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Osman MF, Shawali IH, Metwally LIA, Kamel AH, Ibrahim MES. CT perfusion for response evaluation after interventional ablation of hepatocellular carcinoma: a prospective study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00660-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Computed tomography (CT) perfusion was found to be useful in assessing treatment response in a variety of cancers through the evaluation in the arterial perfusion changes. We investigated the performance of CT perfusion parameters for assessment of hepatocellular carcinoma (HCC) response to radiofrequency ablation (RFA) and trans-arterial chemoembolization (TACE). We conducted a prospective diagnostic test accuracy study that recruited 70 HCC patients who were scheduled to undergo TACE or RFA. For each dynamic CT scan acquisition, four single perfusion CT image maps were generated, including functional maps of blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface (PS).
Results
In TACE-treated lesions, the BV achieved a sensitivity and specific of 100% and 83.3%, at a cutoff level of ≤ 122 ml/min/100 gm, for responders. Likewise, at a cutoff level of > 10 s, transit time had a sensitivity of 90.5% and specificity of 100%. At a cutoff level of ≤ 14 ml/min/100 gm, the PS had a sensitivity of 100% and specificity of 83.33% for responders. In RFA-treated lesions, at a cutoff level of ≤ 170 ml/min/100 gm and ≤ 11 ml/100 gm, the BF and BV had a sensitivity of 100% and specificity 100%, respectively, for responders. At a cutoff level of ≤ 11 ml/min/100 gm, PS had a sensitivity 77.27% and specificity 80%.
Conclusions
The present study confirms the feasibility of CT perfusion for assessment of response to TACE and RFA among patients with HCC.
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Wythe S, Davies TW, O'Beirne J, Martin D, Gilbert‐Kawai E. Observational study of the microcirculation in patients with liver cirrhosis. JGH Open 2019; 3:518-524. [PMID: 31832553 PMCID: PMC6891028 DOI: 10.1002/jgh3.12196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Liver cirrhosis is associated with widespread microcirculatory dysfunction and hemodynamic derangement, which may play a role in the pathogenesis of multiple organ failure. Little is known, however, about the progression of microvascular alterations as the severity of liver disease worsens. Therefore, our aim is to quantify the peripheral systemic microcirculatory changes associated with increasing severity of liver cirrhosis. METHODS Forty patients with liver cirrhosis were studied and divided into groups based on Child-Pugh classes A (n = 9), B (n = 18), and C (n = 13) for comparison. Incident dark field imaging was used to evaluate the sublingual microcirculation and near-infrared spectroscopy at the thenar eminence to assess microvascular reactivity and function. RESULTS There was no difference in microcirculatory flow index (P = 0.655), heterogeneity index (P = 0.702), or vessel density (P = 0.923) between the different Child-Pugh groups. Microvascular reactivity did not change as the severity of liver disease worsened. CONCLUSIONS This study showed no association between peripheral systemic microcirculatory alterations and the severity of liver disease. Further research with larger study cohorts are needed to clarify the relationship between microcirculatory abnormalities and disease progression and to establish if the peripheral microcirculation is affected by the pathophysiology of worsening cirrhosis.
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Affiliation(s)
- Stephen Wythe
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research CentreInstitute of Sport and Exercise HealthLondonUK
- Department of Intensive CareRoyal Free Hospital Pond StreetLondonUK
| | - Thomas W Davies
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research CentreInstitute of Sport and Exercise HealthLondonUK
- Department of Intensive CareRoyal Free Hospital Pond StreetLondonUK
| | - James O'Beirne
- Department of HepatologySunshine Coast University Hospital, Sunshine Coast Hospital and Health ServiceBrisbaneQueenslandAustralia
- University of the Sunshine CoastSunshine Coast RegionQueenslandAustralia
| | - Daniel Martin
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research CentreInstitute of Sport and Exercise HealthLondonUK
- Department of Intensive CareRoyal Free Hospital Pond StreetLondonUK
| | - Edward Gilbert‐Kawai
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research CentreInstitute of Sport and Exercise HealthLondonUK
