Hepatocellular Carcinoma in Cirrhotic Liver Disease

Ippolito, Davide; Sironi, Sandro; Pozzi, Massimo; Antolini, Laura; Ratti, Laura; Alberzoni, Chiara; Leone, Biagio Eugenio; Meloni, Franca; Valsecchi, Maria Grazia; Fazio, Ferruccio

doi:10.1016/j.acra.2008.02.005

Cited by 76 publications

(17 citation statements)

References 25 publications

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“…With the increasing speed of imaging technology, dynamic contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) have been widely used in the characterization of solid tumors, particularly for tumors of the liver, kidney, and breast (1-7). Among these studies, analyzing the enhancement pattern of the liver tumor was used as a vital approach to differentiate malignant from benign lesions (8,9), evaluate tumor vascularity (10), and response to treatment (11,12).…”

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confidence: 99%

Dynamic Evolutionary Changes in Blood Flow Measured by MDCT in a Hepatic VX2 Tumor Implant over an Extended 28-day Growth Period: Time-Density Curve Analysis

Exner

Shi

et al. 2009

Academic Radiology

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Rationale and Objectives The enhancement pattern of malignant tumors has been studied in short-term animal models (7–14 days), but the reported results have been variable and inconsistent. The purpose of this study was to investigate the changing blood flow characteristics of VX2 tumors implanted in rabbit livers with contrast-enhanced multidetector computed tomography (MDCT) to establish a predictable pattern of vascular evolution over an extended 28-day growth period. Materials and Methods VX2 carcinoma was implanted in livers of 10 male New Zealand White rabbits. Dynamic CT (2/seconds × 60 seconds) was conducted on days 7, 14, 21, and 28 after tumor implantation. Enhancement parameters of time-density curve (TDC), time to start (T0), time to peak (TP), maximum enhancement (ΔH), slope of enhancement (SLe), and washout (SLw) in tumor center, tumor rim, and normal liver were analyzed. Tumor samples corresponding to CT images of one tumor on days 14 and 21 and seven tumors on day 28 were stained with hematoxylin and eosin and anti-CD31 monoclonal antibody. The relationship between enhancement parameters and histology parameters (thickness of tumor border, extent of blood stasis, and luminar vessel density) was analyzed. Results Consistent growth, appearance, and vascular changes occurred in 7 of 10 animals over the 4-week observation period. Peripheral rim-like enhancement was noted in CT images. TDC analysis showed that tumor rim enhancement was pronounced and more rapid than normal liver initially but this difference diminished with tumor progression. The SLe, SLw, and ΔH decreased from 10.03 ± 3.25 Hu/second, 0.42 ± 0.25 Hu/sec, and 58.00 ± 25.27 Hu on day 7 to 5.86 ± 2.73 Hu/second, 0.10 ± 0.13 Hu/second, and 37.78 ± 8.89 Hu/second on day 28, respectively. TP increased from 12.71 ± 4.85 seconds on day 7 to 25.57 ± 7.75 seconds on day 28. No significant changes were noted on the TDC parameters in normal liver. The maximum density difference between tumor rim and normal liver (Drim-liver) appeared 10.5 ± 2.1 seconds after contrast injection. The maximum Drim-liver decreased from 54.33 ± 37.86 Hu on day 7 to 11.16 ± 13.03 Hu on day 28. On histological analysis, viable tumor cells were found in tumor rim with few luminar vessels. The tumor border showed desmoplastic reaction, vascular dilation and proliferation, inflammatory cell infiltration, and blood stasis. These findings were more obvious on day 28 than those on day 14. TP showed significant positive correlations with the extent of blood stasis in tumor border and adjacent liver and the maximum thickness of the tumor border (r = 0.945 and 0.893 respectively, P < .05). Conclusion The rabbit VX2 liver tumor is a hypovascular tumor with perilesional enhancement over its lifespan as imaged by MDCT. Consistent changes in the measured vascular parameters correlated with the size/age of the tumor implants. These findings suggest that the accuracy of CT enhancement imaging for VX2 liver tumor detection might be decreased with tumor development.

