Does the presence of distant and local malignancy alter parenchymal perfusion in apparently disease-free areas of the liver?

Our objective was to investigate if hepatic arterial (HAP) and portal venou s perfusion (PVP) in apparently normal areas of liver, as measured by funct ional CT, are affected by the presence of extra- and intrahepatic malignanc y Three patient groups were compared: A, controls with no malignancy (N = 1 0); B, extrahepatic malignancy without liver involvement (N = 12); and C, s ubjects with metastases elsewhere in the liver (N = 13). HAP, PVP, and a CT hepatic perfusion index (CT-HPI) calculated as HAP/(HAP + PVP) were calcul ated on a section free of metastatic disease, using a previously published method. Figures for PVP were (median and interquartile range) in group A we re 1.06 (0.9-1.30). in B 1.03 (0.81-1.09), and in C 0.75 (0.54-1.02) ml/min /ml; for HAP group A values were 0.07 (0.052-0.078), in B 0.07 (0.053-0.147 ), and in C 0.12 (0.091-0.146) ml/min/ml and for CT-HPI Group A values were 4.9% (4.8-6.6%), in B 5.6% (3.8-13.6%), and in C 14.3% (10.4-15.4%). Signi ficant differences in all indices were seen between groups A and C. A signi ficant difference (P = 0.017) was seen between groups B and C in the CT-HPI values. In conclusion, patients with liver metastases show abnormal blood flow in apparently normal liver compared to controls. This difference was n ot seen in subjects with malignancy without liver metastases. Possible expl anations would be either the unmasking of occult metastatic disease or vaso active or mechanical effects due to liver malignancy.