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Hatzidakis A, Perisinakis K, Kalarakis G, Papadakis A, Savva E, Ippolito D, Karantanas A. Perfusion-CT analysis for assessment of hepatocellular carcinoma lesions: diagnostic value of different perfusion maps. Acta Radiol 2019; 60:561-568. [PMID: 30114926 DOI: 10.1177/0284185118791200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Computed tomography liver perfusion (CTLP) has been improved in recent years, offering a variety of perfusion-parametric maps. A map that better discriminates hepatocellular carcinoma (HCC) is still to be found. PURPOSE To compare different CTLP maps, regarding their ability to differentiate cirrhotic or non-cirrhotic parenchyma from malignant HCC. MATERIAL AND METHODS Twenty-six patients (11 cirrhotic) with 50 diagnosed HCC lesions, underwent CTLP on a 128-row dual-energy CT system. Nine different maps were generated. Regions of interest (ROIs) were positioned on non-tumorous parenchyma and on HCCs found on previous magnetic resonance imaging. Perfusion parameters for non-cirrhotic and cirrhotic livers were compared. Receiver operating characteristic (ROC) analysis was employed to evaluate each map's ability to discriminate HCCs from non-tumorous livers. Comparison of ROC curves was performed to evaluate statistical significance of differences in the discriminating efficiency of derived perfusion maps. RESULTS Perfusion parameters for non-tumorous liver and HCCs recorded in cirrhotic patients did not significantly differ from corresponding values recorded in non-cirrhotic patients ( P > 0.05). The highest power for HCC discrimination was found for the maximum-slope-of-increase (MSI) parametric map, with estimated the area under ROC curve of 0.997. An MSI cut-off criterion of 2.2 HU/s was found to provide 96% sensitivity and 100% specificity. Time to peak, blood flow, and transit time to peak were also found to have high discriminating power. CONCLUSION Among available CTLP-derived perfusion parameters, MSI was found to provide the highest diagnostic accuracy in discriminating HCCs from non-tumorous parenchyma. Perfusion parameters for non-tumorous livers and HCCs were not found to significantly differ between cirrhotic and non-cirrhotic patients.
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Affiliation(s)
- Adam Hatzidakis
- 1 University Hospital of Heraklion, Department of Medical Imaging, Heraklion, Greece
| | - Kostas Perisinakis
- 2 University Hospital of Heraklion, Department of Medical Physics, Heraklion, Greece
| | - Georgios Kalarakis
- 1 University Hospital of Heraklion, Department of Medical Imaging, Heraklion, Greece
| | - Antonis Papadakis
- 2 University Hospital of Heraklion, Department of Medical Physics, Heraklion, Greece
| | - Eirini Savva
- 3 University Hospital of Heraklion, Department of Internal Medicine, Heraklion, Greece
| | - Davide Ippolito
- 4 Azienda Ospedaliera San Gerardo, Department of Diagnostic Radiology, Monza, Lombardia, Italy
| | - Apostolos Karantanas
- 1 University Hospital of Heraklion, Department of Medical Imaging, Heraklion, Greece
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Correlation between acoustic radiation force impulse (ARFI)-based tissue elasticity measurements and perfusion parameters acquired by perfusion CT in cirrhotic livers: a proof of principle. J Med Ultrason (2001) 2018; 46:81-88. [PMID: 29948475 DOI: 10.1007/s10396-018-0886-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/21/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate whether liver stiffness measured by acoustic radiation force impulse (ARFI) sonoelastography always correlates with the liver perfusion parameters quantified by perfusion CT in patients with known liver cirrhosis. METHODS Sonoelastography and perfusion CT were performed in 50 patients (mean age 65.5; range 45-87 years) with liver cirrhosis, who were classified according to Child-Pugh into class A (30/50, 60%), B (17/50, 34%), and C (3/50, 6%). For standardized ARFI measurements in the left liver lobe at a depth of 4 cm, a convex 6-MHz probe was used. CT examinations were performed using 80 kV, 100 mAs, and 50 ml of iodinated contrast agent injected at 5 ml/s. Using standardized region-of-interest measurements, we quantified arterial, portal venous, and total liver perfusion. RESULTS There was a significant linear correlation between tissue stiffness and arterial liver perfusion (p = 0.015), and also when limiting the analysis to patients with histology (p = 0.019). In addition, there was a positive correlation between the total blood supply (arterial + portal-venous liver perfusion) to the liver and tissue stiffness (p = 0.001; with histology, p = 0.027). Shear wave velocity increased with higher Child-Pugh stages (p = 0.013). CONCLUSION The degree of tissue stiffness in cirrhotic livers correlates expectedly-even if only moderately-with the magnitude of arterial liver perfusion and total liver perfusion. As such, liver elastography remains the leading imaging tool in assessing liver fibrosis.
