Perfusion measurement of the whole upper abdomen of patients with and without liver diseases: Initial experience with 320-detector row CT
Introduction
Because various liver diseases lead to significant changes in hepatic microcirculation, quantification of hepatic perfusion can improve the assessment and management of liver diseases. Various imaging techniques, such as xenon-enhanced computed tomography (CT), non-contrast or contrast-enhanced magnetic resonance imaging (MRI), isotope scintigraphy, and Doppler ultrasound, as well as positron emission tomography using oxygen-15 labeled water, have been used for evaluation of hepatic perfusion. However, their acceptance and clinical application are limited due to high cost, low spatial resolution, or poor reproducibility [1].
CT perfusion (CTP) with cine imaging and administration of contrast media is a method of perfusion analysis in which quantitative maps of tissue perfusion can be created from cine CT data and displayed by using a color scale, which allows for quantification of perfusion in absolute units at high spatial resolution [1], [2]. This method is reportedly useful for evaluation of liver damage or severity of hepatic fibrosis associated with chronic liver disease [3], [4], assessment of hepatic tumor perfusion [5], [6], prediction of tumor response to therapies [7], [8], and evaluation of hepatic perfusion changes after surgical [9], [10] or radiological [11], [12] interventions. This method is also reportedly useful for evaluation of various diseases and conditions in other upper abdominal organs, such as pancreas [13], [14], spleen [15], [16], [17], and stomach [18], [19], [20]. However, some problems remain with using this method, such as limited cranio-caudal scan range, additional radiation exposure, long breathholding for portal flow measurement, separation of arterial and portal blood flow, standardization of analytic methods, and unknown effects of extra-hepatic factors [1], [2]. Our study dealt with the first problem.
Recently, a new generation of CT systems with 320-detector rows has become clinically available and is capable of performing volumetric imaging. These systems provide a single rotational acquisition, which covers 16 cm in the z-direction, and almost the whole upper abdomen can be appraised by means of serial rotational acquisitions at a single location in the z-direction.
The purpose of this study was thus to report our initial experiences of upper abdominal CTP with 320-detector row CT for assessment of liver diseases and therapeutic effects.
Section snippets
Patients
We selected 42 consecutive patients at high risk of malignant liver or upper abdominal tumor (34 highly suspected to have lung cancer, 2 highly suspected to have intrathoracic mesothelioma, and 1 with atypical carcinoid in the lung) or portal hypertension (5 with chronic liver disease) for inclusion in this study. Before being enrolled, all subjects gave their informed consent after the nature of the procedure had been fully explained in accordance with the regulations of the institutional
Results
Mean HAPs, HPPs, APFs, and APs for the normal patient group are shown in Table 1, Table 2. No significant differences were found for HAP, HPP, or APF among liver subsegments except for APF for liver segments 3 and 5 (p < 0.01). No significant differences were detected among pancreas head, body and tail, either, but a significant difference was found between gastric fundus and antrum (p < 0.001).
Mean HAP and APF for the disease group were significantly higher than for the normal group (p < 0.05 and
Discussion
Perfusion imaging can detect regional and global changes in organ perfusion and is an effective method for detecting hemodynamic characteristics of various diseases. Of the various techniques in use, CT perfusion is the least invasive method and has the advantage of providing highly reliable quantification of perfusion in abdominal organs and lesions at low cost [1]. Although many researchers have stressed the clinical usefulness of this technique, some problems remain. One of the major
Conclusion
With 320-detector row CT, it is possible to conduct perfusion measurements of the whole upper abdomen. Our preliminary results suggested that estimated perfusion values have the potential to be used for evaluation of hepatic diseases and therapeutic effects.
Conflict of interest
Takeshi Yoshikawa: Toshiba Corporation research grant and Koninklijke Philips Electronics NV research grant.
Yoshiharu Ohno: Toshiba Corporation research grant, Koninklijke Philips Electronics NV research grant, Bayer AG research grant, DAIICHI SANKYO Group research grant, Eisai Co., Ltd., research grant, Mitsubishi Chemical Holdings Corporation research grant, and Terumo Corporation research grant.
Kazuro Sugimura: Toshiba Corporation research grant, Koninklijke Philips Electronics NV research
Acknowledgements
The authors wish to thank Yoshikazu Kotani, M.D., Yoshihiro Nishimura, M.D., Ph.D. (Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine), and Yoshimasa Maniwa, M.D., Ph.D., Wataru Nishio, M.D. (Division of Thoracic Surgery, Department of Surgery, Kobe University Graduate School of Medicine) for their contributions to this work.
The authors also wish to express special thanks to Hiroyasu Inokawa, M.S., Nao Kishitani, B.S., Naoki Sugihara,
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