CT Perfusion of the Liver

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 24, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 3.25
Safety: 0.25
Radiation Safety and Dose: 0.25
Procedures: 3.00
Abdomen and Pelvis: 3.00

Registered Radiologist Assistant: 1.00
Procedures: 1.00
Abdominal Section: 1.00

Outline

1. Introduction
2. Basic Principles of CT Perfusion Imaging
3. CT Acquisition Protocol
4. Calculation of CT Perfusion Parameters
   1. Single-Input versus Dual-Input Model
   2. Single-Compartment versus Dual-Compartment Model
   3. Dual-Compartment Model versus Distributed Parameter Model
5. CT Perfusion Parameters
6. Applications in Clinical Oncologic Imaging of the Liver
   1. General Introduction: Alteration of CT Perfusion Parameters in Liver tumors
   2. Early Detection of Liver Tumors
   3. Assessment of Prognosis Based on Tumor Perfusion
   4. Monitoring Therapeutic Effects
   5. Diagnosing Tumor Recurrence
7. Current Challenges and Future Directions
   1. Radiation Dose
   2. Protocol Standardization
   3. Reproducibility
   4. Motion Correction
   5. Other Issues
8. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with morphological imaging techniques used to diagnose liver disease
2. identify challenges when performing CT perfusion imaging of the liver
3. be familiar with the classification of RECIST
4. identify the disadvantages of assessing tumor specimen with needle biopsy
5. identify the most commonly used first-line imaging modality for staging and monitoring disease in oncology
6. be knowledgeable about the units of attenuation in CT
7. be familiar with the first phase of tissue enhancement during CT perfusion imaging of the liver
8. be familiar with the second phase of tissue enhancement during CT perfusion imaging of the liver
9. understand the unique blood supply to the liver
10. identify the kinetic models used in CT perfusion imaging of the liver
11. be familiar with the timing of the first phase of CT perfusion imaging of the liver
12. be knowledgeable about the minimum concentration of iodine used in CT perfusion imaging of the liver
13. identify the recommended rate of contrast media injection for CT perfusion imaging of the liver
14. recognize the percentage of blood flow to the portal vein in the liver
15. be familiar with the causes of increased hepatic arterial flow associated to hepatic metastases
16. identify how the HAP is separated from the PVP
17. be able to define HPI
18. identify the various kinetic models used in CT perfusion imaging of the liver
19. be familiar with the evolution of hepatocellular dysplastic nodules to HCC
20. be familiar with the introduction of distributed parameter models
21. be able to define MTT
22. be able to define extraction fraction
23. understand the effects of arteriovenous shunts on the MTT
24. identify the clinical application of CT perfusion imaging of the liver
25. be familiar with the early findings on CT perfusion imaging studies of the liver
26. be familiar with the use of maximum slope in patients with HCC
27. be familiar with the advantages of early detection rates in HCC
28. be able to identify the process of confirmation of earlier detection of liver metastases with CT perfusion imaging of the liver
29. be familiar with alternate techniques to performing CT perfusion imaging of the liver
30. be able to define tumor angiogenesis
31. be familiar with the use of HPI to determine patient survival
32. be familiar with the use of antiangiogenic drugs for therapeutic treatment
33. understand the limitations of PET imaging when using antiangiogenic drugs
34. be able to define the acronym TACE
35. identify the antiangiogenic agent used in the study reported by Ren et al
36. be familiar with the techniques used to reduce radiation exposure during CT perfusion imaging of the liver
37. be able to define AEF
38. identify the current challenges for performing CT perfusion imaging of the liver
39. understand the reason to use motion correction when performing CT perfusion imaging of the liver
40. identify the different methods of motion correction when performing CT perfusion imaging of the liver