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Seyyedi S, Liapi E, Lasser T, Ivkov R, Hatwar R, Stayman JW. Low-Dose CT Perfusion of the Liver using Reconstruction of Difference. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2018; 2:205-214. [PMID: 29785411 DOI: 10.1109/trpms.2018.2812360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Liver CT perfusion (CTP) is used in the detection, staging, and treatment response analysis of hepatic diseases. Unfortunately, CTP radiation exposures is significant, limiting more widespread use. Traditional CTP data processing reconstructs individual temporal samples, ignoring a large amount of shared anatomical information between temporal samples, suggesting opportunities for improved data processing. We adopt a prior-image-based reconstruction approach called Reconstruction of Difference (RoD) to enable low-exposure CTP acquisition. RoD differs from many algorithms by directly estimating the attenuation changes between the current patient state and a prior CT volume. We propose to use a high-fidelity unenhanced baseline CT image to integrate prior anatomical knowledge into subsequent data reconstructions. Using simulation studies based on a 4D digital anthropomorphic phantom with realistic time-attenuation curves, we compare RoD with conventional filtered-backprojection, penalized-likelihood estimation, and prior image penalized-likelihood estimation. We evaluate each method in comparisons of reconstructions at individual time points, accuracy of estimated time-attenuation curves, and in an analysis of common perfusion metric maps including hepatic arterial perfusion, hepatic portal perfusion, perfusion index, and time-to-peak. Results suggest that RoD enables significant exposure reductions, outperforming standard and more sophisticated model-based reconstruction, making RoD a potentially important tool to enable low-dose liver CTP.
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Affiliation(s)
- Saeed Seyyedi
- Computer Aided Medical Procedures and Chair of Biomedical Physics, Technical University of Munich, Munich, 85748 Germany
| | - Eleni Liapi
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21205 USA
| | - Tobias Lasser
- Computer Aided Medical Procedures, Technical University of Munich, Munich, 85748 Germany
| | - Robert Ivkov
- Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD 21205 USA
| | - Rajeev Hatwar
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21205 USA
| | - J Webster Stayman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205 USA
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Hatem Shalaby M, Ali Shehata KA. CT perfusion in hepatocellular carcinoma: Is it reliable? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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7
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Davies T, Wythe S, O'Beirne J, Martin D, Gilbert-Kawai E. Review article: the role of the microcirculation in liver cirrhosis. Aliment Pharmacol Ther 2017; 46:825-835. [PMID: 29023881 DOI: 10.1111/apt.14279] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 04/11/2017] [Accepted: 08/06/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intrahepatic microvascular derangements and microcirculatory dysfunction are key in the development of liver cirrhosis and its associated complications. While much has been documented relating to cirrhosis and the dysfunction of the microcirculation in the liver parenchyma, far less is known about the state of the extrahepatic microcirculation and the role this may have in the pathogenesis of multiple organ failure in end stage liver cirrhosis. AIM To provide an update on the role of the microcirculation in the pathophysiology of cirrhosis and its associated complications and briefly discuss some of the imaging techniques which may be used to directly investigate the microcirculation. METHODS A Medline literature search was conducted using the following search terms: 'cirrhosis', 'microcirculation', 'circulation', 'systemic', 'inflammation', 'peripheral', 'hepatorenal' and 'hepatopulmonary'. RESULTS Significant heterogeneous microvascular alterations exist in patients with cirrhosis. Data suggest that the systemic inflammation, associated with advanced cirrhosis, induces microcirculatory dysregulation and contributes to haemodynamic derangement. The resultant vasoconstriction and hypoperfusion in the systemic extrahepatic microvasculature, is likely to be instrumental in the pathophysiology of organ failure in decompensated cirrhosis, however the mechanistic action of vasoactive agents used to correct the circulatory disturbance of advanced cirrhosis is poorly understood. CONCLUSIONS Further research into the role of the microcirculation in patients with liver cirrhosis, will improve physicians understanding of the pathophysiology of cirrhosis, and may provide a platform for real time evaluation of an individual's microcirculatory response to vasoactive mediators, thus guiding their therapy.
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Affiliation(s)
- T Davies
- Intensive Care Department, Royal Free Hospital, London, UK.,UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, London, UK
| | - S Wythe
- Intensive Care Department, Royal Free Hospital, London, UK.,UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, London, UK
| | - J O'Beirne
- Department of Hepatology, Nambour General Hospital, Sunshine Coast Hospital and Health Service, Nambour, Qld, Australia
| | - D Martin
- Intensive Care Department, Royal Free Hospital, London, UK.,UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, London, UK
| | - E Gilbert-Kawai
- Intensive Care Department, Royal Free Hospital, London, UK.,UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, London, UK
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8
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Oğul H, Kantarcı M, Genç B, Pirimoğlu B, Cullu N, Kızrak Y, Yılmaz O, Karabulut N. Perfusion CT imaging of the liver: review of clinical applications. Diagn Interv Radiol 2015; 20:379-89. [PMID: 24834487 DOI: 10.5152/dir.2014.13396] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Perfusion computed tomography (CT) has a great potential for determining hepatic and portal blood flow; it offers the advantages of quantitative determination of lesion hemodynamics, distinguishing malignant and benign processes, as well as providing morphological data. Many studies have reported the use of this method in the assessment of hepatic tumors, hepatic fibrosis associated with chronic liver disease, treatment response following radiotherapy and chemotherapy, and hepatic perfusion changes after radiological or surgical interventions. The main goal of liver perfusion imaging is to improve the accuracy in the characterization of liver disorders. In this study, we reviewed the clinical application of perfusion CT in various hepatic diseases.
