Liver CT perfusion: which is the relevant delay that reduces radiation dose and maintains diagnostic accuracy?

Bevilacqua, Alessandro; Malavasi, Silvia; Vilgrain, Valérie

doi:10.1007/s00330-019-06259-9

Cited by 7 publications

(7 citation statements)

References 31 publications

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“…Generated parametric maps are vendor-specific, and as a result, radiologists need to acquire experience and establish intra-institutional reference values before using CTLP in HCC diagnosis. However, great effort has been made to standardize CTLP acquisition protocols [ 117 ] and reduce radiation exposure [ 118 , 119 , 120 ]. With the advent of comparative studies to indicate when the additional use of CT perfusion might be beneficial for the patient and further development of automated image analysis software, CTLP might reach the availability of brain perfusion, which has a central role in the management of stroke [ 121 ].…”

Section: Ct Perfusionmentioning

confidence: 99%

Current Imaging Diagnosis of Hepatocellular Carcinoma

Chartampilas

Rafailidis

Georgopoulou

et al. 2022

Cancers

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Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer related death worldwide. Radiology has traditionally played a central role in HCC management, ranging from screening of high-risk patients to non-invasive diagnosis, as well as the evaluation of treatment response and post-treatment follow-up. From liver ultrasonography with or without contrast to dynamic multiple phased CT and dynamic MRI with diffusion protocols, great progress has been achieved in the last decade. Throughout the last few years, pathological, biological, genetic, and immune-chemical analyses have revealed several tumoral subtypes with diverse biological behavior, highlighting the need for the re-evaluation of established radiological methods. Considering these changes, novel methods that provide functional and quantitative parameters in addition to morphological information are increasingly incorporated into modern diagnostic protocols for HCC. In this way, differential diagnosis became even more challenging throughout the last few years. Use of liver specific contrast agents, as well as CT/MRI perfusion techniques, seem to not only allow earlier detection and more accurate characterization of HCC lesions, but also make it possible to predict response to treatment and survival. Nevertheless, several limitations and technical considerations still exist. This review will describe and discuss all these imaging modalities and their advances in the imaging of HCC lesions in cirrhotic and non-cirrhotic livers. Sensitivity and specificity rates, method limitations, and technical considerations will be discussed.

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Section: Ct Perfusionmentioning

confidence: 99%

Current Imaging Diagnosis of Hepatocellular Carcinoma

Chartampilas

Rafailidis

Georgopoulou

et al. 2022

Cancers

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“…Although CT perfusion has not been clinically applied due to its high radiation dose, the current technological development in CT is moving towards high speed, low dose, deep learning, and multienergy (31). Low-dose CT perfusion scanning can already be achieved (32)(33)(34). Therefore, CT perfusion can be used to evaluate the treatment effect in the early stage without increasing the radiation dose of patients.…”

Section: Discussionmentioning

confidence: 99%

Early Assessment of Response to Radiofrequency Ablation With CT Perfusion Imaging in Rabbit VX2 Liver Tumor Model

et al. 2021

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ObjectivesTo discriminate viable tumors from benign periablational enhancement (BPE) in early stage after radiofrequency ablation (RFA) is a major confounding problem. The goal of this study is to evaluate quantitative assessment and diagnostic value of CT perfusion between viable tumors and BPE after RFA in the rabbit liver VX2 tumor model, with pathological results as the standard.MethodsTwenty-eight VX2 liver tumors were treated with RFA, on days 1, 3, 7, and 14, seven rabbits were randomly chosen for CT perfusion and performed pathology examinations immediately. The perfusion parameters along with the profile of time-density curves (TDCs) and pseudo-color images of the parameters were observed in both BPE and viable tumors, then compared with the pathology results. The perfusion parameters included blood flow (BF), blood volume (BV), time to peak (TTP), permeability (P), arterial liver perfusion (ALP), portal venous perfusion (PVP) and hepatic perfusion index (HPI).ResultsA total of 26/28 rabbits successfully underwent CT perfusion, while 6/26 lesions were confirmed to be viable tumors. The TDCs of BPE were mainly speed-up platform curves (15/26), while the viable tumors showed mainly speed-up speed-down (3/6) and speed-up platform (2/6) curves. The PVP values were significantly higher, and the HPI values were significantly lower for BPE at all time points than viable tumors (P < 0.05). Both of PVP value and HPI value have high efficiency for the differential diagnosis of the viable tumors and BPE at each time point. These characteristics of CT perfusion parameters were consistent with pathological changes.ConclusionsThe TDCs, PVP and HPI have the potential to indicate BPE and viable tumors effectively early after RFA treatment, the results were highly consistent with pathology. CT perfusion has advantages with great efficacy in monitoring the therapeutic effect early after RFA treatment.

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“…Therefore, for each patient sixteen examinations (one E 0 and fifteen E τ ) were associated to as many delayed acquisition protocols. The same datasets were previously used to provide some hints to reduce the administered dose in liver CTp while maintaining diagnostic accuracy [36].…”

Section: Generation Of Virtual Tccsmentioning

confidence: 99%

“…While all these approaches rely on heuristic criteria to set the baseline length, the work in [36] is an early attempt to measure the effects of scan delay on perfusion parameters, with the aim of reducing the dose administered to patient. The work provides resuming results regarding the effects of scan delay on perfusion values, but without either discussing the causes of worsening in accuracy or mentioning how many patients are involved.…”

Section: Introductionmentioning

confidence: 99%

“…To this purpose, fifty-nine hepatic CTp studies carried out with no scan delay (whose perfusion results represent a benchmark) are analysed. Stemming from the original acquisitions, several datasets are generated for each patient simulating the usage of acquisition protocols with different scan delays, according to what reported in [36]. Baseline values and different perfusion parameters are calculated for each dataset using the maximum slope method, and the effects of shortening the baseline through scan delays are measured for each patient by using the original sequences as a reference.…”

Section: Introductionmentioning

confidence: 99%

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