title: Renal versus splenic maximum slope based perfusion CT modelling in patients with portal-hypertension.
abstract: OBJECTIVE
  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).
  
  
  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).
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Zurich, CH-8091, Zurich, Switzerland. michaelalexander.fischer@usz.ch.|Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden. michaelalexander.fischer@usz.ch.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fischer
authors.affiliation: Department of Radiology, Karolinska University Hospital Huddinge, SE-14186, Stockholm, Sweden.
authors.forename: Katharina
authors.initials: K
authors.lastname: Brehmer
authors.affiliation: Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden.|Department of Radiology, Karolinska University Hospital Huddinge, SE-14186, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Svensson
authors.affiliation: Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden.|Department of Radiology, Karolinska University Hospital Huddinge, SE-14186, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Aspelin
authors.affiliation: Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden.|Department of Radiology, Karolinska University Hospital Huddinge, SE-14186, Stockholm, Sweden.
authors.forename: Torkel B
authors.initials: TB
authors.lastname: Brismar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging*; D007479:Iopamidol / Q000031:analogs & derivatives; D007668:Kidney / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011856:Radiographic Image Enhancement / Q000379:methods; D012189:Retrospective Studies; D013154:Spleen / Q000098:blood supply* / Q000000981:diagnostic imaging*; D036542:Tomography, Spiral Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol
keywords: Computed tomography; Liver cirrhosis; Maximum slope model; Perfusion imaging; Portal hypertension