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Perfusion computed tomography for detection of hepatocellular carcinoma in patients with liver cirrhosis

  • Computed Tomography
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Abstract

Purpose

To evaluate the diagnostic performance of dynamic perfusion CT (P-CT) for detection of hepatocellular carcinoma (HCC) in the cirrhotic liver.

Materials and methods

Twenty-six cirrhotic patients (19 men, aged 69 ± 10 years) with suspicion of HCC prospectively underwent P-CT of the liver using the 4D spiral-mode (100/80 kV; 150/175mAs/rot) of a dual-source system. Two readers assessed: (1) arterial liver-perfusion (ALP), portal-venous liver-perfusion (PLP) and hepatic perfusion-index (HPI) maps alone; and (2) side-by-side with maximum-intensity-projections of arterial time-points (art-MIP) for detection of HCC using histopathology and imaging follow-up as standard of reference. Another reader quantitatively assessed perfusion maps of detected lesions.

Results

A total of 48 HCCs in 21/26 (81 %) patients with a mean size of 20 ± 10 mm were detected by histopathology (9/48, 19 %) or imaging follow-up (39/48, 81 %). Detection rates (Reader1/Reader2) of HPI maps and side-by-side analysis of HPI combined with arterial MIP were 92/88 % and 98/96 %, respectively. Positive-predictive values were 63/63 % and 68/71 %, respectively. A cut-off value of ≥85 % HPI and ≥99 % HPI yielded a sensitivity and specificity of 100 %, respectively, for detection of HCC.

Conclusion

P-CT shows a high sensitivity for detection of HCC in the cirrhotic liver. Quantitative assessment has the potential to reduce false-positive findings improving the specificity of HCC diagnosis.

Key points

• Visual analysis of perfusion maps shows good sensitivity for detection of HCC.

• Additional assessment of anatomical arterial MIPs further improves detection rates of HCC.

• Quantitative perfusion analysis has the potential to reduce false-positive findings.

• In cirrhotic livers, a hepatic-perfusion-index ≥ 9 9 % might be specific for HCC.

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Acknowledgments

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 obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden

    Michael A. Fischer, Nikolaos Kartalis, Aristeidis Grigoriadis, Louiza Loizou, Bertil Leidner, Peter Aspelin & Torkel B. Brismar

  2. Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden

    Michael A. Fischer, Nikolaos Kartalis, Aristeidis Grigoriadis, Louiza Loizou, Bertil Leidner, Peter Aspelin & Torkel B. Brismar

  3. Department of Hepatology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden

    Per Stål

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  1. Michael A. Fischer
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Correspondence to Michael A. Fischer.

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Fischer, M.A., Kartalis, N., Grigoriadis, A. et al. Perfusion computed tomography for detection of hepatocellular carcinoma in patients with liver cirrhosis. Eur Radiol 25, 3123–3132 (2015). https://doi.org/10.1007/s00330-015-3732-1

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  • DOI: https://doi.org/10.1007/s00330-015-3732-1

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