Threshold for Enhancement in Treated Hepatocellular Carcinoma on MDCT: Effect on Necrosis Quantification

AJR. American Journal of Roentgenology
Atilla ArslanogluVahid Yaghmai

Abstract

The objective of our study was to determine whether the conventionally used enhancement threshold of 10 HU for assessing tumor viability in treated hepatocellular carcinoma (HCC) lesions is valid. To distinguish pseudoenhancement from enhancement in a tumor, we used an in vivo model: The attenuation of 54 hepatic cysts during the unenhanced and portal venous phases of MDCT, similar to what may be observed in HCC with central necrosis, was used to determine the threshold for pseudoenhancement. To validate this model, we compared the attenuation value of liver parenchyma in this cohort with that of 22 HCCs during the late arterial phase of enhancement. We tested the effect of this pseudoenhancement on quantifying necrosis in HCC compared with the conventionally used threshold of 10 HU. Values of enhancing HCC tissue on arterial phase MDCT (mean, 121.3 HU) were comparable with normal liver parenchyma on venous phase MDCT (117.3 HU) (p = 0.27). The threshold of 17.1 HU was the best threshold for the detection of pseudoenhancement in cysts (99% accuracy, 100% sensitivity, and 98% specificity). When this threshold was used instead of the conventional threshold of 10 HU, the mean necrosis proportion of treated HCC increased from 34.0%...Continue Reading

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Citations

Nov 14, 2017·Radiographics : a Review Publication of the Radiological Society of North America, Inc·Khaled M ElsayesClaude B Sirlin
May 3, 2019·Future Oncology·Francesca PatellaBradford J Wood
Feb 26, 2019·Korean Journal of Radiology : Official Journal of the Korean Radiological Society·Sungwon KimJin Young Choi
Sep 25, 2021·Radiographics : a Review Publication of the Radiological Society of North America, Inc·Frank H MillerRobert J Lewandowski

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