title: Quantitative evaluation of CT-perfusion map as indicator of tumor response to transarterial chemoembolization and radiofrequency ablation in HCC patients.
abstract: OBJECTIVE
  To assess if radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may influence the evaluation of perfusion parameters obtained with CT-perfusion (CT-p) in HCC treated patients.
  
  
  METHODS
  Thirty-three consecutive cirrhotic patients with biopsy-proven diagnosis of HCC lesions and candidates to TACE or RFA were included. The CT-p study of hepatic parenchyma and of treated lesions was performed about 1 month after treatment on 16 multidetector CT after injection of 50mL of non ionic contrast agent (350mg I/mL) at a flow rate of 6mL/s acquiring 40 dynamic scans. A dedicated perfusion software which generated a quantitative map of arterial and portal perfusion by means of colour scale was employed.The following perfusion parameters were assessed before and after RFA or TACE treatment: hepatic perfusion (HP), arterial perfusion (AP), blood volume (BV), time to peak (TTP), hepatic perfusion index (HPI).
  
  
  RESULTS
  A complete treatment was obtained in 16 cases and incomplete treatment in the 17 remaining cases. The perfusion data of completely treated lesions were: HP 10.2±6.3; AP 10.4±7; BV 4.05±4.8; TTP 38.9±4.2; HPI 9.9±9.2, whereas in partially treated lesions were: HP 43.2±15.1mL/s/100g; AP 38.7±8.8mL/min; BV 20.7±9.5mL/100mg; TTP 24±3.7s; HPI 61.7±7.5%. In adjacent cirrhotic parenchyma, the parameters of all evaluated patients were: HP 13.2±4; AP 12.3±3.4; BV 11.8±2.8; TTP 43.9±2.9; and HPI 17.1±9.8. A significant difference (P<0.001) was found for all parameters between residual viable tumor tissue (P<0.001) compared to successfully treated lesion due to the presence of residual arterial vascular structure in viable portion of treated HCC.
  
  
  CONCLUSIONS
  According to our results, CT-p evaluation is not influenced by TACE or RFA treatments, thus representing a feasible technique that allows a reproducible quantitative evaluation of treatment response in HCC patients.
authors: School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy. Electronic address: davide.atena@tiscalinet.it.
authors: Davide
authors: D
authors: Ippolito
authors: School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy.
authors: Davide
authors: D
authors: Fior
authors: School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy.
authors: Pietro Andrea
authors: PA
authors: Bonaffini
authors: School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy.
authors: Cristina
authors: C
authors: Capraro
authors: Department of Interventional Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy.
authors: Davide
authors: D
authors: Leni
authors: Department of Interventional Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy.
authors: Rocco
authors: R
authors: Corso
authors: School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy.
authors: Sandro
authors: S
authors: Sironi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008099:Liver / Q000000981:diagnostic imaging* / Q000601:surgery; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D018365:Neoplasm, Residual; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: Computed tomography; Hepatocellular carcinoma; Perfusion-CT; Radiofrequency ablation; Transarterial chemoembolization; Treatment response