CT perfusion for response evaluation after interventional ablation of hepatocellular carcinoma: a prospective study

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 m1/100 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.

Automated summary

The study confirmed the feasibility of using CT perfusion to assess response to TACE and RFA in HCC patients, with BV, MTT, and PS perfusion parameters showing high sensitivity and specificity in TACE treatment, while BF and BV perfusion parameters showing high sensitivity and specificity in RFA treatment.