rfusion parameters and corresponding histogram parameters derived from traditional triphasic enhanced computed tomography (CT) scans in predicting histological grade of HCC. Triple Arterial Phase CT of the Liver with Radiation Dose Equivalent to Methods: The study was conducted in Department of Radiology of Aga Khan University Hospital and Sind Institute of Urology and Transplantation, Karachi from Feb 2006 to Feb 2007. 3. Diagnostic sensitivity of hepatocellular carcinoma imaging and its 20(1), 32539. Based on the special characteristics of dual blood supply of the liver, PCT can achieve quantitatively detection blood perfusion in the lesions, thus providing information regarding biological features of the tumor24. Among them, all of thePVP value andAEF value were significantly higher in MVI negative group than those in positive group, while forHPI (Max), the value of MVI positive group was significantly higher than that of negative group (Table 3). 28, 213223 (2015). & Dong, W. Revisiting surgical strategies for hepatocellular carcinoma with microvascular invasion. We consulted the electronic medical records of our hospital from September 2017 to September 2020. In order to compensate for the decrease in PVP, arterial liver perfusion will increase, which eventually leads to an increase in HPI33,34. This retrospective study was approved by the ethics committee of the Second Hospital of Shandong University. 24. Grendell JH, Friedman SL, McQuaid KR. Ryu, T. et al. The mean value of AEF, the 75th percentiles of AEF and rAEF, and the 25th percentile of HFtumor exhibited the highest sensitivity of 94.4%. Hepatocellular carcinoma (HCC) is an important cause of death worldwide . Hepatocellular carcinoma. Oncol. Radiographics. Traditional PCT is largely unused clinically attributed to the high radiation dose and poor image quality. The T test was used to analyze continuous variables, while Chi-square test was used for analysis of categorical variables. https://doi.org/10.1007/s10278-014-9725-9 (2015). Triple-Phase MDCT of Hepatocellular Carcinoma - AJR To obtain PDF Abstract OBJECTIVE. These authors contributed equally: Fang Zhao and Guodong Pang. Hepatocellular carcinoma receives most of its blood supply from branches of the hepatic artery, accounting for its characteristic enhancement pattern: early arterial enhancement with early "washout." The mean interval between the CT imaging and surgery or biopsy was 5.5days (range 119days) for patients with IMCCs, and 7days (range 143days) for patients with HCCs. IMCC has similar risk factors with HCC, including chronic viral hepatitis, cirrhosis, and so on5,6, but has distinctly different prognosis and different treatment methods7. Finally, 36 patients diagnosed with IMCCs (mean age, 58.9years; male:female=20:16) and 54 patients diagnosed with HCCs (mean age, 57.3years; male:female=36:18) were included. Flow chart of inclusion and exclusion criteria for the subject enrollment in the study. Therefore, it is of paramount importance to predict MVI before surgery. Background and aims: The American Association for the Study of Liver Disease issued guidelines that proposed that hepatocellular carcinoma (HCC) can be diagnosed if a mass is larger than 2 cm in a cirrhotic liver and shows typical features of HCC at triphasic liver computed tomography (CT) or dynamic magnetic resonance imaging (MRI). Sci Rep 11, 23163 (2021). To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The 25th percentile of HFtumor was significantly higher in patients with HCCs than IMCCs (P=0.036). 2. Bains S, Behr S, Corvera C et al (2012) SUVmax values in FDG-PET/CT scans of patients with HCC: a possible new prognostic factor. AEF, which reflects the HAP, could also be used to predict MVI26. Kim, K. W. et al. Thus, it may affect the accuracy of the results. https://doi.org/10.3748/wjg.v22.i42.9279 (2016). J. Radiol. PubMedGoogle Scholar. World Scientific Pub Co Inc. (2008) ISBN:9812707999. J. Radiol. Furthermore, radiomics analysis demands high image quality, which can be significantly affected by scanning conditions and artifacts. Quantitative parameter images derived from the triphasic CT scans. Markers for microvascular invasion in hepatocellular carcinoma: Where do we stand?. https://doi.org/10.1159/000504193 (2020). https://doi.org/10.1038/s41598-023-35913-y, DOI: https://doi.org/10.1038/s41598-023-35913-y. CT computed tomography, HCC hepatocellular carcinoma, MVI microvascular invasion. . Rim enhancement on delayed post-contrast images causing a capsule-appearance is considered relatively specific for hepatocellular carcinoma (see case 4). Imaging 28(2), 21323. Nat. Even for isolated HCC smaller than 2 cm, overall survival (OS) and recurrence free survival (RFS) in patients with MVI is still lower than in patients without MVI8,9. Manini MA, Sangiovanni A, Fornari F et-al. Tri-phasic CT scan based on model-free maximum was used to calculate the perfusion parameters of hepatic arterial supply perfusion (HAP), portal vein blood supply perfusion (PVP), hepatic artery perfusion Index (HPI), and arterial enhancement fraction (AEF). Risk factors of intrahepatic cholangiocarcinoma in the United States: a case-control study. A two-tailed P<0.05 indicated statistical significance. Check for errors and try again. Best cases from the AFIP: fibrolamellar hepatocellular carcinoma. DWI can also delineate the extent of infiltrative HCC, as in such a case. Accurate differentiation between HCC and IMCC is challenging, but vital because their prognoses and treatments differ substantially. Kelsen D, Daly JM, Kern SE et-al. Intraclass correlation analysis was applied to assess interobserver agreement between the two radiologists using an intraclass correlation coefficient (ICC). Representative CT perfusion images derived from the triphasic CT scans of IMCCs and HCCs are shown in Fig. MATERIALS AND METHODS. The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis. Schlichtemeier, S. M. et al. Guo, Y. et al. If neither of these options are possible,then a variety of options exist including chemotherapy, transarterial chemoembolisation (TACE), transarterial radioembolization (TARE) / selective internal radiation therapy (SIRT), thermal ablation (RFA, cryoablation, or microwave ablation), and chemical ablation20-22. 27. The portal vein accounts for~75% of the liver's blood supply with the remainder from the hepatic artery, so a later arterial phase is required for the best enhancement of the parenchyma. The following mechanism may be at play to explain the observation. Among all parameters, the mean value of AEF, the 75th percentiles of AEF and rAEF, and the 25th percentile of HFtumor exhibited the highest sensitivities of 94.4%, while the 50th percentile of rAEF had the highest specificity of 82.4%. Llovet, J. M. et al. PVP, AFF, HPI and their related parameters had certain value in predicting MVI. Breathing training before scanning. To help characterize the vascularity of hypervascular liver lesions. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Cancer. Microscopically they range from well-differentiated to undifferentiated. Then, quantitative data were compared using an independent Students t-test or MannWhitney U-test between IMCC and HCC. Mahnken AH. In the present study, not only were the perfusion parameters derived from traditional triphasic CT scans, but the corresponding histogram analyses were also employed to further investigate the differentiation of the two tumors. (2018) Case Reports in Surgery. 3 (1): 1-15. Article are done as the contrast passes thro. Miles, K. A., Hayball, M. P. & Dixon, A. K. Functional images of hepatic perfusion obtained with dynamic CT. Radiology 188(2), 40511. (A) and (C) are portal phase images of MVI negative and positive patients. 29 out of 33 MVI negative and 43 out of 48 MVI positive patients reported HBV history. Radiology 266, 177184 (2013). Value of perfusion parameters and histogram analysis of trip - LWW The mean value, and all thepercentiles of the arterial enhancement fraction (AEF) were significantly higher in HCCs than in IMCCs. The 10th percentiles of the AEF and rAEF had the highest AUC of 0.788 for differentiating IMCC from HCC, with sensitivities and specificities of 87.0%, 83.3%, and 61.8%, 64.7%, respectively. All Statistical analyses were performed using SPSS software (SPSS statistics; IBM). Characterization of hepatocellular carcinomas with triphasic CT and Hepatocellular carcinoma also occurs in the pediatric population, and is the second most common pediatric primary liver tumor after hepatoblastoma. Malhi H, Grant EG, Duddalwar V. Contrast-Enhanced Ultrasound of the Liver and Kidney. Tumor regions of interest (ROIs) were delineated along the margins of tumor lesion on all continuous sections, including any cystic, necrotic, and hemorrhagic portions. Korean J Radiol. Triphasic computed tomography (CT) scan in focal tumoral liver lesions Wen, T. et al. J. Magn. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. A. et al. https://doi.org/10.1371/journal.pone.0197488 (2018). Pport, A. R., Sommer, W. H., Nikolaou, K., Reiser, M. F. & Zech, C. J. (2017) British journal of haematology. The description of heterogeneity using histogram analyses has shown to be superior to mean values34,35,36,37. 