Assessment of the severity of liver disease and fibrotic change: the usefulness of hepatic CT perfusion imaging.

This study assessed the utility of CT perfusion for quantitative assessment of liver function and fibrosis. Tissue blood flow (TBF), tissue blood volume (TBV), mean transit time (MTT) and hepatic arterial fraction (HAF) were measured with CT perfusion using the deconvolution algorithm in 38 patients with chronic liver diseases and 10 patients without liver disease. Using Child-Pugh classification, 21 patients were classified as Child A, 10 as Child B, and 7 as Child C. In 20 patients, the degree of fibrosis was quantitated in surgically-resected specimens and compared with the perfusion parameters. The mean TBF, TBV, MTT and HAF of patients with-out liver disease were 103.9+/-18 ml/min/100 g, 12.5+/-2.0 ml/100 g, 11.1+/-1.6 sec and 18.4+/-5.6%, respectively (+/-SD). The mean TBF of patients with Child A, B and C were 95.1+/-24, 86.7+/-29 and 75.5+/-6.5 ml/min/100 g, respectively. TBF tended to decrease with the severity of chronic liver disease. The mean HAF of patients with Child A, B and C were 18.6+/-8.3, 29.8+/-11.2 and 40.2+/-11.1%, respectively. HAF of patients without liver disease was significantly different from those of Child B and C (p<0.05, each). However, there were no significant differences in TBV and MTT between each groups. HAF correlated significantly with the degree of fibrosis (R2=0.588, p<0.05). Our results showed that parameters of CT perfusion correlated significantly with the severity of liver fibrosis and cirrhosis. Quantitative measurement of hepatic tissue blood flow by CT perfusion is useful for evaluation of the severity of disease and fibrotic change.

[1]  R. D. Bowen,et al.  NON-INVASIVE MEASUREMENT OF RENAL BLOOD FLOW , 1981 .

[2]  Y. Israel,et al.  Correlation of intrahepatic pressure with collagen in the Disse space and hepatomegaly in humans and in the rat , 1981 .

[3]  S. Leveson,et al.  LIVER PERFUSION SCINTIGRAPHY - METHOD, NORMAL RANGE AND LAPAROTOMY CORRELATION IN 100 PATIENTS , 1983 .

[4]  R. Brasch,et al.  Contrast-enhanced NMR imaging: animal studies using gadolinium-DTPA complex. , 1984, AJR. American journal of roentgenology.

[5]  K. Okuda,et al.  Portal venous hemodynamics in chronic liver disease: effects of posture change and exercise. , 1985, Radiology.

[6]  M. Rojkind,et al.  A simple micromethod for collagen and total protein determination in formalin-fixed paraffin-embedded sections. , 1985, The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society.

[7]  W W Lautt,et al.  Mechanism and role of intrinsic regulation of hepatic arterial blood flow: hepatic arterial buffer response. , 1985, The American journal of physiology.

[8]  W. Jiménez,et al.  Measurement of fibrosis in needle liver biopsies: Evaluation of a colorimetric method , 1985, Hepatology.

[9]  A M Peters,et al.  Noninvasive measurement of blood flow and extraction fraction. , 1987, Nuclear medicine communications.

[10]  J. Figueras,et al.  Calculation of portal contribution to hepatic blood flow with 99mTc-microcolloids. A noninvasive method to diagnose liver graft rejection. , 1988, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[11]  A. Zimmermann,et al.  Determinants of hepatic function in liver cirrhosis in the rat. Multivariate analysis. , 1988, The Journal of clinical investigation.

[12]  P. Macmathuna,et al.  Hepatic arterial and portal venous components of liver blood flow: a dynamic scintigraphic study. , 1988, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[13]  R. Groszmann,et al.  Feasibility spectrum for Doppler flowmetry of splanchnic vessels. In normal and cirrhotic populations. , 1990, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[14]  A. Gressner.  Liver fibrosis: perspectives in pathobiochemical research and clinical outlook. , 1991, European journal of clinical chemistry and clinical biochemistry : journal of the Forum of European Clinical Chemistry Societies.

[15]  S Rees,et al.  Measurement of tissue perfusion by dynamic computed tomography. , 1992, The British journal of radiology.

[16]  J A Goldberg,et al.  Hepatic perfusion changes in patients with liver metastases: comparison with those patients with cirrhosis. , 1993, Gut.

[17]  R. Dondelinger,et al.  Duplex Ultrasonographic Evaluation of Liver Transplants , 1993, Acta radiologica.

