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CT Perfusion Imaging Can Predict Patients' Survival and Early Response to Transarterial Chemo-Lipiodol Infusion for Liver Metastases from Colorectal Cancers.

Lv WF, Han JK, Cheng DL, Zhou CZ, Ni M, Lu D - Korean J Radiol (2015)

Bottom Line: The percentage change of CTPI parameters of target lesions were compared between responders and non-responders at 1 month after TACLI.The best cut-off value was -21.5% and patients who exhibited a ≥ 21.5% decrease in HAP had a significantly higher overall survival rate than those who exhibited a < 21.5% decrease (p < 0.001).The percentage change in HAP after TACLI with a cutoff value of -21.5% is the optimal predictor.

View Article: PubMed Central - PubMed

Affiliation: PET/CT Center, Qilu Hospital, First Affiliated Hospital of Shandong University, Jinan 250012, China. ; Department of Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei 230001, China.

ABSTRACT

Objective: To prospectively evaluate the performance of computed tomography perfusion imaging (CTPI) in predicting the early response to transarterial chemo-lipiodol infusion (TACLI) and survival of patients with colorectal cancer liver metastases (CRLM).

Materials and methods: Computed tomography perfusion imaging was performed before and 1 month after TACLI in 61 consecutive patients. Therapeutic response was evaluated on CT scans 1 month and 4 months after TACLI; the patients were classified as responders and non-responders based on 4-month CT scans after TACLI. The percentage change of CTPI parameters of target lesions were compared between responders and non-responders at 1 month after TACLI. The optimal parameter and cutoff value were determined. The patients were divided into 2 subgroups according to the cutoff value. The log-rank test was used to compare the survival rates of the 2 subgroups.

Results: Four-month images were obtained from 58 patients, of which 39.7% were responders and 60.3% were non-responders. The percentage change in hepatic arterial perfusion (HAP) 1 month after TACLI was the optimal predicting parameter (p = 0.003). The best cut-off value was -21.5% and patients who exhibited a ≥ 21.5% decrease in HAP had a significantly higher overall survival rate than those who exhibited a < 21.5% decrease (p < 0.001).

Conclusion: Computed tomography perfusion imaging can predict the early response to TACLI and survival of patients with CRLM. The percentage change in HAP after TACLI with a cutoff value of -21.5% is the optimal predictor.

No MeSH data available.


Related in: MedlinePlus

CTPI manifestations of hypervascular lesion before and after TACLI.Patient is 59-year-old male at 10 months after resection of colonic cancer. Conventional CT plain scan of liver discloses well-defined heterogeneous hypodense mass in Segment IV (A, arrows), and enhanced CT image shows early wash-in during hepatic arterial phase (B, arrows) and early wash-out during portal venous phase (C, arrows). On CTPI before TACLI, target lesion is present as hyperperfusion in HBF (D, arrows) and HAF (E, arrows) maps. After TACLI, conventional CT plain scan of liver shows lipiodol retention in partial pattern (F, arrows), enhanced CT discloses enhancement of residual lesion during arterial phase (G, arrow) and portal venous phase (H, arrow). On CTPI after TACLI, HBF (I, arrow) and HAF (J, arrow) maps reveal significant decrease in perfusion relative to those before TACLI. CTPI = computed tomography perfusion imaging, HAF = hepatic arterial fraction, HBF = hepatic blood flow, TACLI = transarterial chemo-lipiodol infusion
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Figure 2: CTPI manifestations of hypervascular lesion before and after TACLI.Patient is 59-year-old male at 10 months after resection of colonic cancer. Conventional CT plain scan of liver discloses well-defined heterogeneous hypodense mass in Segment IV (A, arrows), and enhanced CT image shows early wash-in during hepatic arterial phase (B, arrows) and early wash-out during portal venous phase (C, arrows). On CTPI before TACLI, target lesion is present as hyperperfusion in HBF (D, arrows) and HAF (E, arrows) maps. After TACLI, conventional CT plain scan of liver shows lipiodol retention in partial pattern (F, arrows), enhanced CT discloses enhancement of residual lesion during arterial phase (G, arrow) and portal venous phase (H, arrow). On CTPI after TACLI, HBF (I, arrow) and HAF (J, arrow) maps reveal significant decrease in perfusion relative to those before TACLI. CTPI = computed tomography perfusion imaging, HAF = hepatic arterial fraction, HBF = hepatic blood flow, TACLI = transarterial chemo-lipiodol infusion

Mentions: In the hypervascular lesions (n = 24), a heterogeneous hyperperfusion was present in HBF and HAF maps (Fig. 2), however, a hypoperfusion was displayed in the HBV, MTT, and PS maps. An early wash-in and early wash-out during the hepatic arterial and portal venous phases were observed in time-density curve (TDC) map. By contrast, in the hypovascular lesions (n = 37), a heterogeneous hypoperfusion was found in HBF, HBV, MTT, and PS maps, meanwhile, a slight hyperperfusion was shown in the HAF map (Fig. 3), and a flat perfusion curve was exhibited in the TDC map. With regard to the CTPI parameters, the mean HBF, HBV, MTT, and PVP values in the target lesions were significantly lower (p = 0.026, 0.017, 0.021, and 0.002, respectively), but the HAF and HAP values were significantly higher (p < 0.001 and p = 0.011, respectively) than those in the normal liver parenchyma. No statistical difference was found in mean PS value (p = 0.056) (Table 2).


