Prognostic value of computed tomographic perfusion in the diagnosis of liver fibrosis and cirrhosis. Pilot study

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Abstract

Relevance: Most diffuse liver diseases lead to fibrosis over time with the risk of cirrhosis. With progressive fibrosis and cirrhosis of the liver both physical properties of the hepatic parenchyma and its hemodynamics change. The only reliable method for determining the stage of the disease is puncture biopsy and subsequent histological examination, but this method is invasive and associated with complications. Currently, the determination of the severity of cirrhosis is based on clinical data (the Child-Pugh scale) and elastography is considered to be the main non-invasive instrumental method. It lets reliably differentiate the initial fibrosis and cirrhosis of the liver, while the F2 and F3 stages according to the conventional METAVIR scale remain a "gray zone", as well as the differentiation of degrees of the severity of cirrhosis. In addition elastography has a  number of limitations. The main ones of which are operator dependence, apparatus dependence and the inability to determine functional changes in the liver. With the use of perfusion computed tomography (CT perfusion) it is possible to assess the functionality of the liver by quantifying changes in hemodynamics. The method applied measures the characteristics of blood flow in the tissue at a given scanning level by computed-tomographic data on the dynamics of the distribution of the contrast agent in the area of interest is collected, besides the type of liver perfusion is determined. This parameter is needed to assess the dynamics of treatment against the background of drug therapy.

Objective: To identify statistically significant parameters of CT perfusion to determine the severity of hemodynamic disturbances in patients with various stages of liver fibrosis and cirrhosis and to compare the values of parameters of liver CT perfusion with fibrosis according to the METAVIR conditional scale determined using elastography.

Materials and methods: 18  patients were included in this parallel pilot study. On the basis of clinical and laboratory data and the results of elastography, 10 of them were diagnosed with fibrosis and cirrhosis. The stages of fibrosis F1, F2 were determined in 3  patients; stages F3, F4  – in 7. In the group of patients with F3, F4, according to the METAVIR conditional scale, subgroups were distinguished depending on the severity of cirrhosis: compensated – 3 patients, subcompensated – 2, decompensated – 2. The control group consisted of 8 patients with organ diseases abdominal cavity not associated with liver damage. All patients underwent CT perfusion of the liver on a Philips iCT 256 using the following scan parameters: 80 KVp, 120 mAc, total scan time 56 s, and slice thickness 5.0 mm. Intravenously, bolus was administered to all patients with 50 ml of ioversol 350 mg/ml, the rate of administration was 3.8–4.0 ml/s, the time from the moment of administration of the contrast medium to the start of scanning was 6 s. After receiving a series of images, the data was processed on a Philips workstation. Quantitative analysis was carried out according to the following indicators: TTP (time to peak, s), BV (blood volume, ml/100 g), AP (arterial perfusion, ml/min/100 ml), PP (portal perfusion, ml/min/100  ml), TP (total perfusion, ml/min/100 ml) and HPI (hepatic perfusion index, %).

Results: In the control group of 8  patients, the perfusion values were: TTP 37.4±5.2  s, BV 16.1±5.0 ml/100 g, AP 25.0±7.5 ml/min/100 ml, PP 44.5±14.5 ml/min/100 ml, TP 70.1±14.9 ml/min/100 ml, HPI 70.1±14.9%. In 3 patients with F1, F2, according to the METAVIR conditional scale, the following statistically significant values (p<0.039) of perfusion indices were determined: BV 27.2±8.6  ml/100  g, AP 20.0±3.8  ml/min/100  ml; with compensated liver cirrhosis (n=3): TTP 46.2±1.7  s, BV 12.4±1.9  ml/100  g, AP 10.7±2.8 ml/min/100 ml, PP 37.3±5.2 ml/min/100 ml, TP 48.1±3.5  ml/min/100  ml, HPI 22.4±5.5%; subcompensated (n=2): TTP 43.0±3.2  s, BV 8.9±2.6 ml/100 g, AP 12.8±3.0 ml/min/100 ml, PP 27.7±9.0 ml/min/100 ml, TP 40.5±7.3 ml/min/100 ml; decompensated (n=2): BV 30.5±1.8 ml/100 g, PP 8.5±1.5 ml/min/100 ml, HPI 81.3±1.8%.

Conclusion: The preliminary results obtained confirm that CT perfusion can be used to predict and assess the severity of hemodynamic disturbances in patients with varying degrees of severity of cirrhosis and supplements clinical, laboratory and elastography data.

About the authors

G. A. Stashuk

Moscow Regional Research and Clinical Institute (MONIKI)

Email: stashukmoniki@mail.ru
ORCID iD: 0000-0003-1058-0611

Galina A. Stashuk – MD, PhD, Head of Department of Roentgenology No. 2; Professor, Chair of Radiation Diagnostics, Postgraduate Training Faculty 

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

D. Ya. Smirnova

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.
Email: d-ya-sm@yandex.ru
ORCID iD: 0000-0002-0128-7977

Daria Ya. Smirnova – MD, Postgraduate Student, Chair of Radiation Diagnostics, Postgraduate Training Faculty 

61/2–15 Shchepkina ul., Moscow, 129110

Russian Federation

D. V. Podrez

Moscow Regional Research and Clinical Institute (MONIKI)

