Correlation of magnetic resonance signal characteristics and perfusion parameters assessed by volume perfusion computed tomography in hepatocellular carcinoma: Impact on lesion characterization

Figure 1 “Typical” hepatocellular carcinoma lesion with typical pattern on volume perfusion computed tomography and magnetic resonance imaging and hepatocellular carcinoma with “atypical” magnetic resonance pattern. MR depicts a typical pattern with hyperintense signal in T2 weighted image (A1) and low signal in T1 weighted image (B1) in combination with a strong arterial wash in (C1). (D1) Strong arterial blood supply of the lesion (ALP 58 mL/100 mL per minute) was found in combination with a Drop-out of portal venous perfusion (PVP 3 mL/100 mL per minute) (E1). Accordingly hepatic perfusion index (HPI) was high (96%) (F1). The lesion has an infiltrative growth pattern and is isointense in T2 weighted images (A2) and T1 weighted images (B2). The arterial phase on MRI does not depict a clear wash-in (C2). However VPCT depicts strong arterial blood supply of the lesion (D2) (ALP 53 mL/100 mL per minute) in combination with drop-out of portal venous perfusion (E2) (PVP 2 mL/100 mL per minute). The resulting HPI is 97% (F2). VPCT: Volume perfusion computed tomography; ALP: Arterial liver perfusion; PVP: Portal venous perfusion; MRI: Magnetic resonance imaging; HPI: Hepatic perfusion index.

Figure 2 Scattered plot showing the distribution of arterial liver perfusion in n = 36 hepatocellular carcinoma lesions depending on the lesion's size. Red line indicates the mean ALP value (49.8 mL/100 g tissue per minute). ALP: Arterial liver perfusion.

Figure 3 Scattered plot showing the distribution of hepatic perfusion index in n = 36 hepatocellular carcinoma lesions depending on the lesion’s size. Red line indicates the mean HPI value (94.4%). HPI: Hepatic perfusion index.

Figure 4 Scattered plot showing the distribution of hepatic perfusion index in typical vs atypical hepatocellular carcinoma in n = 36 hepatocellular carcinoma lesions. The green line indicates the mean value (typical vs atypical 95.0% vs 93.7%, respectively). The red Boxes indicate the box-and-whisker plots indicating the upper and lower quartiles. HPI: Hepatic perfusion index.

Figure 5 Scattered plot showing the distribution of arterial liver perfusion in typical vs atypical hepatocellular carcinoma in n = 36 hepatocellular carcinoma lesions. The green line indicates the mean value (typical vs atypical; 48.9 mL/100 g tissue/min vs 52.5 mL/100 g tissue/min), respectively). The red Boxes indicate the box-and-whisker plots indicating the upper and lower quartiles. ALP: Arterial liver perfusion.