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Affiliation(s)
- Hayri Oğul
- Department of Radiology, Atatürk University, School of Medicine, Erzurum, Turkey.
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9
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Haimerl M, Jung EM, Beyer L, Pregler B, Dollinger M, Sieroń D, Niessen C, Stroszczynski C, Wiggermann P. Chronic liver disease: Correlation of CEUS-based microperfusion and indocyanine green clearance. Clin Hemorheol Microcirc 2015; 61:195-204. [DOI: 10.3233/ch-151990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Haimerl
- Institute for Radiology, University Hospital Regensburg, Germany
| | - E.-M. Jung
- Institute for Radiology, University Hospital Regensburg, Germany
| | - L.P. Beyer
- Institute for Radiology, University Hospital Regensburg, Germany
| | - B. Pregler
- Institute for Radiology, University Hospital Regensburg, Germany
| | - M. Dollinger
- Institute for Radiology, University Hospital Regensburg, Germany
| | - D. Sieroń
- Department of Radiology, District Hospital of Orthopedics and Trauma Surgery, Piekary Śląskie, Poland
| | - C. Niessen
- Institute for Radiology, University Hospital Regensburg, Germany
| | - C. Stroszczynski
- Institute for Radiology, University Hospital Regensburg, Germany
| | - P. Wiggermann
- Institute for Radiology, University Hospital Regensburg, Germany
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10
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Peeters G, Debbaut C, Cornillie P, De Schryver T, Monbaliu D, Laleman W, Segers P. A Multilevel Modeling Framework to Study Hepatic Perfusion Characteristics in Case of Liver Cirrhosis. J Biomech Eng 2015; 137:051007. [DOI: 10.1115/1.4029280] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Indexed: 12/16/2022]
Abstract
Liver cirrhosis represents the end-stage of different liver disorders, progressively affecting hepatic architecture, hemodynamics, and function. Morphologically, cirrhosis is characterized by diffuse fibrosis, the conversion of normal liver architecture into structurally abnormal regenerative nodules and the formation of an abundant vascular network. To date, the vascular remodeling and altered hemodynamics due to cirrhosis are still poorly understood, even though they seem to play a pivotal role in cirrhogenesis. This study aims to determine the perfusion characteristics of the cirrhotic circulation using a multilevel modeling approach including computational fluid dynamics (CFD) simulations. Vascular corrosion casting and multilevel micro-CT imaging of a single human cirrhotic liver generated detailed datasets of the hepatic circulation, including typical pathological characteristics of cirrhosis such as shunt vessels and dilated sinusoids. Image processing resulted in anatomically correct 3D reconstructions of the microvasculature up to a diameter of about 500 μm. Subsequently, two cubic samples (150 × 150 × 150 μm3) were virtually dissected from vascularized zones in between regenerative nodules and applied for CFD simulations to study the altered cirrhotic microperfusion and permeability. Additionally, a conceptual 3D model of the cirrhotic macrocirculation was developed to reveal the hemodynamic impact of regenerative nodules. Our results illustrate that the cirrhotic microcirculation is characterized by an anisotropic permeability showing the highest value in the direction parallel to the central vein (kd,zz = 1.68 × 10−13 m2 and kd,zz = 7.79 × 10−13 m2 for sample 1 and 2, respectively) and lower values in the circumferential (kd,ϑϑ = 5.78 × 10−14 m2 and kd,ϑϑ = 5.65 × 10−13 m2 for sample 1 and 2, respectively) and radial (kd,rr = 9.87 × 10−14 m2 and kd,rr = 5.13 × 10−13 m2 for sample 1 and 2, respectively) direction. Overall, the observed permeabilities are markedly higher compared to a normal liver, implying a locally decreased intrahepatic vascular resistance (IVR) probably due to local compensation mechanisms (dilated sinusoids and shunt vessels). These counteract the IVR increase caused by the presence of regenerative nodules and dynamic contraction mechanisms (e.g., stellate cells, NO-concentration, etc.). Our conceptual 3D model of the cirrhotic macrocirculation indicates that regenerative nodules severely increase the IVR beyond about 65 vol. % of regenerative nodules. Numerical modeling allows quantifying perfusion characteristics of the cirrhotic macro- and microcirculation, i.e., the effect of regenerative nodules and compensation mechanisms such as dilated sinusoids and shunt vessels. Future research will focus on the development of models to study time-dependent degenerative adaptation of the cirrhotic macro- and microcirculation.
