of liver metastases using perfusion CT. Br J Radiol 71:276–281

    PubMed  CAS  Google Scholar 

  21. Bader TR, Herneth AM, Blaicher W et al (1998) Hepatic perfusion after liver transplantation: noninvasive measurement with dynamic single-section CT. Radiology 209:129–134

    PubMed  CAS  Google Scholar 

  22. Tsushima Y, Funabasama S, Sanada S, Aoki J, Endo K (2003) Perfusion changes of hepatic parenchyma due to infectious hepatobiliary disease: demonstration by perfusion CT. Comput Med Imaging Graph 27:289–291

    Article  PubMed  Google Scholar 

  23. Tsushima Y, Blomley MJK, Kusano S, Endo K (1999) The portal component of hepatic perfusion measured by dynamic CT (an indicator of hepatic parenchymal damage). Dig Dis Sci 44:1632–1638

    Article  PubMed  CAS  Google Scholar 

  24. Tsushima Y, Blomley MJK, Yokoyama H, Kusano S, Endo K (2001) Does the presence of distant and local malignancy alter parenchymal perfusion in apparently disease-free areas of the liver? Dig Dis Sci 46:2113–2119

    Article  PubMed  CAS  Google Scholar 

  25. Tsushima Y, Blomley MJK, Kusano S, Endo K (2002) Measuring portal venous perfusion with contrast-enhanced CT: comparison of direct and indirect methods. Acad Radiol 9:276–282

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  27. 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

    PubMed  Google Scholar 

  28. Hashimoto K, Murakami T, Dono K et al (2007) Quantitative tissue blood flow measurement of the liver parenchyma: comparison between xenon CT and perfusion CT. Dig Dis Sci 52:943–949

    Article  PubMed  Google Scholar 

  29. Sahani DV, Holalkere N-S, Mueller PR, Zhu AX (2007) Advanced hepatocellular carcinoma: CT perfusion of liver and tumor tissue-initial experience. Radiology 243:736–743

    Article  PubMed  Google Scholar 

  30. Bisdas S, Foo CZ, Thng CH, Vogl TJ, Koh TS (2008) Optimization of perfusion CT protocol for imaging of extracranial head and neck tumors. J Digit Imaging PMID:18454289

  31. Leggett DA, Kelley BB, Bunce IH, Miles KA (1997) Colorectal cancer: diagnostic potential of CT measurements of hepatic perfusion and implications for contrast enhancement protocols. Radiology 205:716–720

    PubMed  CAS  Google Scholar 

  32. Fuentes MA, Keith CJ, Griffiths M, Durbridge G, Miles KA (2002) Hepatic haemodynamics: interrelationships between contrast enhancement and perfusion on CT and Doppler perfusion indices. Br J Radiol 75:17–23

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors acknowledge grant support from the Singapore Cancer Syndicate (Grant number SCS-CS-0072).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sotirios Bisdas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Koh, T.S., Thng, C.H., Hartono, S. et al. Dynamic contrast-enhanced CT imaging of hepatocellular carcinoma in cirrhosis: feasibility of a prolonged dual-phase imaging protocol with tracer kinetics modeling. Eur Radiol 19, 1184–1196 (2009). https://doi.org/10.1007/s00330-008-1252-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-008-1252-y

Keywords

Navigation