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Original research article


Role of Perfusion CT Differentiating Hemangiomas from Malignant Hepatic Lesions.

Jagjeet SinghSanjiv SharmaNeeti AggarwalR G SoodShikha SoodRavinder Sidhu
Department of Radiodiagnosis and Intervention Radiology, Indira Gandhi Medical College, Shimla, Himachal PradeshDepartment of Imaging Sciences, University of Rochester Medical Center, New York, USA
Date of Submission: 30-May-2013, Date of Acceptance: 05-Feb-2014, Date of Web Publication: 27-Feb-2014.
Corresponding Author:
Corresponding Author

Jagjeet Singh

Department of Radiodiagnosis and Intervention Radiology, IGMC, Shimla - 171 001, Himachal Pradesh, India.
E-mail: djagjeetsingh86@gmail.com

Corresponding Author:
Corresponding Author

Jagjeet Singh

Department of Radiodiagnosis and Intervention Radiology, IGMC, Shimla - 171 001, Himachal Pradesh, India.
E-mail: djagjeetsingh86@gmail.com

DOI: 10.4103/2156-7514.127959 Facebook Twitter Google Linkedin

ABSTRACT



Objective: The purpose of the study was to determine the role of computed tomography (CT) perfusion in differentiating hemangiomas from malignant hepatic lesions.
Materials and Methods: This study was approved by the institutional review board. All the patients provided informed consent. CT perfusion was performed with 64 multidetector CT (MDCT) scanner on 45 patients including 27 cases of metastasis, 9 cases of hepatocellular carcinoma (HCC), and 9 cases of hemangiomas. A 14 cm span of the liver was covered during the perfusion study. Data was analyzed to calculate blood flow (BF), blood volume (BV), permeability surface area product (PS), mean transit time (MTT), hepatic arterial fraction (HAF), and induced residue fraction time of onset (IRFTO). CT perfusion parameters at the periphery of lesions and background liver parenchyma were compared.
Results: Significant changes were observed in the perfusion parameters at the periphery of different lesions. Of all the perfusion parameters BF, HAF, and IRFTO showed most significant changes. In our study we found: BF of more than 400 ml/100 g/min at the periphery of the hemangiomas showed sensitivity of 88.9%, specificity of 83.3%, positive predictive value (PPV) of 57.1%, and negative predictive value (NPV) of 96.7% in differentiating hemangiomas from hepatic malignancy; HAF of more than 60% at the periphery of hemangiomas showed sensitivity of 77.8%, specificity of 86.1%, PPV of 58.3% and NPV of 93.9% in differentiating hemangiomas from hepatic malignancy; IRFTO of more than 3 s at the periphery of hemangiomas showed sensitivity of 77.8%, specificity of 86.1%, PPV of 58.3%, and NPV of 93.9% in differentiating hemangiomas from hepatic malignancy.
Conclusion: Perfusion CT is a helpful tool in differentiating hemangiomas from hepatic malignancy by its ability to determine changes in perfusion parameters of the lesions.
Keywords: Hemangioma, Hepatocellular Carcinoma, Liver, Metastasis, Perfusion

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  2. Guodong Pang, Zuyun Duan, Chunchun Shao, Fang Zhao, Hai Zhong and Guangrui Shao (2018) Heterogeneity analysis of triphasic CT scan perfusion parameters in differential diagnosis of hepatocellular carcinoma and hemangioma. Medicine 97(38):e12512. doi: 10.1097/MD.0000000000012512
  3. Wei-Fu Lv, Jian-Kui Han, De-Lei Cheng, Chun-Ze Zhou, Ming Ni and Dong Lu (2015) CT Perfusion Imaging Can Predict Patients' Survival and Early Response to Transarterial Chemo-Lipiodol Infusion for Liver Metastases from Colorectal Cancers. Korean J Radiol 16(4):810. doi: 10.3348/kjr.2015.16.4.810
  4. Ernst Klotz, Ulrike Haberland, Gerhard Glatting, Stefan O. Schoenberg, Christian Fink, Ulrike Attenberger and Thomas Henzler (2015) Technical prerequisites and imaging protocols for CT perfusion imaging in oncology. European Journal of Radiology 84(12):2359. doi: 10.1016/j.ejrad.2015.06.010
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  6. Wolfgang M. Thaiss, Alexander W. Sauter, Malte Bongers, Marius Horger and Konstantin Nikolaou (2015) Clinical applications for dual energy CT versus dynamic contrast enhanced CT in oncology. European Journal of Radiology 84(12):2368. doi: 10.1016/j.ejrad.2015.06.001
  7. Sascha Kaufmann, Maximilian Schulze, Thomas Horger, Aenne Oelker, Konstantin Nikolaou and Marius Horger (2015) Reproducibility of VPCT Parameters in the Normal Pancreas. Academic Radiology 22(9):1099. doi: 10.1016/j.acra.2015.04.005
  8. X. Wang, T. Henzler, J. Gawlitza, S. Diehl, T. Wilhelm, S.O. Schoenberg, Z.Y. Jin, H.D. Xue and A. Smakic (2016) Image quality of mean temporal arterial and mean temporal portal venous phase images calculated from low dose dynamic volume perfusion CT datasets in patients with hepatocellular carcinoma and pancreatic cancer. European Journal of Radiology 85(11):2104. doi: 10.1016/j.ejrad.2016.09.024
  9. Ke Yang, Xiao-Ming Zhang, Lin Yang, Hao Xu and Juan Peng (2016) Advanced imaging techniques in the therapeutic response of transarterial chemoembolization for hepatocellular carcinoma. WJG 22(20):4835. doi: 10.3748/wjg.v22.i20.4835

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