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Affiliation(s)
- Geert Peeters
- IBiTech – bioMMeda, Department of Electronics and Information Systems, iMinds Medical IT Department, Ghent University, De Pintelaan 185 – Block B, Gent 9000, Belgium e-mail:
| | - Charlotte Debbaut
- IBiTech – bioMMeda, Department of Electronics and Information Systems, iMinds Medical IT Department, Ghent University, De Pintelaan 185 – Block B, Gent 9000, Belgium e-mail:
| | - Pieter Cornillie
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke 9820, Belgium
| | - Thomas De Schryver
- Centre for X-Ray Tomography, Department of Physics and Astronomy, Ghent University, Proeftuinstraat 86, Gent 9000, Belgium
| | - Diethard Monbaliu
- Department of Microbiology and Immunology, Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Wim Laleman
- Department of Liver and Biliopancreatic Disorders, Hepatology, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Patrick Segers
- IBiTech – bioMMeda, Department of Electronics and Information Systems, iMinds Medical IT Department, Ghent University, De Pintelaan 185 – Block B, Gent 9000, Belgium e-mail:
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Ogul H, Bayraktutan U, Kizrak Y, Pirimoglu B, Yuceler Z, Sagsoz ME, Yilmaz O, Aydinli B, Ozturk G, Kantarci M. Abdominal perfusion computed tomography. Eurasian J Med 2015; 45:50-7. [PMID: 25610249 DOI: 10.5152/eajm.2013.09] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 06/16/2012] [Indexed: 01/03/2023] Open
Abstract
The purpose of this article is to provide an up to date review on the spectrum of applications of perfusion computed tomography (CT) in the abdomen. New imaging techniques have been developed with the objective of obtaining a structural and functional analysis of different organs. Recently, perfusion CT has aroused the interest of many researchers who are studying the applicability of imaging modalities in the evaluation of abdominal organs and diseases. Per-fusion CT enables fast, non-invasive imaging of the tumor vascular physiology. Moreover, it can act as an in vivo biomarker of tumor-related angiogenesis.
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Affiliation(s)
- Hayri Ogul
- Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey
| | | | - Yesim Kizrak
- Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Berhan Pirimoglu
- Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Zeynep Yuceler
- Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey
| | - M Erdem Sagsoz
- Department of Biophysics, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Omer Yilmaz
- Department of General Surgery, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Bulent Aydinli
- Department of General Surgery, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Gurkan Ozturk
- Department of General Surgery, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Mecit Kantarci
- Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey
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Wang SY, Zhang D, Tang LM, Li SY, Wen M, Song XJ. Effects of Electroacupuncture Stimulation at "Zusanli" Acupoint on Hepatic NO Release and Blood Perfusion in Mice. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:826805. [PMID: 25649678 PMCID: PMC4306412 DOI: 10.1155/2015/826805] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/24/2014] [Accepted: 12/24/2014] [Indexed: 12/19/2022]
Abstract
The study is to observe the influence of electroacupuncture (EA) stimulation at "Zusanli" (ST36) on the release of nitric oxide (NO) and blood perfusion (BP) in the liver and further explore whether the hepatic blood perfusion (HBP) changes were regulated by EA ST36 induced NO in nitric oxide synthase inhibited mice. The HBP change of the mice was detected by laser speckle perfusion imaging (LSPI) before and after being given interventions, and the NO in liver tissue was detected by nitric acid reductase in each group. The NO levels and HBP in the L-NAME group were significantly lower than those in the control group (P < 0.01). The NO level and HBP increase in EA group were significantly higher than those in control group (P < 0.05). The NO level in the L-NAME EA group was slightly higher than that in the L-NAME group. The HBP increase in the L-NAME EA group was not statistically significant. These results showed that EA could accelerate the synthesis of NO and thereby increase HBP via vasodilation in liver tissue.
