CT Perfusion Effective for Monitoring Treatment Response to Hepatocellular Carcinoma

A new study was initiated to prospectively evaluate the changes in parameters of computed tomography (CT) perfusion imaging pre- and post-transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) in different treatment response groups, and to correlate the changes with various responses of HCC to TACE.

TACE has been widely accepted as a choice of treatment for advanced HCC. CT perfusion is a noninvasive and reproducible technique for assessing perfusion changes due to TACE therapy for locally advanced HCC. However, there are few reports on the application of this technique in evaluating the efficacy of TACE based on quantitative analysis of perfusion parameters.

In the study published on October 7, 2008, in the World Journal of Gastroenterology, researchers led by a professor from Beijing Friendship Hospital affiliated to Capital Medical University (Beijing, China) used 64-rows multi-detector CT, which can offer a greater coverage (up to 4 cm) of the tumor and portal vein in the scanning range. A CT perfusion scan for patients with HCC allows assessment of perfusion changes due to TACE therapy. This study additionally investigated the correlation between changes in CT perfusion parameters pre- and post-TACE treatment of HCC and various responses to TACE.

The following response evaluation criteria [complete response (CR): disappearance of all target lesions; partial response (PR): at least a 30% decrease in the sum of the longest diameters (LD) of target lesions; progressive disease (PD): at least a 20% increase in the sum of the LD of target lesions; stable disease (SD): neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD] for solid tumors (RECIST) were referred to when it was necessary to assess the therapeutic effect after TACE.

In the PR treatment response group, hepatic artery perfusion (HAP), hepatic arterial fracture (HAF) and hepatic blood volume (HBV) of viable tumors were reduced post-TACE compared with before pre-TACE, while no significant difference was observed in HBF, MTT, PS, and portal vein perfusion (PVP) pre- and post-TACE. In the SD treatment response group, there was no significant difference in perfusion parameters pre- and post-TACE. In the PD treatment group, HAP, HAF, PVP, and hepatic blood flow (HBF) of viable tumors were significantly increased after TACE compared with pre-TACE, while no significant difference was found in other perfusion parameters pre- and post-TACE.

The study's findings, according to the researchers, suggested that changes in CT perfusion parameters in viable tumors are correlated with different response of HCC to TACE. Therefore, CT perfusion imaging is a viable technique for monitoring response of HCC to TACE.

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