Objective
To assess the impact on absolute values and reproducibility of adding portal venous (PV) to arterial input functions in computed tomography perfusion (CTp) evaluations of liver tumors and normal liver.
Methods
Institutional review board approval and written informed consent were obtained; the study complied with HIPAA regulations. CTp source datasets, obtained from seven patients (containing 9 liver tumors) on two occasions, 2-7 days apart, were analyzed by deconvolution modeling using dual (“Liver” protocol, PV and aorta) and single (“Body” protocol, aorta only) vascular inputs. Identical tumor, normal liver, aortic and, where applicable, PV ROIs were used in corresponding analyses to generate tissue blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability (PS) values. Test-retest variability was assessed by within-patient coefficients of variation (wCV).
Results
For liver tumor and normal liver, median BF, BV and PS were significantly higher for the Liver protocol than Body protocol: 171.3-177.8 vs. 39.4-42.0 mL/min/100g, 17.2-18.7 vs. 3.1-4.2 mL/100g, 65.1-78.9 vs. 50.4- 66.1 mL/min/100g, respectively (all p<0.01). There were no differences in MTT between protocols. wCVs were lower for all parameters with the Liver protocol than Body protocol: BF, 7.5-11.2% vs 11.7-20.8%; BV, 10.1-14.4% vs. 16.6-30.1%; MTT, 4.2-5.5% vs. 10.4-12.9%; and PS, 7.3-12.1% vs. 12.6-20.3%, respectively.
Conclusion
Utilization of dual vascular input CTp liver analyses has substantial impact on absolute CTp parameter values and test-retest variability. Incorporation of the portal venous inputs may yield more precise results, however, it imposes substantial practical constraints on acquiring the necessary data.