What is the “washout” of hepatocellular carcinoma as observed on the equilibrium phase CT?: consideration based on the concept of extracellular volume fraction

Purpose To verify the hypothesis that extracellular volume fraction (ECV) and precontrast CT density are the main determinants of washout of hepatocellular carcinoma (HCC) at the equilibrium phase CT. Materials and methods Between 2018 and 2020, patients with surgically resected HCC were recruited w...

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Veröffentlicht in:Japanese journal of radiology Jg. 40; H. 11; S. 1148 - 1155
Hauptverfasser: Sakamoto, Keiko, Tanaka, Shinji, Sato, Keisuke, Ito, Emi, Nishiyama, Marie, Urakawa, Hiroshi, Arima, Hisatomi, Yoshimitsu, Kengo
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Singapore Springer Nature Singapore 01.11.2022
Springer Nature B.V
Schlagworte:
Computed tomography
Degeneration
Density
Equilibrium
Hemorrhage
Hepatocellular carcinoma
Imaging
Liver cancer
Medicine
Medicine & Public Health
Nuclear Medicine
Original
Original Article
Radiology
Radiotherapy
Hepatocellular carcinoma
Extracellular volume fraction
Equilibrium phase CT
Washout
ISSN:1867-1071, 1867-108X, 1867-108X
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Zusammenfassung:Purpose To verify the hypothesis that extracellular volume fraction (ECV) and precontrast CT density are the main determinants of washout of hepatocellular carcinoma (HCC) at the equilibrium phase CT. Materials and methods Between 2018 and 2020, patients with surgically resected HCC were recruited who had undergone preoperative 4-phase CT. Those larger than 6 cm were excluded to minimize the possibility of intratumoral hemorrhage or degeneration. Two radiologists reviewed the whole images in consensus and divided cases into washout positive and negative groups. Washout positive group at the equilibrium phase was defined as “HCC showing relatively low density as compared to the surrounding background liver (BGL), irrespective of the presence of early enhancement or fibrous capsule”. Several clinico-pathological and radiological features, including ECV and precontrast CT density, were correlated to the presence of washout, using uni- and multi-variable analyses. Results 27 HCC in 24 patients met the inclusion criteria. 22 (82%) and five HCC belonged to washout positive and negative groups, respectively. Univariable analysis revealed ECV of HCC and BGL, ECV difference between HCC and BGL, and presence of fibrous capsule on the equilibrium phase CT were the significant factors. Multivariable analysis showed ECV of HCC and BGL, and precontrast CT density of BGL, were the independently significant factors related to washout, suggesting washout is more likely observed with lower HCC ECV, higher BGL ECV, and higher BGL precontrast CT density. Conclusion Major determinants of washout of HCC may be ECV of HCC and BGL, and precontrast CT density of BGL.
Bibliographie:ObjectType-Article-1
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ISSN:1867-1071
1867-108X
1867-108X
DOI:10.1007/s11604-022-01295-w