1. Thus, a history of chronic hepatitis B or C infection promoted the development of HCC. AJR Am J Roentgenol. Chernyak V, Fowler K, Kamaya A et al. Fourth, the arterial imaging time used in this article was 3035 seconds, without the use of bolus tracking. Robbins and Cotran pathologic basis of disease. The ROC curves of combined parameters of PVP, HPI and AEF for MVI negative and positive of HCC.AEF refers to the combination of AEF(Min), AEF(Min) and rAEF(Min). The mean lesion diameter for MVI negative patients was 3.40 cm, while the mean lesion diameter for MVI positive patients was 5.52 cm. New pathologic stratification of microvascular invasion in hepatocellular carcinoma: Predicting prognosis after living-donor liver transplantation. Ros, P. R. et al. 19, 424433 (1995). Asayama et al.37 also performed histogram analyses of ADC values to differentiate IMCCs from poorly differentiated HCCs. The remarkable ability of the liver to regenerate means that up to two-thirds of the liver can be resected 19. Ann. However, traditional PCT generally has a high radiation dose, which makes it difficult to be widely used in clinical practice. https://doi.org/10.1016/j.ejso.2016.05.032 (2016). The authors confirm that data published in the article are available, and raw data supporting the findings will be shared by the corresponding author upon reasonable request. (PDF) Biphasic & triphasic computed tomography (CT) scan in focal Radiology 264, 751760 (2012). 2008;190 (4): 1018-27. Blomley, M. J. et al. The reliability and reproducibility of some radiomics features needs to be further studied and clarified, while some other features are difficult to understand by existing medical knowledge. Perfusion computed tomography (PCT) can be used to quantitatively measure liver perfusion parameters and therefore be applied for liver perfusion evaluation. Kim, S. A. et al. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. AJR Am. For the difference between parameters and normal liver parenchyma, PVP including PVP(Min), PVP(Median), PVP (Mean), PVP(0.1), PVP(0.5), HPI (Max) and AEF(Min) were significantly different between the two groups (P<0.05). Liver transplantation is also a curative option. Patient informed consent was waived because this study was a retrospective study. https://doi.org/10.1097/00004728-199505000-00016 (1995). ROC curves were used to evaluate the ability of the statistically significant tumor perfusion parameters and corresponding histogram parameters to discriminate between IMCCs and HCCs. no financial relationships to ineligible companies to disclose. These will entail perfusion behavior changes, and further study is need to expand our knowledge in this regard. Intrahepatic cholangiocarcinomas in cirrhosis are hypervascular in comparison with those in normal livers. Second, the patient sample size was adequate but relatively small, and of single center origin. McGraw-Hill Medical. (2015) Open Access Macedonian Journal of Medical Sciences. First, selection bias could not be completely avoided in this retrospective study. You are using a browser version with limited support for CSS. 67(3), 526534. The 25th percentile of the AEF had the highest sensitivity of85.2%, however, the 50th percentile of the AEF had the highest specificity of70.6%. performed statistical expertise. The arterial phase CT scan was performed at 3035s after the injection of contrast agent. Katyal S, Oliver JH, Peterson MS et-al. Patient informed consent was waived because this study was a retrospective study. AEF Difference in arterial enhancement fraction (AEFtumorAEFliver), rAEF Relative arterial enhancement fraction (AEF/AEFliver), HAP Difference in hepatic arterial perfusion (HAPtumorHAPliver), PVPvariance The variance of the portal vein perfusion, AEFkurtosis The kurtosis value of the arterial enhancement fraction, ROC Receiver operating characteristic, IMCC Intrahepatic mass-forming cholangiocarcinoma, HCC Hepatocellular carcinoma. Hepatocellular Carcinoma (HCC) Workup - Medscape One should remember that a large number of patients will have concomitant cirrhosis, and thus also be at risk for bland portal vein thrombosis from synthetic dysfunction of clotting factors. The incidence of hepatocellular carcinoma is rising, largely attributable to a rise in hepatitis C infection 2. https://doi.org/10.1053/j.gastro.2009.06.003 (2009). Clin Radiol. https://doi.org/10.1245/s10434-012-2513-1 (2013). Internet Explorer). 