title: Detection and differentiation of early hepatocellular carcinoma from cirrhosis using CT perfusion in a rat liver model.
abstract: BACKGROUND
  Functional imaging such as CT perfusion can detect morphological and hemodynamic changes in hepatocellular carcinoma (HCC). Pre-carcinoma and early HCC nodules are difficult to differentiate by observing only their hemodynamics changes. The present study aimed to investigate hemodynamic parameters and evaluate their differential diagnostic cut-off between pre-carcinoma and early HCC nodules using CT perfusion and receiver operating characteristic (ROC) curves.
  
  
  METHODS
  Male Wistar rats were randomly divided into control (n=20) and experimental (n=70) groups. Diethylnitrosamine (DEN) was used to induce pre-carcinoma and early HCC nodules in the experimental group. Perfusion scanning was carried out on all survival rats discontinuously from 8 to 16 weeks. Hepatic portal perfusion (HPP), hepatic arterial fraction (HAF), hepatic arterial perfusion (HAP), hepatic blood volume (HBV), hepatic blood flow (HBF), mean transit time (MTT) and permeability of capillary vessel surface (PS) data were provided by mathematical deconvolution model. The perfusion parameters were compared among the three groups of rats (control, pre-carcinoma and early HCC groups) using the Kruskal-Wallis test and analyzed with ROC curves. Histological examination of the liver tissues with hematoxylin and eosin staining was performed after CT scan.
  
  
  RESULTS
  For HPP, HAF, HBV, HBF and MTT, there were significant differences among the three groups (P<0.05). HAF had the highest areas under the ROC curves: 0.80 (control vs pre-carcinoma groups) and 0.95 (control vs early HCC groups) with corresponding optimal cut-offs of 0.37 and 0.42, respectively. The areas under the ROC curves for HPP was 0.79 (control vs pre-carcinoma groups) and 0.92 (control vs early HCC groups) with corresponding optimal cut-offs of 136.60 mL/min/100 mg and 108.47 mL/min/100 mg, respectively.
  
  
  CONCLUSIONS
  CT perfusion combined with ROC curve analysis is a new diagnosis model for distinguishing between pre-carcinoma and early HCC nodules. HAF and HPP are the ideal reference indices.
authors.affiliation: Department of Radiology, Second Affiliated Hospital, Harbin Medical University, Harbin 150086, China. jhjemail@163.com.
authors.forename: Jin-Ping
authors.initials: JP
authors.lastname: Li
authors.forename: Guang-Long
authors.initials: GL
authors.lastname: Feng
authors.forename: Da-Qing
authors.initials: DQ
authors.lastname: Li
authors.forename: Hai-Bo
authors.initials: HB
authors.lastname: Wang
authors.forename: De-Li
authors.initials: DL
authors.lastname: Zhao
authors.forename: Yong
authors.initials: Y
authors.lastname: Wan
authors.forename: Hui-Jie
authors.initials: HJ
authors.lastname: Jiang
mesh_terms: D000818:Animals; D019540:Area Under Curve; D001783:Blood Flow Velocity; D002199:Capillary Permeability; D006528:Carcinoma, Hepatocellular / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D056486:Chemical and Drug Induced Liver Injury / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D003937:Diagnosis, Differential; D004052:Diethylnitrosamine; D055088:Early Detection of Cancer / Q000379:methods*; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D008102:Liver Circulation; D008106:Liver Cirrhosis, Experimental / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D008114:Liver Neoplasms, Experimental / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D061330:Multidetector Computed Tomography; D055420:Perfusion Imaging / Q000379:methods*; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D017208:Rats, Wistar; D013997:Time Factors
chemical_list: D004052:Diethylnitrosamine