CT Perfusion Imaging Can Predict Patients' Survival and Early Response to Transarterial Chemo-Lipiodol Infusion for Liver Metastases from Colorectal Cancers.

Lv WF, Han JK, Cheng DL, Zhou CZ, Ni M, Lu D - Korean J Radiol (2015)

CTPI manifestations of hypervascular lesion before and after TACLI.Patient is 59-year-old male at 10 months after resection of colonic cancer. Conventional CT plain scan of liver discloses well-defined heterogeneous hypodense mass in Segment IV (A, arrows), and enhanced CT image shows early wash-in during hepatic arterial phase (B, arrows) and early wash-out during portal venous phase (C, arrows). On CTPI before TACLI, target lesion is present as hyperperfusion in HBF (D, arrows) and HAF (E, arrows) maps. After TACLI, conventional CT plain scan of liver shows lipiodol retention in partial pattern (F, arrows), enhanced CT discloses enhancement of residual lesion during arterial phase (G, arrow) and portal venous phase (H, arrow). On CTPI after TACLI, HBF (I, arrow) and HAF (J, arrow) maps reveal significant decrease in perfusion relative to those before TACLI. CTPI = computed tomography perfusion imaging, HAF = hepatic arterial fraction, HBF = hepatic blood flow, TACLI = transarterial chemo-lipiodol infusion
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499545&req=5

Figure 2: CTPI manifestations of hypervascular lesion before and after TACLI.Patient is 59-year-old male at 10 months after resection of colonic cancer. Conventional CT plain scan of liver discloses well-defined heterogeneous hypodense mass in Segment IV (A, arrows), and enhanced CT image shows early wash-in during hepatic arterial phase (B, arrows) and early wash-out during portal venous phase (C, arrows). On CTPI before TACLI, target lesion is present as hyperperfusion in HBF (D, arrows) and HAF (E, arrows) maps. After TACLI, conventional CT plain scan of liver shows lipiodol retention in partial pattern (F, arrows), enhanced CT discloses enhancement of residual lesion during arterial phase (G, arrow) and portal venous phase (H, arrow). On CTPI after TACLI, HBF (I, arrow) and HAF (J, arrow) maps reveal significant decrease in perfusion relative to those before TACLI. CTPI = computed tomography perfusion imaging, HAF = hepatic arterial fraction, HBF = hepatic blood flow, TACLI = transarterial chemo-lipiodol infusion
Mentions: In the hypervascular lesions (n = 24), a heterogeneous hyperperfusion was present in HBF and HAF maps (Fig. 2), however, a hypoperfusion was displayed in the HBV, MTT, and PS maps. An early wash-in and early wash-out during the hepatic arterial and portal venous phases were observed in time-density curve (TDC) map. By contrast, in the hypovascular lesions (n = 37), a heterogeneous hypoperfusion was found in HBF, HBV, MTT, and PS maps, meanwhile, a slight hyperperfusion was shown in the HAF map (Fig. 3), and a flat perfusion curve was exhibited in the TDC map. With regard to the CTPI parameters, the mean HBF, HBV, MTT, and PVP values in the target lesions were significantly lower (p = 0.026, 0.017, 0.021, and 0.002, respectively), but the HAF and HAP values were significantly higher (p < 0.001 and p = 0.011, respectively) than those in the normal liver parenchyma. No statistical difference was found in mean PS value (p = 0.056) (Table 2).

Bottom Line: The percentage change of CTPI parameters of target lesions were compared between responders and non-responders at 1 month after TACLI.The best cut-off value was -21.5% and patients who exhibited a ≥ 21.5% decrease in HAP had a significantly higher overall survival rate than those who exhibited a < 21.5% decrease (p < 0.001).The percentage change in HAP after TACLI with a cutoff value of -21.5% is the optimal predictor.

View Article: PubMed Central - PubMed

Affiliation: PET/CT Center, Qilu Hospital, First Affiliated Hospital of Shandong University, Jinan 250012, China. ; Department of Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei 230001, China.

ABSTRACT

Objective: To prospectively evaluate the performance of computed tomography perfusion imaging (CTPI) in predicting the early response to transarterial chemo-lipiodol infusion (TACLI) and survival of patients with colorectal cancer liver metastases (CRLM).

Materials and methods: Computed tomography perfusion imaging was performed before and 1 month after TACLI in 61 consecutive patients. Therapeutic response was evaluated on CT scans 1 month and 4 months after TACLI; the patients were classified as responders and non-responders based on 4-month CT scans after TACLI. The percentage change of CTPI parameters of target lesions were compared between responders and non-responders at 1 month after TACLI. The optimal parameter and cutoff value were determined. The patients were divided into 2 subgroups according to the cutoff value. The log-rank test was used to compare the survival rates of the 2 subgroups.

Results: Four-month images were obtained from 58 patients, of which 39.7% were responders and 60.3% were non-responders. The percentage change in hepatic arterial perfusion (HAP) 1 month after TACLI was the optimal predicting parameter (p = 0.003). The best cut-off value was -21.5% and patients who exhibited a ≥ 21.5% decrease in HAP had a significantly higher overall survival rate than those who exhibited a < 21.5% decrease (p < 0.001).

Conclusion: Computed tomography perfusion imaging can predict the early response to TACLI and survival of patients with CRLM. The percentage change in HAP after TACLI with a cutoff value of -21.5% is the optimal predictor.

No MeSH data available.


Related in: MedlinePlus