2011;21 (3): 266-80. PLoS One 13(5), e0197488. Arterial peritumoral enhancement was usually seen in HCC with positive MVI, which reflected excessive perfusion in arterial phase when tumor thrombus exists in small branches of portal vein. surrounding liver 17, decreased intensity in the surrounding liver, enhancement is usually arterial ("hypervascularity"), rapid "washout", becoming hypointense to the remainder of the liver (96% specific) 3, this is because the supply to hepatocellular carcinoma is predominantly from the hepatic artery rather than the portal vein, an imaging classification system (LI-RADS) has been developed to stratify lesions, similar to assessment with extracellular gadolinium, but evaluation of the hepatobiliary phase requires care, arterial hyperenhancement with washout assessed on the portal venous phase, washout on transitional phase (3 minutes delayed) is less reliable (see: Eovist and LI-RADS), T2: variable,typically moderately hyperintense, C+ post-SPIO (iron oxide): increases sensitivity in diagnosing small hepatocellular carcinomas, DWI: intratumoral high signal;increases sensitivity and specificity, threads and streaks pattern: sign of tumor thrombus in the portal vein. Current status of transarterial radioembolization. HPB (Oxford). Radiographics. Oncol. Shao, C. C., Zhao, F., Yu, Y. F., Zhu, L. L. & Pang, G. D. Value of perfusion parameters and histogram analysis of triphasic computed tomography in pre-operative prediction of histological grade of hepatocellular carcinoma. In clinical practice, HCC typically shows intense hyper enhancement on the arterial phase, followed by washout during dynamic imaging. https://doi.org/10.1002/jmri.23681 (2012). 28(2), 390395 (2008). Radiographics 28, 747769 (2008). Salem R, Lewandowski RJ, Mulcahy MF, Riaz A, Ryu RK, Ibrahim S, Atassi B, Baker T, Gates V, Miller FH, Sato KT, Wang E, Gupta R, Benson AB, Newman SB, Omary RA, Abecassis M, Kulik L. Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes. PubMedGoogle Scholar. https://doi.org/10.1097/TP.0000000000000489 (2015). Eur. 23(4), 779787. Liver Cancer 9, 15666. Radiology. On gross pathology, hepatocellular carcinomas typically appear as pale masses within the liver and may be unifocal, multifocal or diffusely infiltrative at the time of presentation. We do acknowledge that our research has limitations. J. Approximately 1020% of HCCs may exhibit hypoenhancement in the arterial phase owing to the insufficient development of tumor neovascularity and the retention of dual blood supply17; thus, mimicking IMCC10. 3. Abdullah, S. S. et al. ; Study supervision and coordination: F.Z. J. Magn. Forth, the ROIs of lesion are only to be drawn in a few planes, not in all tumor volumes of interest for the analysis of parameters. GeneReviews [Internet]. Hence, the quantitative perfusion and corresponding histogram analysis were used for the subsequent analyses. Blechacz, B. Sheng, R. F. et al. PVP images showed hyperperfusion from the peripheral to the central part of the tumor. The 10th, 25th, 50th, and 75th percentiles of HAP were significantly higher in HCCs than in IMCCs (P<0.05). The positive predictive value (PPV) and negative predictive value (NPV) were 0.792 and 0.657, respectively. As a pathological concept, microvascular invasion is more clinically instructive on how to make accurate prediction before surgery. The value of AEF in MVI negative patient was significantly higher than in MVI positive patient. and Choi et al.38,39. Tumor size ranged from 2 to 11 cm with median 5.5cm (Table 3). Google Scholar. Sex ratio was 71:10, male to female, and mean age was 56.34 years old with a range of 3181. Robbins & Cotran Pathologic Basis of Disease. https://doi.org/10.1148/radiol.14132361 (2014). Case study, Radiopaedia.org (Accessed on 05 Jul 2023) https://doi.org/10.53347/rID-29243. Kumar V, Abbas AK, Fausto N et-al. Waiver for informed consent was approved by the Ethics Committee of The Second Hospital of Shandong University. All athours reviewed the manuscript. concepts and designed the research. Become a Gold Supporter and see no third-party ads. Zou, X. et al. (PDF) Correlation of Serum Alpha-Fetoprotein (AFP - ResearchGate 28 (2): 609-13. For patients with hepatic tumors, accurate evaluation of the hemodynamic blood status, especially in the area of hepatic perfusion, could provide vital information for prognosis assessments and appropriate clinical treatment options. Reson. The patient is hooked up to an IV, but the first scan is usually done before IV contrast injection. 