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Affiliation(s)
- Shu-you Wang
- Department of Biomedical Engineering, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Dong Zhang
- Department of Biomedical Engineering, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Li-mei Tang
- Department of Biomedical Engineering, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Shun-yue Li
- Department of Biomedical Engineering, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Mei Wen
- Department of Biomedical Engineering, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xiao-jing Song
- Department of Biomedical Engineering, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
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13
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Time-to-peak values can estimate hepatic functional reserve in patients undergoing surgical resection: a comparison between perfusion CT and indocyanine green retention test. J Comput Assist Tomogr 2014; 38:733-41. [PMID: 24834884 DOI: 10.1097/rct.0000000000000102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the potential usefulness of perfusion computed tomography (CT) for the estimation of hepatic functional reserve in patients scheduled for surgical resection and to compare the results with those of the indocyanine green retention test results. METHODS Thirty-one patients with hepatobiliary malignancies were included. Perfusion CT and indocyanine green retention test were performed on the same day, and their results were compared using Pearson correlation test. RESULTS A strong correlation was found between perfusion CT time-to-peak values and indocyanine green retention rate at 15 minutes and indocyanine green plasma disappearance rate values (R, 0.789 and -0.790; R, 0.832 and -0.823, respectively; P < 0.0001). CONCLUSIONS Perfusion CT may be useful for the preoperative noninvasive estimation of hepatic functional reserve for patients undergoing liver resection.
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14
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Debbaut C, Segers P, Cornillie P, Casteleyn C, Dierick M, Laleman W, Monbaliu D. Analyzing the human liver vascular architecture by combining vascular corrosion casting and micro-CT scanning: a feasibility study. J Anat 2014; 224:509-17. [PMID: 24433401 DOI: 10.1111/joa.12156] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2013] [Indexed: 11/26/2022] Open
Abstract
Although a full understanding of the hepatic circulation is one of the keys to successfully perform liver surgery and to elucidate liver pathology, relatively little is known about the functional organization of the liver vasculature. Therefore, we materialized and visualized the human hepatic vasculature at different scales, and performed a morphological analysis by combining vascular corrosion casting with novel micro-computer tomography (CT) and image analysis techniques. A human liver vascular corrosion cast was obtained by simultaneous resin injection in the hepatic artery (HA) and portal vein (PV). A high resolution (110 μm) micro-CT scan of the total cast allowed gathering detailed macrovascular data. Subsequently, a mesocirculation sample (starting at generation 5; 88 × 68 × 80 mm³) and a microcirculation sample (terminal vessels including sinusoids; 2.0 × 1.5 × 1.7 mm³) were dissected and imaged at a 71-μm and 2.6-μm resolution, respectively. Segmentations and 3D reconstructions allowed quantifying the macro- and mesoscale branching topology, and geometrical features of HA, PV and hepatic venous trees up to 13 generations (radii ranging from 13.2 mm to 80 μm; lengths from 74.4 mm to 0.74 mm), as well as microvascular characteristics (mean sinusoidal radius of 6.63 μm). Combining corrosion casting and micro-CT imaging allows quantifying the branching topology and geometrical features of hepatic trees using a multiscale approach from the macro- down to the microcirculation. This may lead to novel insights into liver circulation, such as internal blood flow distributions and anatomical consequences of pathologies (e.g. cirrhosis).
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Affiliation(s)
- Charlotte Debbaut
- Biofluid, Tissue and Solid Mechanics for Medical Applications, Institute Biomedical Technology, Department of Electronics and Information Systems, iMinds Future Health Department, Ghent University, Gent, Belgium
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Abstract
Anatomical-based imaging is used widely for the evaluation of diffuse and focal liver, including detection, characterization, and therapy response assessment. However, a limitation of anatomical-based imaging is that structural changes may occur relatively late in a disease process. By applying conventional anatomical-imaging methods in a more functional manner, specific pathophysiologic alterations of the liver may be assessed and quantified. There has been an increasing interest in both the clinical and research settings, with the expectation that functional-imaging techniques may help solve common diagnostic dilemmas that conventional imaging alone cannot. This review considers the most common functional magnetic resonance imaging, computed tomography, and ultrasound imaging techniques that may be applied to the liver.
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Affiliation(s)
- Vicky Goh
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
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Debbaut C, Vierendeels J, Siggers JH, Repetto R, Monbaliu D, Segers P. A 3D porous media liver lobule model: the importance of vascular septa and anisotropic permeability for homogeneous perfusion. Comput Methods Biomech Biomed Engin 2012; 17:1295-310. [PMID: 23237543 DOI: 10.1080/10255842.2012.744399] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The hepatic blood circulation is complex, particularly at the microcirculatory level. Previously, 2D liver lobule models using porous media and a 3D model using real sinusoidal geometries have been developed. We extended these models to investigate the role of vascular septa (VS) and anisotropic permeability. The lobule was modelled as a hexagonal prism (with or without VS) and the tissue was treated as a porous medium (isotropic or anisotropic permeability). Models were solved using computational fluid dynamics. VS inclusion resulted in more spatially homogeneous perfusion. Anisotropic permeability resulted in a larger axial velocity component than isotropic permeability. A parameter study revealed that results are most sensitive to the lobule size and radial pressure drop. Our model provides insight into hepatic microhaemodynamics, and suggests that inclusion of VS in the model leads to perfusion patterns that are likely to reflect physiological reality. The model has potential for applications to unphysiological and pathological conditions.
