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Role of Perfusion CT Differentiating Hemangiomas from Malignant Hepatic Lesions
Jagjeet Singh1, Sanjiv Sharma1, Neeti Aggarwal1
1Department of Radiodiagnosis and Intervention Radiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
Insights
Computed tomography (CT) perfusion effectively differentiates hepatic hemangiomas from malignant lesions. Key perfusion parameters like blood flow and hepatic arterial fraction show significant changes, aiding diagnosis.
Area of Science:
- Radiology
- Medical Imaging
- Oncology
Background:
- Distinguishing hepatic hemangiomas from malignant liver lesions is crucial for appropriate patient management.
- Computed tomography (CT) perfusion offers dynamic imaging capabilities that may aid in this differentiation.
Purpose of the Study:
- To evaluate the efficacy of CT perfusion in differentiating hepatic hemangiomas from malignant hepatic lesions.
Main Methods:
- A 64-multidetector CT (MDCT) scanner was used for CT perfusion in 45 patients with confirmed hepatic lesions (metastasis, HCC, hemangioma).
- Perfusion parameters including blood flow (BF), blood volume (BV), permeability surface area product (PS), mean transit time (MTT), hepatic arterial fraction (HAF), and induced residue fraction time of onset (IRFTO) were analyzed.
- CT perfusion parameters at the lesion periphery and background liver were compared.
Main Results:
- Significant differences in perfusion parameters were observed between hemangiomas and malignant lesions.
- Blood flow (BF) > 400 ml/100 g/min demonstrated high sensitivity (88.9%) and specificity (83.3%) for hemangiomas.
- Hepatic arterial fraction (HAF) > 60% and IRFTO > 3 s also showed good diagnostic performance.
Conclusions:
- CT perfusion is a valuable tool for differentiating hepatic hemangiomas from malignant hepatic lesions.
- Analysis of specific perfusion parameters can improve diagnostic accuracy in liver lesion characterization.
Objective:
The purpose of the study was to determine the role of computed tomography (CT) perfusion in differentiating hemangiomas from malignant hepatic lesions.
Materials And Methods:
This study was approved by the institutional review board. All the patients provided informed consent. CT perfusion was performed with 64 multidetector CT (MDCT) scanner on 45 patients including 27 cases of metastasis, 9 cases of hepatocellular carcinoma (HCC), and 9 cases of hemangiomas. A 14 cm span of the liver was covered during the perfusion study. Data was analyzed to calculate blood flow (BF), blood volume (BV), permeability surface area product (PS), mean transit time (MTT), hepatic arterial fraction (HAF), and induced residue fraction time of onset (IRFTO). CT perfusion parameters at the periphery of lesions and background liver parenchyma were compared.
Results:
Significant changes were observed in the perfusion parameters at the periphery of different lesions. Of all the perfusion parameters BF, HAF, and IRFTO showed most significant changes. In our study we found: BF of more than 400 ml/100 g/min at the periphery of the hemangiomas showed sensitivity of 88.9%, specificity of 83.3%, positive predictive value (PPV) of 57.1%, and negative predictive value (NPV) of 96.7% in differentiating hemangiomas from hepatic malignancy; HAF of more than 60% at the periphery of hemangiomas showed sensitivity of 77.8%, specificity of 86.1%, PPV of 58.3% and NPV of 93.9% in differentiating hemangiomas from hepatic malignancy; IRFTO of more than 3 s at the periphery of hemangiomas showed sensitivity of 77.8%, specificity of 86.1%, PPV of 58.3%, and NPV of 93.9% in differentiating hemangiomas from hepatic malignancy.
Conclusion:
Perfusion CT is a helpful tool in differentiating hemangiomas from hepatic malignancy by its ability to determine changes in perfusion parameters of the lesions.
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