Liver, Pancreas and Biliary TractTumour-related neoangiogenesis: Functional dynamic perfusion computed tomography for diagnosis and treatment efficacy assessment in hepatocellular carcinoma

BackgroundAim of the study was to determine the value of perfusion computed tomography in the quantitative assessment of tumour-related neoangiogenesis for the diagnosis and treatment of hepatocellular carcinoma lesions.MethodsOverall, 47 consecutive patients with cirrhotic liver disease, with a high risk of hepatocellular carcinoma, and undergoing standard surveillance (six-month intervals) were eligible for inclusion in this prospective study; based on Barcelona Clinic Liver Cancer guidelines, 27 patients were enrolled. Perfusion computed tomography was performed in 29 biopsy-proven hepatocellular carcinoma lesions before and after treatment with transarterial chemoembolization or radiofrequency ablation. The dynamic study was performed with a 256-slice multidetector-computed tomography scanner; the following parameters were measured: hepatic perfusion, arterial perfusion, blood volume, hepatic perfusion index, and time-to-peak in all patients.ResultsHepatocellular carcinoma lesions had the following median perfusion values: perfusion 46.3 mL/min/100 g; blood volume 20.4 mL/100 mg; arterial perfusion 42.9 mL/min; hepatic perfusion index 92.5%; time to peak 18.7 s. Significantly lower perfusion values were obtained in correctly treated lesions or surrounding parenchyma than in viable hepatocellular carcinoma tissue.ConclusionsIn hepatocellular carcinoma, perfusion computed tomography could contribute to a non-invasive quantification of tumour blood supply related to the formation of new arterial structures, and enable the assessment of therapeutic response.