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confidence: 99%

Dynamic Evolutionary Changes in Blood Flow Measured by MDCT in a Hepatic VX2 Tumor Implant over an Extended 28-day Growth Period: Time-Density Curve Analysis

Exner

Shi

et al. 2009

Academic Radiology

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“…The relationships between the imaging measurements of tumor BF have been investigated using MRI, CT, and Doppler ultrasonography [18,42,43]. Hsu et al .…”

Section: Discussionmentioning

confidence: 99%

Assessment of Blood Flow in Hepatocellular Carcinoma: Correlations of Computed Tomography Perfusion Imaging and Circulating Angiogenic Factors

Chen

Pan

Tseng

et al. 2013

IJMS

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Hepatocellular carcinoma (HCC) is a highly vascular tumor through the process of angiogenesis. To evaluate more non-invasive techniques for assessment of blood flow (BF) in HCC, this study examined the relationships between BF of HCC measured by computer tomography (CT) perfusion imaging and four circulating angiogenic factors in HCC patients. Interleukin 6 (IL-6), interleukin 8 (IL-8), vascular endothelial growth factor (VEGF), and platelet derived growth factor (PDGF) in plasma were measured using Bio-Plex multiplex immunoassay in 21 HCC patients and eight healthy controls. Circulating IL-6, IL-8 and VEGF showed higher concentrations in HCC patients than in controls (p < 0.05), and predicted HCC occurrence better than chance (p < 0.01). Twenty-one patients with HCC received 21-phase liver imaging using a 64-slice CT. Total BF, arterial BF, portal BF, arterial fraction (arterial BF/total BF) of the HCC and surrounding liver parenchyma, and HCC-parenchyma ratio were measured using a dual-vessel model. After analyzing the correlations between BF in HCC and four circulating angiogenic factors, we found that the HCC-parenchyma ratio of arterial BF showed a significantly positive correlation with the level of circulating IL-8 (p < 0.05). This circulating biomarker, IL-8, provides a non-invasive tool for assessment of BF in HCC.

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“…The ability to quantitatively map blood perfusion using existing techniques already provides great value in clinical settings, as mapping local hemodynamics lends insight into progression of cancers of the liver, 23, 70 kidney, 53 and pancreas 26, 29 as well as cardiovascular 25, 62 and cerebrovascular disease, 9, 67 and obstetrics. 1, 55 While blood perfusion dynamics are currently quantified in vivo using ultrasound, CT, MRI, and nuclear medicine, 10, 20, 49 resolution is currently limited to 200–500 µm for most clinical ultrasound systems, 54 ~600 µm for CT, 53 ~1.6 mm for MRI, 47 and 5–10 mm for SPECT.…”

Section: Introductionmentioning

confidence: 99%

High Resolution Ultrasound Superharmonic Perfusion Imaging: In Vivo Feasibility and Quantification of Dynamic Contrast-Enhanced Acoustic Angiography

et al. 2016

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Mapping blood perfusion quantitatively allows localization of abnormal physiology and can improve understanding of disease progression. Dynamic contrast-enhanced ultrasound is a low-cost, real-time technique for imaging perfusion dynamics with microbubble contrast agents. Previously, we have demonstrated another contrast agent-specific ultrasound imaging technique, acoustic angiography, which forms static anatomical images of the superharmonic signal produced by microbubbles. In this work, we seek to determine whether acoustic angiography can be utilized for high resolution perfusion imaging in vivo by examining the effect of acquisition rate on superharmonic imaging at low flow rates and demonstrating the feasibility of dynamic contrast-enhanced superharmonic perfusion imaging for the first time. Results in the chorioallantoic membrane model indicate that frame rate and frame averaging do not affect the measured diameter of individual vessels observed, but that frame rate does influence the detection of vessels near and below the resolution limit. The highest number of resolvable vessels was observed at an intermediate frame rate of 3 Hz using a mechanically-steered prototype transducer. We also demonstrate the feasibility of quantitatively mapping perfusion rate in 2D in a mouse model with spatial resolution of ~100 µm. This type of imaging could provide non-invasive, high resolution quantification of microvascular function at penetration depths of several centimeters.

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Hepatocellular Carcinoma in Cirrhotic Liver Disease

Cited by 76 publications

References 25 publications

Dynamic Evolutionary Changes in Blood Flow Measured by MDCT in a Hepatic VX2 Tumor Implant over an Extended 28-day Growth Period: Time-Density Curve Analysis

Dynamic Evolutionary Changes in Blood Flow Measured by MDCT in a Hepatic VX2 Tumor Implant over an Extended 28-day Growth Period: Time-Density Curve Analysis

Assessment of Blood Flow in Hepatocellular Carcinoma: Correlations of Computed Tomography Perfusion Imaging and Circulating Angiogenic Factors

High Resolution Ultrasound Superharmonic Perfusion Imaging: In Vivo Feasibility and Quantification of Dynamic Contrast-Enhanced Acoustic Angiography

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