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CT liver perfusion in patients with hepatocellular carcinoma: can we modify acquisition protocol to reduce patient exposure?

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To investigate the potential of decreasing the number of scans and associated radiation exposure involved in CT liver perfusion (CTLP) dynamic studies for hepatocellular carcinoma (HCC) assessment.

Methods

Twenty-four CTLP image datasets of patients with HCC were retrospectively analyzed. All examinations were performed on a modern CT system using a standard acquisition protocol involving 35 scans with 1.7 s interval. A deconvolution-based or a standard algorithm was employed to compute ten perfusion parametric maps. 3D ROIs were positioned on 33 confirmed HCCs and non-malignant parenchyma. Analysis was repeated for two subsampled datasets generated from the original dataset by including only the (a) 18 odd-numbered scans with 3.4 s interval and (b) 18 first scans with 1.7 s interval. Standard and modified datasets were compared regarding the (a) accuracy of calculated perfusion parameters, (b) power of parametric maps to discriminate HCCs from liver parenchyma, and (c) associated radiation exposure.

Results

When the time interval between successive scans was doubled, perfusion parameters of HCCs were found unaffected (p > 0.05) and the discriminating efficiency of parametric maps was preserved (p < 0.05). In contrast, significant differences were found for all perfusion parameters of HCCs when acquisition duration was reduced to half (p < 0.05), while the discriminating efficiency of four parametric maps was significantly deteriorated (p < 0.05). Modified CTLP acquisition protocols were found to involve 48.5% less patient exposure.

Conclusions

Doubling the interscan time interval may considerably reduce radiation exposure from CTLP studies performed for HCC evaluation without affecting the diagnostic efficiency of perfusion maps generated with either standard or deconvolution-based mathematical model.

Key Points

• CT liver perfusion for HCC diagnosis/assessment is not routinely used in clinical practice mainly due to the associated high radiation exposure.

• Two alternative acquisition protocols involving 18 scans of the liver were compared with the standard 35-scan protocol.

• Increasing the time interval between successive scans to 3.4 s was found to preserve the accuracy of computed perfusion parameters derived with a standard or a deconvolution-based model and to reduce radiation exposure by 48.5%.

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Abbreviations

AUC:

Area under the ROC curve

BF:

Blood flow

BV:

Blood volume

CTLP:

Computed tomography liver perfusion

DLP:

Dose length product

DSA:

Digital subtraction angiography

EASL:

European Association for the Study of the Liver

ED:

Effective dose

HaBF:

Hepatic arterial blood flow

HAF:

Hepatic arterial fraction

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

IRF:

Impulse residue function

IRF-T0:

Contrast arrival delay

IQR:

Interquartile range

MSI:

Mean slope of increase

MTT:

Mean transit time

PEI:

Positive enhancement integral

PS:

Permeability surface

REML:

Restricted maximum likelihood

Tmax:

Transit time to impulse residue peak

TTP:

Time to peak

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, Karolinska University Hospital, Stockholm, Sweden

    Georgios Kalarakis

  2. Department of Medical Physics, University Hospital of Heraklion, Heraklion, Greece

    Kostas Perisinakis

  3. University of Crete – Medical School, Heraklion, Greece

    Georgios Kalarakis, Kostas Perisinakis, Evangelos Akoumianakis & Ioannis Karageorgiou

  4. Department of Interventional Radiology, AHEPA University Hospital, Thessaloniki, Greece

    Adam Hatzidakis

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  1. Georgios Kalarakis
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  2. Kostas Perisinakis
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  3. Evangelos Akoumianakis
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  4. Ioannis Karageorgiou
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  5. Adam Hatzidakis
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Correspondence to Georgios Kalarakis.

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The scientific guarantor of this publication is Adam Hatzidakis.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Kalarakis, G., Perisinakis, K., Akoumianakis, E. et al. CT liver perfusion in patients with hepatocellular carcinoma: can we modify acquisition protocol to reduce patient exposure?. Eur Radiol 31, 1410–1419 (2021). https://doi.org/10.1007/s00330-020-07206-9

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  • DOI: https://doi.org/10.1007/s00330-020-07206-9

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