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Affiliation(s)
- Charlotte Debbaut
- a Biofluid, Tissue and Solid Mechanics for Medical Applications (bioMMeda), Institute Biomedical Technology, Ghent University , Campus Heymans - Blok B, De Pintelaan 185, 9000 Gent , Belgium
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Ridolfi F, Abbattista T, Busilacchi P, Brunelli E. Contrast-enhanced ultrasound evaluation of hepatic microvascular changes in liver diseases. World J Gastroenterol 2012; 18:5225-30. [PMID: 23066317 PMCID: PMC3468855 DOI: 10.3748/wjg.v18.i37.5225] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 05/31/2012] [Accepted: 08/04/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess if software assisted-contrast-enhanced ultrasonography (CEUS) provides reproducible perfusion parameters of hepatic parenchyma in patients affected by chronic liver disease.
METHODS: Forty patients with chronic viral liver disease, with (n = 20) or without (n = 20) cirrhosis, and 10 healthy subjects underwent CEUS and video recordings of each examination were then analysed with Esaote’s Qontrast software. CEUS dedicated software Qontrast was used to determine peak (the maximum signal intensity), time to peak (TTP), region of blood value (RBV) proportional to the area under the time-intensity curve, mean transit time (MTT) measured in seconds and region of blood flow (RBF).
RESULTS: Qontrast-assisted CEUS parameters displayed high inter-observer reproducibility (κ coefficients of 0.87 for MTT and 0.90 TTP). When the region of interest included a main hepatic vein, Qontrast-calculated TTP was significantly shorter in cirrhotic patients (vs non-cirrhotics and healthy subjects) (71.0 ± 11.3 s vs 82.4 ± 15.6 s, 86.3 ± 20.3 s, P < 0.05). MTTs in the patients with liver cirrhosis were significantly shorter than those of controls (111.9 ± 22.0 s vs 139.4 ± 39.8 s, P < 0.05), but there was no significant difference between the cirrhotic and non-cirrhotic groups (111.9 ± 22.0 s vs 110.3 ± 14.6 s). Peak enhancement in the patients with liver cirrhosis was also higher than that observed in controls (23.9 ± 5.9 vs 18.9 ± 7.1, P = 0.05). There were no significant intergroup differences in the RBVs and RBFs.
CONCLUSION: Qontrast-assisted CEUS revealed reproducible differences in liver perfusion parameters during the development of hepatic fibrogenesis.
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Kim KA, Park MS, Kim IS, Kiefer B, Chung WS, Kim MJ, Kim KW. Quantitative evaluation of liver cirrhosis using T1 relaxation time with 3 tesla MRI before and after oxygen inhalation. J Magn Reson Imaging 2012; 36:405-10. [PMID: 22392835 DOI: 10.1002/jmri.23620] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 01/13/2012] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To quantify liver T1 relaxation times before and after oxygen inhalation in patients with and without liver cirrhosis using a 3 Tesla (T) MRI. MATERIALS AND METHODS Institutional Review Board approval and written informed consent were obtained. Ninety-two noncirrhotic patients and 87 patients with hepatitis B viral liver cirrhosis (72 Child-Pugh class A and 15 Child-Pugh class B or C) underwent MRI with a 3.0T system before and after the supply of 100% oxygen at a rate of 15 L/min by means of a nonrebreather ventilation mask for 3 min. T1 maps were acquired using three-dimensional spoiled gradient echo sequences with two different flip angles (2° and 14°) and a fixed TR/TE (2.54 ms/0.95 ms). Liver T1 values were obtained using a T1 processing tool (MapIT software). The mean baseline T1 values of three groups (control, Child-Pugh class A, and Child-Pugh class B/C) were compared using an analysis of variance test. Liver T1 value before and after oxygenation was compared using a paired t-test for each group. RESULTS The baseline liver T1 value was significantly higher in the control group (941 ± 136 ms) than in Child-Pugh A (858 ± 143 ms) and Child-Pugh B/C (783 ± 164 ms) group (P < 0.001 and P < 0.0001). The reduction in the liver T1 value after oxygen inhalation was significant in the control group (P = 0.012) but not significant in Child-Pugh class A (P = 0.079) and Child-Pugh class B/C (P = 0.752). CONCLUSION The baseline liver T1 relaxation time was significantly different between the patients with and without liver cirrhosis. The shortening effect of oxygen on the liver T1 value was significant in the control group but not in the cirrhotic patients.
