Quantitative perfusion imaging of neoplastic liver lesions: A multi-institution study

Shivani Pahwa, Hao Liu, Yong Chen, Sara Dastmalchian, Gregory O'Connor, Ziang Lu, Chaitra Badve, Alice Yu, Katherine Wright, Hamid Chalian, Shengxiang Rao, Caixia Fu, Ignacio Vallines, Mark Griswold, Nicole Seiberlich, Mengsu Zeng, Vikas Gulani, Shivani Pahwa, Hao Liu, Yong Chen, Sara Dastmalchian, Gregory O'Connor, Ziang Lu, Chaitra Badve, Alice Yu, Katherine Wright, Hamid Chalian, Shengxiang Rao, Caixia Fu, Ignacio Vallines, Mark Griswold, Nicole Seiberlich, Mengsu Zeng, Vikas Gulani

Abstract

We describe multi-institutional experience using free-breathing, 3D Spiral GRAPPA-based quantitative perfusion MRI in characterizing neoplastic liver masses. 45 patients (age: 48-72 years) were prospectively recruited at University Hospitals, Cleveland, USA on a 3 Tesla (T) MRI, and at Zhongshan Hospital, Shanghai, China on a 1.5 T MRI. Contrast-enhanced volumetric T1-weighted images were acquired and a dual-input single-compartment model used to derive arterial fraction (AF), distribution volume (DV) and mean transit time (MTT) for the lesions and normal parenchyma. The measurements were compared using two-tailed Student's t-test, with Bonferroni correction applied for multiple-comparison testing. 28 hepatocellular carcinoma (HCC) and 17 metastatic lesions were evaluated. No significant difference was noted in perfusion parameters of normal liver parenchyma and neoplastic masses at two centers (p = 0.62 for AF, 0.015 for DV, 0.42 for MTT for HCC, p = 0.13 for AF, 0.97 for DV, 0.78 for MTT for metastases). There was statistically significant difference in AF, DV, and MTT of metastases and AF and DV of HCC compared to normal liver parenchyma (p < 0.5/9 = 0.0055). A statistically significant difference was noted in the MTT of metastases compared to hepatocellular carcinoma (p < 0.001*10-5). In conclusion, 3D Spiral-GRAPPA enabled quantitative free-breathing perfusion MRI exam provides robust perfusion parameters.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Perfusion modeling in a patient with metastatic breast cancer. Arterial and portal input function (a), concentration-time curve of the lesion and surrounding tissue (b) for the lesion depicted in T1-weighted image (c). Perfusion modeling revealed the lesion to have an arterial fraction of 95.3%, distribution volume of 48.0% and mean transit time of 96.6 seconds. The corresponding values for the liver parenchyma were arterial fraction of 16.9%, distribution volume of 30.8% and mean transit time of 5.2 seconds.
Figure 2
Figure 2
(a) Standard arterial phase VIBE image depicts an irregular liver contour in a patient with cirrhosis on surveillance for hepatocellular carcinoma- no focal lesion is seen. (b) Spiral DCE acquisition performed 12 days after the clinical study depicts three arterially enhancing lesions. These lesions were detected in the follow up clinical exam performed 3 months after the first exam (c).
Figure 3
Figure 3
Liver perfusion maps for a patient with hepatocellular carcinoma. Free breathing spiral DCE images averaged over 9 frames show the lesion in arterial (a), venous (b) and delayed phases (c). Corresponding liver perfusion maps depict arterial fraction of 77% (d), distribution volume of 45% (e) and mean transit time of 12 seconds (f).
Figure 4
Figure 4
Liver perfusion maps for a patient with metastatic carcinoma lung. Axial CT image shows three hypodense lesions (a). Corresponding liver perfusion maps depict arterial fraction (b), distribution volume (c) and mean transit time (d).

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