Michael A Fischer1,2, Katharina Brehmer3, Anders Svensson4,3, Peter Aspelin4,3, Torkel B Brismar4,3. 1. Department of Diagnostic and Interventional Radiology, University Hospital Zurich, CH-8091, Zurich, Switzerland. michaelalexander.fischer@usz.ch. 2. Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden. michaelalexander.fischer@usz.ch. 3. Department of Radiology, Karolinska University Hospital Huddinge, SE-14186, Stockholm, Sweden. 4. Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden.
Abstract
PURPOSE: To assess liver perfusion-CT (P-CT) parameters derived from peak-splenic (PSE) versus peak-renal enhancement (PRE) maximum slope-based modelling in different levels of portal-venous hypertension (PVH). MATERIAL AND METHODS: Twenty-four patients (16 men; mean age 68 ± 10 years) who underwent dynamic P-CT for detection of hepatocellular carcinoma (HCC) were retrospectively divided into three groups: (1) without PVH (n = 8), (2) with PVH (n = 8), (3) with PVH and thrombosis (n = 8). Time to PSE and PRE and arterial liver perfusion (ALP), portal-venous liver perfusion (PLP) and hepatic perfusion-index (HPI) of the liver and HCC derived from PSE- versus PRE-based modelling were compared between the groups. RESULTS: Time to PSE was significantly longer in PVH groups 2 and 3 (P = 0.02), whereas PRE was similar in groups 1, 2 and 3 (P > 0.05). In group 1, liver and HCC perfusion parameters were similar for PSE- and PRE-based modelling (all P > 0.05), whereas significant differences were seen for PLP and HPI (liver only) in group 2 and ALP in group 3 (all P < 0.05). CONCLUSION: PSE is delayed in patients with PVH, resulting in a miscalculation of PSE-based P-CT parameters. Maximum slope-based P-CT might be improved by replacing PSE with PRE-modelling, whereas the difference between PSE and PRE might serve as a non-invasive biomarker of PVH. KEY POINTS: • Peak-splenic enhancement is decreased and delayed in patients with portal-venous hypertension • The maximum-slope method uses PSE to calculate arterial and portal-venous liver perfusion • Peak-renal enhancement (PRE) is insensitive to PVH and might improve perfusion modelling • The difference between PSE and PRE might serve as a non-invasive PVH biomarker.
PURPOSE: To assess liver perfusion-CT (P-CT) parameters derived from peak-splenic (PSE) versus peak-renal enhancement (PRE) maximum slope-based modelling in different levels of portal-venous hypertension (PVH). MATERIAL AND METHODS: Twenty-four patients (16 men; mean age 68 ± 10 years) who underwent dynamic P-CT for detection of hepatocellular carcinoma (HCC) were retrospectively divided into three groups: (1) without PVH (n = 8), (2) with PVH (n = 8), (3) with PVH and thrombosis (n = 8). Time to PSE and PRE and arterial liver perfusion (ALP), portal-venous liver perfusion (PLP) and hepatic perfusion-index (HPI) of the liver and HCC derived from PSE- versus PRE-based modelling were compared between the groups. RESULTS: Time to PSE was significantly longer in PVH groups 2 and 3 (P = 0.02), whereas PRE was similar in groups 1, 2 and 3 (P > 0.05). In group 1, liver and HCC perfusion parameters were similar for PSE- and PRE-based modelling (all P > 0.05), whereas significant differences were seen for PLP and HPI (liver only) in group 2 and ALP in group 3 (all P < 0.05). CONCLUSION: PSE is delayed in patients with PVH, resulting in a miscalculation of PSE-based P-CT parameters. Maximum slope-based P-CT might be improved by replacing PSE with PRE-modelling, whereas the difference between PSE and PRE might serve as a non-invasive biomarker of PVH. KEY POINTS: • Peak-splenic enhancement is decreased and delayed in patients with portal-venous hypertension • The maximum-slope method uses PSE to calculate arterial and portal-venous liver perfusion • Peak-renal enhancement (PRE) is insensitive to PVH and might improve perfusion modelling • The difference between PSE and PRE might serve as a non-invasive PVH biomarker.
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