Computed tomography perfusion of the liver: Assessment of pure portal blood flow studied with CT perfusion during superior mesenteric arterial portography

Purpose: To quantitatively assess the portal component of hepatic blood flow using computed tomography (CT) perfusion studies during superior mesenteric arterial portography. Material and Methods: Thirty-four patients with hepatocellular carcinoma and liver cirrhosis (LC) and 13 patients with liver metastasis without chronic liver disease were enrolled in this study. Ten milliliters of a non-ionic contrast medium (150 mgI) was injected at a rate of 5 rolls via a catheter placed in the superior mesenteric artery. Single-slice cine CT images at the level of the main trunk or the right/left main trunk of the portal vein were acquired over 40 s. The deconvolution method was then used on these CT images to measure blood flow (BF), blood volume (BV), and mean transit time (MTT) in (a) liver parenchyma in patients with HCC and liver cirrhosis; (b) liver parenchyma in patients with liver metastasis without cirrhosis; (c) directly in the HCC; and (d) directly in one of the metastases. Results: In 34 LC patients (a), BF, BV, and MTT in the liver parenchyma were 44.7 +/- 24.5 ml/min/ 100 g, 3.9 +/- 2.4 ml/100 g, and 10.9 +/- 5.5s, respectively. In 13 patients without cirrhosis (b), BF, BV, and MTT in the liver parenchyma were 89.6 +/- 52.0 ml/min/100g, 6.3 +/- 3.2 ml/100 g, and 8.7 +/- 3.6 sec, respectively. A significant difference in BF and BV was seen in patients with liver cirrhosis compared to those without cirrhosis. BF, BV, and MTT measured directly in HCC (c) were 6.5 +/- 4.5 ml/min/100g, 0.4 +/- 0.4 ml/100g, and 3.0 +/- 3.1 sec respectively, and BF, BV, and MTT in liver metastases (d) were 19.3 +/- 21.7 ml/min/100g, 0.6+0.8ml/100g, and 1.8 +/- 1.6 s, respectively. Conclusion: CT perfusion studies during superior mesenteric arterial portography allow quantitative assessment of pure portal blood flow in the liver.