[18]  G R Sutherland,et al.  Early detection of occult colorectal hepatic metastases using duplex colour Doppler sonography , 1993, The British journal of surgery.

[19]  A K Dixon,et al.  Functional images of hepatic perfusion obtained with dynamic CT. , 1993, Radiology.

[20]  Gratz Kf.  [Functional scintigraphy in the follow-up of transplants]. , 1993 .

[21]  E. Tanaka,et al.  Serum collagen type IV for the assessment of fibrosis and resistance to interferon therapy in chronic hepatitis C. , 1994, Scandinavian journal of gastroenterology.

[22]  S. Keiding.  Drug Administration to Liver Patients: Aspects of Liver Pathophysiology , 1995, Seminars in liver disease.

[23]  Y. Kinosada,et al.  Single photon emission computed tomography to determine effective hepatic blood flow and intrahepatic shunting , 1995, Hepatology.

[24]  M Kormano,et al.  Liver Perfusion Studied with Ultrafast CT , 1995, Journal of computer assisted tomography.

[25]  I. Sproat,et al.  Hepatic artery thrombosis after liver transplantation: temporal accuracy of diagnosis with duplex US and the syndrome of impending thrombosis. , 1996, Radiology.

[26]  K. Miles,et al.  Colorectal cancer: diagnostic potential of CT measurements of hepatic perfusion and implications for contrast enhancement protocols. , 1997, Radiology.

[27]  R Sinnatamby,et al.  In vivo assessment of neovascularization of liver metastases using perfusion CT. , 1998, The British journal of radiology.

[28]  G. Belforte,et al.  Assessment of the hepatic circulation in humans: new concepts based on evidence derived from a D-sorbitol clearance method. , 1998, The Journal of laboratory and clinical medicine.

[29]  A. Herneth,et al.  Hepatic perfusion after liver transplantation: noninvasive measurement with dynamic single-section CT. , 1998, Radiology.

[30]  W. Fleig,et al.  Hepatic arterial flow volume and reserve in patients with cirrhosis: use of intra-arterial Doppler and adenosine infusion. , 1999, Gastroenterology.

[31]  J. Bosch,et al.  Complications of cirrhosis. I. Portal hypertension. , 2000, Journal of hepatology.

[32]  B. V. Van Beers,et al.  Non-invasive quantification of liver perfusion with dynamic computed tomography and a dual-input one-compartmental model. , 2000, Clinical science.

[33]  C. McArdle,et al.  Potential role of doppler perfusion index in selection of patients with colorectal cancer for adjuvant chemotherapy , 2000, The Lancet.

[34]  R. Prokesch,et al.  Measurement of Hepatic Perfusion with Dynamic Computed Tomography: Assessment of Normal Values and Comparison of Two Methods to Compensate for Motion Artifacts , 2000, Investigative radiology.

[35]  R Materne,et al.  Hepatic perfusion parameters in chronic liver disease: dynamic CT measurements correlated with disease severity. , 2001, AJR. American journal of roentgenology.

[36]  F Frouin,et al.  Early changes in liver perfusion caused by occult metastases in rats: detection with quantitative CT. , 2001, Radiology.

[37]  Ting-Yim Lee.  Functional CT: physiological models , 2002 .

[38]  S. Taylor-Robinson,et al.  Liver microbubble transit time compared with histology and Child-Pugh score in diffuse liver disease: a cross sectional study , 2003, Gut.

[39]  Y. Tsushima,et al.  The Portal Component of Hepatic Perfusion Measured by Dynamic CT (An Indicator of Hepatic Parenchymal Damage) , 1999, Digestive Diseases and Sciences.

[40]  E. Leen,et al.  Hepatic Blood Flow Changes in Chronic Hepatitis C Measured by Duplex Doppler Color Sonography: Relationship to Histological Features , 1998, Digestive Diseases and Sciences.

[41]  Carrison K. S. Tong,et al.  Measurement of liver blood flow using oxygen-15 labelled water and dynamic positron emission tomography: Limitations of model description , 1996, European Journal of Nuclear Medicine.

[42]  P. Bedossa,et al.  Alpha-2-macroglobulin and hepatic fibrosis , 1994, Digestive Diseases and Sciences.

[43]  M. Spinello,et al.  Percutaneous blind biopsy versus laparoscopy with guided biopsy in diagnosis of cirrhosis , 2005, Digestive Diseases and Sciences.