A Clinical Study Of Dual-source Ct Perfusion Imaging In Primary Hepatic Carcinoma Before And After Transcatheter Arterial Chemoembolization

Objective To investigate the clinical value of dual-source CT Perfusion Imaging (CTPI) in determining the hemodynamic features of Primary Hepatic Carcinoma (PHC) before and after Transcatheter Arterial Chemoembolization (TACE).Methods Thirty PHC patients were recruited for this study. CT perfusion scans were performed 1-3 days before receiving TACE and 4-6 weeks afterwards with a Siemens definition dual-source CT. Arterial Liver Perfusion (ALP), Portal Venous Perfusion (PVP), Hepatic Perfusion Index (HPI), Blood Flow (BF), Perseability (P) and Patlak Blood Volume(pBV)of all PHC lesions were collected and analyzed by syngo Body PCT perfusion software build-in the dual-source CT. The hemodynamic features of PHC pre-TACE and post-TACE were evaluated according to those perfusion parameters and the pseudo-color map and the Maximum Intensity Projection (MIP) map.Results (1) The time-density curve (TDC) of PHC performed as a tachy-ascensus model. The TDC ran rapidly in arterial phase and achieved the peak near spleen peak. The peak of the curve presented earlier, subsequently the curve stayed stable for a time or descended quickly. In contrast, the TDC of the surrounding normal liver tissues rose slowly in arterial phase, whereas it rose rapidly and achieved the peak in portal vein phase. The curve ran smoothly and softly. (2) Before TACE treatment, the tumor tissues demonstrated hyper-perfusion on ALP,HPI,BF,P and pBV map in all 30 cases including homogeneous hyper-perfusion in 10 cases, inhomogeneous hyper-perfusion in 20 cases as shown by ALP map, in contrast with all the necrosis tissues demonstrating hypo-perfusion or lacking blood perfusion. The values of ALP,HPI,BF,pBV of the tumor lesions were higher than that of the surrounding normal liver tissues (p<0.01), whereas the values of PVP were lower in the surrounding normal tissues compared to the tumor lesions (p<0.01). The values of P showed no significant changes (p>0.05). (3) After TACE, MIP map shows that the lipiodol deposition pattern of tumor lesions forms complete in 7 cases and incomplete in 23 cases. ALP,PVP,HPI,BF,P,pBV perfusion maps show that PHC lesions in the area for the deposition of lipiodol were no perfusion. The lipiodol deposition rarefied or lacking areas show differentially hyperperfusion in contrast with the surrounding normal liver tissues on the ALP, HPI, BF, pBV maps. Furthermore, the hyperperfusion was observed in the border area of 4 cases with which the lesions have lipiodol deposition forming complete. The values of ALP, HPI, BF, P and pBV of PHC lesions after TACE treatment were significantly lower than that of tumors prior to treatment (p<0.05), while the changes of the values of PVP were not statistically significant (p>0.05). The values of ALP, PVP, HPI, BF and pBV between the viable tumors (remnant and recurrence tumor) after TACE and the surrounding normal liver tissues were notably significant in statistics (p<0.01), while the values of P have no difference before and after the treatment(p>0.05). The values of ALP,HPI,BF,pBV in the viable tumors were significant higher than that of the surrounding normal liver tissues.Conclusions CT perfusion imaging directly and quantitatively represents the hemodynamic features and changes in PHC before and after TACE treatment. CT perfusion imaging may provide clinical relevant information on the diagnosis of PHC, the therapeutic effect of TACE on PHC, and monitoring the tumor recurrence after TACE treatment.