Email: podrez_dima@mail.ru
ORCID iD: 0000-0003-1415-9672

Dmitriy V. Podrez – MD, Junior Research Fellow, Department of Radiology 

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

References

  1. Shipley LC, Axley PD, Singal AK. Liver fibrosis: A clinical update. EMJ Hepatol. 2019;7(1):105–17.
  2. Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, Cosgrove D, Ferraioli G, Friedrich-Rust M, Gilja OH, Goertz RS, Karlas T, de Knegt R, de Ledinghen V, Piscaglia F, Procopet B, Saftoiu A, Sidhu PS, Sporea I, Thiele M. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version). Ultraschall Med. 2017;38(4):e16–47. doi: 10.1055/s-0043-103952.
  3. Lee SM, Lee JM, Kang HJ, Yang HK, Yoon JH, Chang W, An SJ, Lee KB, Baek SY. Liver fibrosis staging with a new 2D-shear wave elastography using comb-push technique: Applicability, reproducibility, and diagnostic performance. PLoS One. 2017;12(5):e0177264. doi: 10.1371/journal.pone.0177264.
  4. Fujimoto K, Kato M, Kudo M, Yada N, Shiina T, Ueshima K, Yamada Y, Ishida T, Azuma M, Yamasaki M, Yamamoto K, Hayashi N, Takehara T. Novel image analysis method using ultrasound elastography for noninvasive evaluation of hepatic fibrosis in patients with chronic hepatitis C. Oncology. 2013;84 Suppl 1:3–12. doi: 10.1159/000345883.
  5. Goyal R, Mallick SR, Mahanta M, Kedia S, Shalimar, Dhingra R, Sharma H, Das P, Datta Gupta S, Panda S, Acharya SK. Fibroscan can avoid liver biopsy in Indian patients with chronic hepatitis B. J Gastroenterol Hepatol. 2013;28(11): 1738–45. doi: 10.1111/jgh.12318.
  6. Hatzidakis A, Perisinakis K, Kalarakis G, Papadakis A, Savva E, Ippolito D, Karantanas A. Perfusion-CT analysis for assessment of hepatocellular carcinoma lesions: diagnostic value of different perfusion maps. Acta Radiol. 2019;60(5):561–8. doi: 10.1177/0284185118791200.
  7. Долгушин МБ, Тулин ПЕ, Оджарова АА, Мещерякова НА, Невзоров ДИ, Меньков МА, Патютко ЮИ, Долгушин БИ. КТ-перфузия в дифференциальной диагностике опухолей печени. Медицинская визуализация. 2015;(5):18–31.
  8. Marquez HP, Puippe G, Mathew RP, Alkadhi H, Pfammatter T, Fischer MA. CT perfusion for early response evaluation of radiofrequency ablation of focal liver lesions: First experience. Cardiovasc Intervent Radiol. 2017;40(1):90–8. doi: 10.1007/s00270-016-1444-9.
  9. Kantarci M, Pirimoglu B, Ozturk G, Aydinli B, Ogul H, Okur A, Kizrak Y, Ozyigit O, Celik M. Clinical utility of hepatic-perfusion computerized tomography in living-donor liver transplantation: a preliminary study. Transplant Proc. 2015;47(2):399–407. doi: 10.1016/j.transproceed.2014.11.038.
  10. Kim SH, Kamaya A, Willmann JK. CT perfusion of the liver: principles and applications in oncology. Radiology. 2014;272(2):322–44. doi: 10.1148/radiol.14130091.
  11. Зыкин БИ, Огурцов ПП, Ионова ЕА, Постнова НА. К вопросу стандартизации измерений в ультразвуковой двумерной сдвиговолновой эластографии: эластометрия или велосиметрия? (Дискуссионная статья). Вестник последипломного медицинского образования. 2020;(1):54–60.
  12. Fu J, Wu B, Wu H, Lin F, Deng W. Accuracy of real-time shear wave elastography in staging hepatic fibrosis: a meta-analysis. BMC Med Imaging. 2020;20(1):16. doi: 10.1186/s12880-020-0414-5.
  13. Yamashita N, Ohho A, Yamasaki A, Kurokawa M, Kotoh K, Kajiwara E. Hepatocarcinogenesis in chronic hepatitis C patients achieving a sustained virological response to interferon: significance of lifelong periodic cancer screening for improving outcomes. J Gastroenterol. 2014;49(11):1504–13. doi: 10.1007/s00535-013-0921-z.
  14. Zhan Y, Wu Y, Chen J, Liu F, Han X. [Value of liver perfusion imaging of 256-slice CT in evaluation of the cirrhosis]. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2016;41(1):44–50. Chinese. doi: 10.11817/j.issn.1672-7347.2016.01.007.
  15. Brown JJ, Naylor MJ, Yagan N. Imaging of hepatic cirrhosis. Radiology. 1997;202(1):1–16. doi: 10.1148/radiology.202.1.8988182.
  16. McCuskey RS. A dynamic and static study of hepatic arterioles and hepatic sphincters. Am J Anat. 1966;119(3):455–77. doi: 10.1002/aja.1001190307.
  17. Якимова ВБ. Артериальная гемодинамика на различных стадиях хронических гепатитов и цирроза печени. Сибирский медицинский журнал. 2005;(7):51–3.
  18. Wang Q, Koniaris LG, Milgrom DP, Patel A, Hu M, Cui E, Deng Y, Akisik F. CT and MRI imaging and interpretation of hepatic arterioportal shunts. Transl Gastroenterol Hepatol. 2019;4:34. doi: 10.21037/tgh.2019.05.05.

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Copyright (c) 2020 Stashuk G.A., Smirnova D.Y., Podrez D.V.

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