title: Perfusion computed tomography for detection of hepatocellular carcinoma in patients with liver cirrhosis.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of dynamic perfusion CT (P-CT) for detection of hepatocellular carcinoma (HCC) in the cirrhotic liver.
  
  
  METHODS
  Twenty-six cirrhotic patients (19 men, aged 69 ± 10 years) with suspicion of HCC prospectively underwent P-CT of the liver using the 4D spiral-mode (100/80 kV; 150/175mAs/rot) of a dual-source system. Two readers assessed: (1) arterial liver-perfusion (ALP), portal-venous liver-perfusion (PLP) and hepatic perfusion-index (HPI) maps alone; and (2) side-by-side with maximum-intensity-projections of arterial time-points (art-MIP) for detection of HCC using histopathology and imaging follow-up as standard of reference. Another reader quantitatively assessed perfusion maps of detected lesions.
  
  
  RESULTS
  A total of 48 HCCs in 21/26 (81%) patients with a mean size of 20 ± 10 mm were detected by histopathology (9/48, 19%) or imaging follow-up (39/48, 81%). Detection rates (Reader1/Reader2) of HPI maps and side-by-side analysis of HPI combined with arterial MIP were 92/88% and 98/96%, respectively. Positive-predictive values were 63/63% and 68/71%, respectively. A cut-off value of ≥85% HPI and ≥99% HPI yielded a sensitivity and specificity of 100%, respectively, for detection of HCC.
  
  
  CONCLUSIONS
  P-CT shows a high sensitivity for detection of HCC in the cirrhotic liver. Quantitative assessment has the potential to reduce false-positive findings improving the specificity of HCC diagnosis.
  
  
  CONCLUSIONS
  • Visual analysis of perfusion maps shows good sensitivity for detection of HCC. • Additional assessment of anatomical arterial MIPs further improves detection rates of HCC. • Quantitative perfusion analysis has the potential to reduce false-positive findings. • In cirrhotic livers, a hepatic-perfusion-index ≥ 9 9% might be specific for HCC.
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden. michaelalexander.fischer@usz.ch.|Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden. michaelalexander.fischer@usz.ch.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fischer
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.|Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kartalis
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.|Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden.
authors.forename: Aristeidis
authors.initials: A
authors.lastname: Grigoriadis
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.|Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden.
authors.forename: Louiza
authors.initials: L
authors.lastname: Loizou
authors.affiliation: Department of Hepatology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Stål
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.|Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Leidner
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.|Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Aspelin
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.|Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden.
authors.forename: Torkel B
authors.initials: TB
authors.lastname: Brismar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D056973:Four-Dimensional Computed Tomography / Q000706:statistics & numerical data*; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000706:statistics & numerical data; D008102:Liver Circulation / Q000502:physiology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000706:statistics & numerical data; D011169:Portal Vein / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011829:Radiation Dosage; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000706:statistics & numerical data*
chemical_list: D003287:Contrast Media
keywords: Arterialized pseudolesion; Computed tomography; Hepatocellular carcinoma; Liver cirrhosis; Perfusion imaging