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Affiliation(s)
- Kyung Ah Kim
- Department of Diagnostic Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Quantitative Color Mapping of the Arterial Enhancement Fraction in Patients With Diffuse Liver Disease. AJR Am J Roentgenol 2011; 197:876-83. [DOI: 10.2214/ajr.10.5943] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Qin HY, Sun HR, Li YJ, Shen BZ. Application of CT perfusion imaging to the histological differentiation of adrenal gland tumors. Eur J Radiol 2011; 81:502-7. [PMID: 21306850 DOI: 10.1016/j.ejrad.2010.12.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 12/03/2010] [Accepted: 12/28/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND CT perfusion imaging has been used in diagnosis and classification of tumors widely and in assess tumor angiogenesis in some organs. However, there are few reports describing CT perfusion imaging of adrenal gland tumors. OBJECTIVE This study aimed to evaluate the application of CT perfusion imaging in analysis of angiogenesis in adrenal tumors and in diagnosis of adrenal tumors. PATIENTS AND METHODS Forty four patients with adrenal gland tumors (26 with adenomas and 18 with nonadenomas) were enrolled in this study. CT scan of adrenal glands was performed with the perfusion of non-ionic contrast medium Ultravist. The obtained images were processed with deconvolution algorithms-based perfusion software and then perfusion parameter maps and values (blood flow, blood volume, mean transit time, and permeability surface-area production) were generated and analyzed respectively. RESULTS Univariate multivariate logistic regression indicated that blood volume (OR: 1.261, 95% CI: 1.056, 1.505, P=0.010) was associated with the likelihood of adrenal adenoma. Receiver operating characteristic analysis showed that the blood volume value of ≥9.325 ml min(-1) 100 g(-1) predicted adrenal adenoma with sensitivity of 76.9% and specificity of 73.2%. In addition, permeability surface-area production in adenoma was higher than in non-adenoma (27.11±15.45 vs. 16.76±14.44 ml min(-1) 100 g(-1), P<0.05). The other parameters had no clear prognostic significance. CONCLUSIONS CT perfusion imaging can quantitatively distinguish adrenal gland tumors with different histological characteristics. Especially, blood volume can be used in differentiating adrenal adenomas from nonadenomas.
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Affiliation(s)
- Hai-yan Qin
- Department of Imaging, The Fourth Affiliated Hospital, Harbin Medical University, Harbin 150001, China
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Zhang Q, Yuan ZG, Wang DQ, Yan ZH, Tang J, Liu ZQ. Perfusion CT findings in liver of patients with tumor during chemotherapy. World J Gastroenterol 2010; 16:3202-5. [PMID: 20593507 PMCID: PMC2896759 DOI: 10.3748/wjg.v16.i25.3202] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To investigate the microcirculation changes in liver of patients with tumor during chemotherapy by perfusion computed tomography (CT).
METHODS: Sixty patients with tumor and 20 controls were enrolled in this study. Perfusion CT parameters of patients and controls were compared, including hepatic perfusion index (HPI), mean transit time (MTT), and permeability-surface area product (PS). Correlation between perfusion CT parameters, treatment cycle and alanine aminotransferase (ALT) level was studied.
RESULTS: No difference was found in HPI (25.68% ± 7.38% vs 26.82% ± 5.13%), MTT (19.67 ± 5.68 s vs 21.70 ± 5.43 s) and PS (17.00 ± 4.56 mL/100 mL per min vs 19.92 ± 6.35 mL/100 mL per min) between patients and controls. The HPI and MTT were significantly higher in patients undergoing 2 cycles of chemotherapy than in controls and those undergoing 1 cycle of chemotherapy (29.76% ± 5.87% vs 25.68% ± 7.38% and 25.35% ± 4.05%, and 25.61 ± 5.01 s vs 19.67 ± 5.68 s and 19.74 ± 4.54 s, respectively, P < 0.05). The HPI was higher in patients with hepatic steatosis than in controls and those without hepatic steatosis (30.85% ± 6.17% vs 25.68% ± 7.38% and 25.70% ± 4.24%, P < 0.05). Treatment cycle was well correlated with HPI and MTT (r = 0.40, r = 0.50, P < 0.01). ALT level was not correlated with perfusion CT parameters.
CONCLUSION: HPI and MTT are significantly increased in patients with tumor during chemotherapy and well correlated with treatment cycle. Chemotherapy affects hepatic microcirculation in patients with tumor. Changes in hepatic microcirculation can be quantitatively assessed by perfusion CT.
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