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Quantitative measurement of hepatic portal perfusion by multidetector row CT with compensation for respiratory misregistration

¹ Department of Radiology, Division of Medical Intelligence and Informatics, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, ² Department of Radiology, School of Medicine, Hiroshima University, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima 734-8551, ³ Department of Radiology, Kure City Medical Association Hospital, 15–24, Asahi-cho, Kure 737-0056, ⁴ Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi-cho, Minami-ku, Hiroshima 734-8551 and ⁵ Department of Pathology, School of Health Sciences, Hiroshima Women's University, 1-1-71, Ujina-Higashi, Minami-ku, Hiroshima, 734-8554, Japan

View larger version (134K): [in a new window]   Figure 1. Typical placement of regions of interest (ROIs) for the measurement of CT values. ROIs in the right lobe of the liver, spleen, and portal trunk are drawn as large as possible, avoiding large vessels. ROIs in the liver and spleen have margins not less than 5 mm from the organ surfaces; this avoids partial volume effects and artefacts from the ribs. An enhanced area in segment 7 indicates hepatocellular carcinoma (arrow).

View larger version (13K): [in a new window]   Figure 2. An example of the time–attenuation curve in portal perfusion measurement. Time–attenuation curve of relative enhancement (HU) of the liver, spleen (a), and subtracted liver (a pure portal venous curve separate from its arterial component) (b). Gs, the peak splenic gradient; Gl, the peak gradient of original hepatic time–attenuation curve; Gp, the peak gradient of subtracted hepatic time–attenuation curve in the portal venous phase.

View larger version (89K): [in a new window]   Figure 3. Quantification of hepatic fibrosis. (a) Photomicrograph of a liver section from a cirrhosis patient shows regenerating nodules of various sizes encircled by fibrotic septa (blackish areas) including the portal triads. The fibrotic area is 24.6% of the total area. (b) Photomicrograph of a liver section from a normal liver patient shows minimal deposition of collagen around the portal triads. The fibrotic area is 5.2% of the total area. (Sirius Red/Fast Green staining; original magnification, scale=1 mm).

View larger version (125K): [in a new window]   Figure 4. Five representative scan images from the serial data are shown. Images at almost the same anatomical level can be selected by virtue of multirow detector CT. The advantage of this technique is emphasised in patients with small spleen (like this case).

View larger version (17K): [in a new window]   Figure 5. Distribution of portal perfusion values between hepatic diseases. Box plots in which the boundary of the box closest to zero indicates the 25th percentile, line within the box marks the median, and the boundary of the box farthest from zero indicates the 75th percentile. Error bars below and above the boxes indicate 10th and 90th percentiles, respectively. Outliers are represented as individual dots. Graphs show box plots of portal perfusion (a), and in patients with cirrhosis (the Child-Pugh classification system) (b).

View larger version (24K): [in a new window]   Figure 6. Box-whisker plot showing distribution of portal perfusion values in liver cirrhosis patients with and without primary tumour.

View larger version (15K): [in a new window]   Figure 7. Relationship between portal perfusion and fibrotic area in the liver tumour patients. The data points denote hepatic perfusion values in ml min–1ml–1.