Can dual-energy CT replace perfusion CT for the functional evaluation of advanced hepatocellular carcinoma?

Mulé, Sebastien; Pigneur, F.; Quelever, Ronan; Tenenhaus, Arthur; Baranès, Laurence; Richard, Patrick; Tacher, Vania; Hérin, Edouard; Pasquier, H.; Ronot, Maxime; Rahmouni, Alain; Vilgrain, Valérie; Luciani, Alain

doi:10.1007/s00330-017-5151-y

Cited by 43 publications

(33 citation statements)

References 27 publications

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“…For DECT, the three materials in the thorax most frequently analyzed are iodine, air, and soft tissue. A single contrast material–enhanced acquisition can supply both virtual nonenhanced images and contrast‐enhanced CT data, which may obviate the additional acquisition of true nonenhanced CT scans 11,20 . In the study by Reiter et al, 21 the size of pulmonary nodules ≤3 cm were evaluated by DECT.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of dual‐energy and perfusion CT parameters for diagnosing solitary pulmonary nodules

et al. 2021

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Background To evaluate the correlation and accuracy of dual‐energy CT (DECT) (70/Sn150) and low‐dose volume perfusion CT (VPCT) parameters for the diagnosis of solitary pulmonary nodules (SPN). Methods A total of 15 patients with benign SPN (mean age 56 ± 7 years) and 34 patients with malignant SPN and clinical indication for surgery (mean age 58 ± 6 years) were enrolled from July 2017 to September 2019 at a single institution. All the patients underwent low‐dose VPCT with a scan volume of 114 mm on the z‐axis and a venous phase enhancement DECT (70/150 Sn) scan just before surgery on the same day. All CT findings were studied in comparison with the pathological results after surgery. Perfusion and dual‐energy CT parameters such as blood flow (BF), blood volume (BV), mean transit time (MTT), flow extraction product (FED), pulmonary nodule enhancement peak (PPnod) and iodine concentration (IC) were evaluated as well as t‐test, chi‐square test, Pearson correlation analysis, and ROC curve analysis to determine the significance of study parameters. Results The effective radiation dosage of the VPCT and DECT scans were 4.67 ± 0.26 mSv and 0.32 ± 0.10 mSv, respectively. Significant correlations were found between iodine concentration from DECT and VPCT parameters (r = 0.376–0.533, p < 0.05). The sensitivity and specificity of IC to differentiate the SPN were 86.67% and 72.73%, which was slightly lower than that of BV (94.44%, 73.33%), FED (88.89%, 80.00%) and PPnod (94.44%, 80.00%). Conclusions VPCT scans have low radiation dosage achieved by shortening the z‐axis scan range for assessment of SPN. IC from DECT is significantly correlated with VPCT parameters, and VPCT parameters have better diagnostic performance for SPN than DECT parameters.

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Section: Discussionmentioning

confidence: 99%

Evaluation of dual‐energy and perfusion CT parameters for diagnosing solitary pulmonary nodules

et al. 2021

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“…CT perfusion imaging clinical application has not been widely promoted because of the large radiation dose. Mule S, et al have shown arterial IC to be significantly related to both arterial blood flow and blood volume, confirming the ability of DECT to evaluate both morphological and perfusion changes 28 . Sonja Gordic, et al found strong intra-individual correlations between iodine density and arterial perfusion ( r = 0.75) 29 .…”

Section: Discussionmentioning

confidence: 74%

Quantitative dual-energy CT for evaluating hepatocellular carcinoma after transarterial chemoembolization

Yue

Jiang

et al. 2021

Sci Rep

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We aimed to investigate the role of the quantitative parameters of dual-energy computed tomography (DECT) in evaluating patients with hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE). We retrospectively identified 80 HCC patients (mean age, 56 years; 61 men) treated by TACE who received contrast-enhanced DECT and were retreated by TACE within 7 days between November 2018 and December 2019. Taking digital subtraction angiography (DSA) and CT images as reference standard, two readers measured and calculated the values of normalized iodine concentration at arterial phase (NICAP), normalized iodine concentration at portal venous phase (NICPP), iodine concentration difference (ICD), arterial iodine fraction (AIF) and slope of the spectral Hounsfield unit curve (λHu) by placing matched regions of interests (ROIs) within the tumor active area (TAA), adjacent normal hepatic parenchyma (ANHP) and tumor necrotic area (TNA). Differences between the parameters were analyzed by the Kruskal–Wallis H test. Receiver operating characteristic analysis of the parameters performance in differentiating the three tissues types was performed. AIF exhibited a good performance in distinguishing TAA (0.93 ± 0.31) and ANHP (0.18 ± 0.14), the areas under the receiver operating characteristic curve (AUC) was 0.989, while the λHu exhibited an excellent performance in distinguishing TAA (3.32 ± 1.24) and TNA (0.29 ± 0.27), with an AUC of 1.000. In conclusion, quantitative DECT can be effectively used to evaluate the tumor viability in HCC patients treated by TACE.

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“…One study using 4-dimensional perfusion CT found that 5 out of 6 liver tumor lesions included in the study showed significant decreases in tumor perfusion compared with baseline one week after the onset of sorafenib treatment, which might support the hypothesis of vascular normalization after sorafenib treatment in that outlier case (77). However, Mule et al (78) questioned whether perfusion CT could be replaced by dual-energy CT for evaluating the response to sorafenib or radioembolization in patients with advanced HCC.…”

Section: Perfusion Imagingmentioning

confidence: 83%

Imaging evaluation of sorafenib for treatment of advanced hepatocellular carcinoma

Zheng

Jiang

et al. 2018

Chinese Journal of Cancer Research

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Sorafenib, which is a novel targeted agent, plays an important role in treating advanced hepatocellular carcinoma (HCC) through its antiangiogenic and antiproliferative effects. However, conventional morphology-based radiographic evaluation systems may underestimate the efficacy of sorafenib in HCC due to a lack of apparent tumor shrinkage or altered tumor morphology in many cases. This calls for the development of more accurate imaging methods for evaluating sorafenib. The introduction of tumor burden measurements based on viability and other evolving imaging approaches for assessing therapeutic effects are promising for overcoming some of the limitations of the morphology-based criteria. In this review, we summarize various imaging methods that are used to assess treatment responses of advanced HCC to sorafenib. Imaging markers predictive of prognosis in advanced HCC after treatment with sorafenib are also included and discussed.

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Can dual-energy CT replace perfusion CT for the functional evaluation of advanced hepatocellular carcinoma?

Abstract: • Late-arterial iodine concentration is highly related to arterial BF and BV. • Portal iodine concentration mainly reflects tumour blood volume. • Dual-energy CT offers significantly decreased radiation dose compared with perfusion CT.

Cited by 43 publications

References 27 publications

Evaluation of dual‐energy and perfusion CT parameters for diagnosing solitary pulmonary nodules

Evaluation of dual‐energy and perfusion CT parameters for diagnosing solitary pulmonary nodules

Quantitative dual-energy CT for evaluating hepatocellular carcinoma after transarterial chemoembolization

Imaging evaluation of sorafenib for treatment of advanced hepatocellular carcinoma

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