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Eur J Radiol. 2017 May;90:34-41. doi: 10.1016/j.ejrad.2017.02.027. Epub 2017 Feb 20.

Diagnostic value of dynamic contrast-enhanced CT with perfusion imaging in the quantitative assessment of tumor response to sorafenib in patients with advanced hepatocellular carcinoma: A feasibility study.

Author information

1
School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, University of Milano-Bicocca, H. S. Gerardo, Monza, Italy. Electronic address: davide.atena@tiscalinet.it.
2
School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, University of Milano-Bicocca, H. S. Gerardo, Monza, Italy.
3
School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca, Milan, Italy.
4
School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca, Milan, Italy; Liver Center Section of Digestive Diseases, Yale University, New Haven, CTUSA.

Abstract

PURPOSE:

To investigate the feasibility of perfusion-CT (p-CT) measurements in quantitative assessment of hemodynamic changes related to sorafenib in patients with advanced hepatocellular carcinoma (HCC).

MATERIALS AND METHODS:

Twenty-two patients with advanced HCC underwent p-CT study (256-MDCT scanner) before and 2 months after sorafenib administration. Dedicated perfusion software generated a quantitative map of arterial and portal perfusion and calculated the following perfusion parameters in target liver lesion: hepatic perfusion (HP), time-to-peak (TTP), blood volume (BV), arterial perfusion (AP), and hepatic perfusion index (HPI). After the follow-up scan, patients were categorized as responders and non-responders, according to mRECIST. Perfusion values were analyzed and compared in HCC lesions and in the cirrhotic parenchyma (n=22), such as between baseline and follow-up in progressors and non-progressors.

RESULTS:

Before treatment, all mean perfusion values were significantly higher in HCC lesions than in the cirrhotic parenchyma (HP 47.8±17.2 vs 13.3±6.3mL/s per 100g; AP 47.9±18.1 vs 12.9±10.7mL/s; p<0.001). The group that responded to sorafenib (n=17) showed a significant reduction of values in HCC target lesions after therapy (HP 29.2±23.3 vs 48.1±15.1; AP 29.4±24.6 vs 49.2±17.4; p<0.01), in comparison with the non-responder group (n=5) that demonstrated no significant variation before and after treatment of HP (46.9±25.1 vs 46.7±24.1) and AP (43.4±21.7 vs 43.5±24.6). Among the responder group, HP percentage variation (Δ) in target lesions, during treatment, showed a significantly different (p=0.04) ΔHP in the group with complete response (79%) compared to the group with partial response or stable disease (16%).

CONCLUSIONS:

p-CT technique can be used for HCC quantitative assessment of changes related to anti-angiogenic therapy. Identification of response predictors might help clinicians in selection of patients who may benefit from targeted-therapy allowing for optimization of individualized treatment.

KEYWORDS:

Anti-angiogenic treatment; Cirrhosis; Computed tomography; Hepatocellular carcinoma; Perfusion imaging; Quantitative imaging

PMID:
28583645
DOI:
10.1016/j.ejrad.2017.02.027
[Indexed for MEDLINE]

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