• Vol. 40 No. 6, 269–275
  • 15 June 2011

Wash-out of Hepatocellular Carcinoma: Quantitative Region of Interest Analysis on CT



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Introduction: This study aims to determine if the quantitative method of region-of-interest (ROI) analysis of lesion attenuation on CT may be a useful adjunct to the conventional approach of diagnosis by visual assessment in assessing tracer wash-out in hepatocellular carcinomas.

Materials and Methods: From a surgical database of 289 patients from 2 institutions, all patients with complete surgical, pathological and preoperative multiphasic CT scans available for review were selected. For each phase of scanning, HU readings of lesion obtained (Lesionarterial, LesionPV and Lesionequilibrium) were analysed using receiver operating curves (ROC) to determine the optimal method and cut-off value for quantitative assessment of tumour wash-out (Lesionarterial – equilibrium, LesionPV – equilibrium or Lesionpeak – equilibrium).

Results: Ninety-four patients with one lesion each met the inclusion criteria. The area under the curve (AUC) values for Lesionarterial – equilibrium (0.941) was higher than the AUC for Lesionpv – equilibrium (0.484) and for Lesionpeak – equilibrium (0.667). Based on ROC analysis, a cut-off of 10HU value for Lesionarterial – equilibrium would yield sensitivity and specificity of 91.5% and 80.9%, respectively. ROI analysis detected 9/21 (42.9%) of lesions missed by visual analysis. Combined ROI and visual analysis yields a sensitivity of 82/94 (87.2%) compared to 73/94 (77.7%) for visual analysis alone.

Conclusion: Our study found that those with pathological gambling had lower scores than the controls in all the domains of the quality of life scale. The impact and the extent of pathological gambling on the quality of life should be borne in mind — not only as a consideration in the management but also as an important indicator of treatment outcome of pathological gamblers.

Hepatocellular carcinoma (HCC) is the fifth most common malignancy in the world. It is estimated to cause approximately half a million deaths annually and is an epidemiologically important tumour. HCC arises mainly from patients with pre-existing chronic viral hepatitis and serological markers of chronic viral infection serve both to identify patients at risk as well as contribute supporting evidence for a diagnosis of HCC.

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