Dual input computed tomography perfusion in evaluating the therapeutic response of transarterial chemoembolization for hepatocellular carcinoma

Abstract

Objective: To assess diagnostic role of multi-detector computed tomographic perfusion in evaluating the therapeutic response of trans-arterial chemo-embolization in hepatocellular carcinoma. Patients & methods: Post trans-arterial chemoembolization HCC patients underwent follow up by hepatic CT perfusion, CT attenuation value and perfusion parameters {arterial flow perfusion (AFP), portal venous perfusion (PVP) & hepatic perfusion index (HPI)} were measured in hypervascular area of treated lesion at perfusion color map suspected as residual disease and adjacent hepatic parenchyma to assess therapeutic efficacy. Parameters distribution were described by their quartile values and statistically analyzed. Results: This study included 31(86%) male and 5(14%) female HCC patients with mean age (54 years). The residual lesion was observed in 25 patients of the 36 patients with increased CT attenuation value(HU), AFP (ml/min/100 ml), HPI (%) and decreased PVP (ml/min/100 ml) in the residual disease compared to surrounding cirrhotic liver parenchyma with P value < 0.05. The calculated parameters in the residual disease: CT attenuation value was 145.50 ± 25.26, AFP was 124.68 ± 19.69, PVP was 30.89 ± 11.52 & HPI was 78.07 ± 6.25. The calculated parameters in surrounding liver parenchyma: CT attenuation value was 99.53 ± 25.09, AFP was 37.12 ± 8.99, PVP was 56.38 ± 15.60 & HPI was 32.78 ± 8.55. Conclusion: CT perfusion evaluates treatment response in TACE treated HCC patients by providing a quantitative assessment of vascularization of residual tumour. Keywords: Hepatocellular carcinoma, Therapeutic response, Transarterial chemoembolization, Arterial flow perfusion, Hepatic perfusion index