Low-dose hepatic computed tomography perfusion imaging and its preliminary study

Ultra-Low-Dose Sparse-View Quantitative CT Liver Perfusion Imaging

Radiation dose of computed tomography liver perfusion imaging can be reduced by collecting fewer x-ray projections in each gantry rotation, but the resulting aliasing artifacts could affect the hepatic perfusion measurement. We investigated the effect of projection undersampling on the assessment of hepatic arterial blood flow (H_ABF) in hepatocellular carcinoma (HCC) when dynamic contrast-enhanced (DCE) liver images were reconstructed with filtered backprojection (FBP) and compressed sensing (CS). DCE liver images of a patient with HCC acquired with a 64-row CT scanner were reconstructed from all the measured projections (984-view) with the standard FBP and from one-third (328-view) and one-fourth (246-view) of all available projections with FBP and CS. Each of the 5 sets of DCE liver images was analyzed with a model-based deconvolution algorithm from which H_ABF maps were generated and compared. Mean H_ABF in the tumor and normal tissue measured by the 328-view CS and FBP protocols was within 5% differences from that assessed by the reference full-view FBP protocol. In addition, the tumor size measured by using the 328-view CS and FBP average images was identical to that determined by using the full-view FBP average image. By contrast, both the 246-view CS and FBP protocols exhibited larger differences (>20%) in anatomical and functional assessments compared with the full-view FBP protocol. The preliminary results suggested that computed tomography perfusion imaging in HCC could be performed with 3 times less projection measurement than the current full-view protocol (67% reduction in radiation dose) when either FBP or CS was used for image reconstruction.

Reproducibility and variability of very low dose hepatic perfusion CT in metastatic liver disease

PURPOSE

We aimed to determine the intra- and interobserver agreement on the software analysis of very low dose hepatic perfusion CT (pCT).

METHODS

A total of 53 pCT examinations were obtained from 21 patients (16 men, 5 women; mean age, 60.4 years) with proven liver metastasis from various primary cancers. The pCT examinations were analyzed by two readers independently and perfusion parameters were noted for whole liver, whole metastasis, metastasis wall, and normal-looking liver (liver tissue without metastasis) in regions of interest (ROIs). Readers repeated the analysis after an interval of one month. Intra- and interobserver agreements were assessed with intraclass correlation coefficients (ICC) and Bland-Altman statistics.

RESULTS

The mean ICCs of all ROIs between readers were 0.91, 0.93, 0.86, 0.45, 0.53, and 0.66 for blood flow (BF), blood volume (BV), permeability, arterial liver perfusion (ALP), portal venous perfusion (PVP) and hepatic perfusion index (HPI), respectively. The mean ICCs of all ROIs between readings were 0.86, 0.91, 0.81, 0.53, 0.56, and 0.71 for BF, BV, permeability, ALP, PVP, and HPI, respectively. There was greater agreement on the parameters measured for the whole metastasis than on the parameters measured for the metastasis wall. The effective dose of all perfusion CT studies was 2.9 mSv.

CONCLUSION

There is greater intra- and interobserver agreement for BF and BV than for permeability, ALP, PVP, and HPI at very low dose hepatic pCT. Permeability, ALP, PVP, and HPI parameters cannot be used in clinical practice for hepatic pCT with an effective dose of 2.9 mSv.

The feasibility of low-dose CT perfusion imaging in gastric cancer

PURPOSE

To investigate feasibility of applying low-dose CT perfusion imaging (CTPI) to diagnose gastric cancer.

MATERIALS AND METHODS

Twenty patients with gastric cancer confirmed by endoscopic biopsy were undergone routine dose (120 kV, 100 mA) and low-dose (120 kV, 50 mA) CTPI examination, respectively. The original data were processed by body perfusion software, and the perfusion parameters values including blood flow (BF), blood volume (BV) and permeability surface (PS) of gastric cancer were measured. Statistical data analyses including paired-samples t test, Pearson correlation analysis and Bland-Altman consistency test were used to compare the perfusion parameters values between the routine dose and low-dose CTPI examinations. Radiation dosage, which the patients received during two CTPI examinations, was also calculated and compared.

RESULTS

There were no statistical differences in the BF, BV and PS values between routine dose group and low-dose group (P > 0.05), and there were significant correlation in the BF, BV and PS values between two groups (P <  0.01). The consistency of BF and BV values between the two groups was preferable to that of PS value. The radiation dosage of the low-dose group was much less than that of routine dose group, and the CTDIvol and DLP values of low-dose CTPI were decreased by 50%, respectively.

CONCLUSION

The parameters BF and BV values may play a valuable role in the diagnosis and assessment of gastric cancer in low-dose CTPI examination.