7(5), 353371. Clin. MRI of small intrahepatic mass-forming cholangiocarcinoma and atypical small hepatocellular carcinoma (3 cm) with cirrhosis and chronic viral hepatitis: a comparative study. The evaluation of hepatocellular carcinoma with biphasic - PubMed Pixel analysis of MR perfusion imaging in predicting radiation therapy outcome in cervical cancer. Because of the heterogeneity of solid tumors, not all tumors have decreased PVP. Zhao et al. 55, 858865 (2011). A meta-analysis indicated that MVI was correlated with reduced 5-year disease free survival (DFS) rates7. Portal vein tumor thrombus can be distinguished from bland thrombus by demonstrating enhancement. Additionally, these tumors have the propensity to invade vascular structures, most commonly the portal vein, but also the hepatic veins, IVC, and right atrium. For the perfusion parameters calculated by the software directly, the mean values of PVP(Min) and AEF(Min) in MVI negative group were 0.107 and 0.295, significantly higher than 0.042 and 0.158 in MVI positive group with P values of 0.035 and 0.005 respectively (Table 2). (B) and (D) are corresponding perfusion images (AEF). Google Scholar Sarma M, Padma S, Pavithran P, Somasundaram VH, Sundaram PS (2021) Extrahepatic metastases of hepatocellular carcinoma on 18F FDG PET CT. Cancer Res. Choi, S. H. et al. Perfusion computed tomography (PCT) is considered to be a prospective tool that could able to evaluate the hemodynamic changes in the liver and expand the role of CT from single morphological imaging to functional imaging. Terminology For some departments and/or radiologists, a triple-phase may instead be used to refer to an initial non-contrast phase followed by a late arterial and portal venous phases. Objective: To assess the diagnostic accuracy of biphasic & triphasic spiral CT in differentiating benign from malignant focal tumoral liver lesions in the patients of Gujranwala region. Diagnostic differences in the sensitivity and specificity between single parameters or the combination of two parameters were compared using the McNemar test. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Fortunately, in recent years, research has progressed in predicting MVI before surgery. Case Discussion. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Ranchod A, Di Muzio B, et al. The aim of the current study was to explore the value of tumor attenuation and quantitative analysis of perfusion parameters obtained from traditional tri-phasic CT scans in grading hepatocellular carcinoma (HCC).Totally 39 patients (42 lesion samples) with pathologically confirmed HCC who underwent tri-phasic CT scans were enrolled. In the HCC group, 44 patients (44/54; 81.5%) had HBV or HCV infection and 10 patients (10/54; 18.5%) had alcoholic liver cirrhosis. https://doi.org/10.1016/j.jamcollsurg.2007.03.002 (2007). Pocha et al randomized 163 patients with cirrhosis to receive either biannual US or annual triphasic CT to compare performance and costs. PVP refers to the combination ofPVP(Min), PVP(Median), PVP(Mean), PVP(0.1), PVP(0.5) and rPVP(Min). RESULTS: The average sensitivity and positive predictive values, respectively, for the detection of HCC were 48.5% and 96.4% for early arterial phase images, 87.1% and 94.0% for late arterial phase images, 87.1% and 94.0% for images from both arterial phases, and 88.5% and 93.4% for images from all three phases. https://doi.org/10.1002/lt.22368 (2011). If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Progressive abdominal enlargement of patient known to have HCV. ADVERTISEMENT: Supporters see fewer/no ads. Preoperative prediction of microvascular invasion of hepatocellular carcinoma with IVIM diffusion-weighted MR imaging and Gd-EOB-DTPA-enhanced MR imaging. Therefore, the MannWhitney U test was performed for data analysis. Update review of the acute porphyrias. Perfusion parameters of triphasic computed tomography hold - Nature Pons F, Varela M, Llovet JM. Among 33 MVI negative patients, mean age was 54.97 years old, compared to 57.29 years old for the 48 MVI positive patients. PCT has been widely used in liver cancer in the past26,27,28,29. Preoperative prediction of microvascular invasion in hepatocellular cancer: A radiomics model using Gd-EOB-DTPA-enhanced MRI. Clin. Scientific Reports J. MagnReson. Check for errors and try again. 14 with median 5.4 (Table 2). A flow diagram of inclusion and exclusion criteria is shown in Fig. Regarding relative parameters, there were statistical differences between the two groups in the parameters of rPVP(Min), rHPI(Max), rAEF(Min) and rAEF(Max). Oncol. MATERIALS AND METHODS. (2003) ISBN:0838515517. For HCC, percutaneous ablation, radiofrequency ablation, surgical resection and liver transplantation are all available treatment options, while thorough surgical resection with negative margins is the only way to cure IMCC8,9. {"url":"/signup-modal-props.json?lang=us"}, Murphy A, Bell D, CT triple-phase liver (protocol). ADS Choi BI, Lee KH, Han JK et-al. 20, 32539. 3 and 4, and Table 4, of the mean value of AEF and all corresponding percentiles of the histogram analysis, the 10th percentile of the AEF had the highest value of 0.769. http://creativecommons.org/licenses/by/4.0/, Conventional, functional and radiomics assessment for intrahepatic cholangiocarcinoma. Oncol.

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