Abstract
BackgroundC-arm computed tomography (CT) guided intervention is an increasingly applied technique in transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). The aim of this study was to analyse the value of parenchymal blood volume (PBV) maps acquired during C-arm CT acquisition, for pre-treatment evaluation and planning of TACE in HCC patients.MethodsA total of 64 HCC lesions in 29 patients (median age, 73 years, range, 62–77 years) were included in this retrospective study. All patients received cross-sectional imaging (MRI or CT) prior to TACE and C-arm CT PBV measurement acquisition before performing TACE. Results of cross-sectional imaging regarding the number of HCC lesions and maximum diameter were compared to PBV–maps. Number of lesions and tumour feeding vessels detected in PBV-maps were compared to conventional angiography. Results of PBV were analysed concerning different tumour morphologies (pre-treated, encapsulated and diffuse).ResultsPre-interventional cross-sectional imaging and PBV maps showed an excellent agreement in lesion diameter (p = 0.88, MD = −0.28 mm) and number of detected lesions (κ = 1.0). Compared to conventional angiography, PBV maps showed an increased number of detected lesions (κ = 0.77, p = 0.001) and tumour feeding vessels (κ = 0.71, p < 0.0001). Diffuse HCC lesion revealed a significantly lower PBV compared to encapsulated lesions (p = 0.0001).ConclusionsC-arm CT acquired PBV measurements detect HCC tumours with a lesion detectability comparable to pre-interventional cross-sectional imaging. Furthermore, this technique facilitates TACE, allowing a more precise localization of HCC lesions and tumour feeding vessels compared to conventional angiography. Additionally, calculated PBV values enable a real time quantitative assessment of tumour perfusion.
Highlights
C-arm computed tomography (CT) guided intervention is an increasingly applied technique in transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC)
Lesion detection in parenchymal blood volume (PBV) maps and pre-interventional imaging PBV-based C-arm CT was feasible in all patients and provided diagnostic quality in all cases
All HCC typical lesions (64/64, lesion diameter >10 mm) detected in preinterventional imaging have been identified in PBV maps (κ = 1, p = 1.0) (Fig. 1). 49/64 lesions were detected in conventional angiography (κ = 0.77, p = 0.001)
Summary
C-arm computed tomography (CT) guided intervention is an increasingly applied technique in transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). The aim of this study was to analyse the value of parenchymal blood volume (PBV) maps acquired during C-arm CT acquisition, for pre-treatment evaluation and planning of TACE in HCC patients. The aim of C-arm CT with a flat detector panel as part of an angiographic suite is to improve the performance of intraarterial treatments such as TACE or selective internal radiation therapy [5]. It allows intraprocedural acquisition of a volume of interest and post-processing including maximum intensity projections and multiplanar reconstructions comparable to conventional CT. Its application in neurological imaging has been reported [11] to show benefits as a monitoring tool during the procedure and as an important tool during the pre-selection process of patients
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