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.
Tiffany Hennedige (2016) Advances in computed tomography and magnetic resonance imaging of hepatocellular carcinoma. WJG22(1):205. doi: 10.3748/wjg.v22.i1.205
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. Medicine97(38):e12512. doi: 10.1097/MD.0000000000012512
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 Radiol16(4):810. doi: 10.3348/kjr.2015.16.4.810
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 Radiology84(12):2359. doi: 10.1016/j.ejrad.2015.06.010
J. Gawlitza, H. Haubenreisser, M. Meyer, C. Hagelstein, S. Sudarski, S.O. Schoenberg and T. Henzler (2016) Comparison of organ-specific-radiation dose levels between 70 kVp perfusion CT and standard tri-phasic liver CT in patients with hepatocellular carcinoma using a Monte-Carlo-Simulation-based analysis platform. European Journal of Radiology Open3:95. doi: 10.1016/j.ejro.2016.04.003
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 Radiology84(12):2368. doi: 10.1016/j.ejrad.2015.06.001
Sascha Kaufmann, Maximilian Schulze, Thomas Horger, Aenne Oelker, Konstantin Nikolaou and Marius Horger (2015) Reproducibility of VPCT Parameters in the Normal Pancreas. Academic Radiology22(9):1099. doi: 10.1016/j.acra.2015.04.005
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 Radiology85(11):2104. doi: 10.1016/j.ejrad.2016.09.024
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. WJG22(20):4835. doi: 10.3748/wjg.v22.i20.4835
This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.