CT perfusion for response evaluation after interventional ablation of hepatocellular carcinoma: a prospective study

Mohamed Fouad Osman,Islam H Shawali,Ahmed Hosni Kamel,Lamiaa I A Metwally,Mohamed El Sherbiny Ibrahim

doi:10.1186/s43055-021-00660-5

Mohamed Fouad Osman, Islam H Shawali + Show 3 more

Open Access

https://doi.org/10.1186/s43055-021-00660-5

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Abstract

BackgroundComputed tomography (CT) perfusion was found to be useful in assessing treatment response in a variety of cancers through the evaluation in the arterial perfusion changes. We investigated the performance of CT perfusion parameters for assessment of hepatocellular carcinoma (HCC) response to radiofrequency ablation (RFA) and trans-arterial chemoembolization (TACE). We conducted a prospective diagnostic test accuracy study that recruited 70 HCC patients who were scheduled to undergo TACE or RFA. For each dynamic CT scan acquisition, four single perfusion CT image maps were generated, including functional maps of blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface (PS).ResultsIn TACE-treated lesions, the BV achieved a sensitivity and specific of 100% and 83.3%, at a cutoff level of ≤ 122 ml/min/100 gm, for responders. Likewise, at a cutoff level of > 10 s, transit time had a sensitivity of 90.5% and specificity of 100%. At a cutoff level of ≤ 14 ml/min/100 gm, the PS had a sensitivity of 100% and specificity of 83.33% for responders. In RFA-treated lesions, at a cutoff level of ≤ 170 ml/min/100 gm and ≤ 11 ml/100 gm, the BF and BV had a sensitivity of 100% and specificity 100%, respectively, for responders. At a cutoff level of ≤ 11 ml/min/100 gm, PS had a sensitivity 77.27% and specificity 80%.ConclusionsThe present study confirms the feasibility of CT perfusion for assessment of response to TACE and RFA among patients with HCC.

Highlights

Computed tomography (CT) perfusion was found to be useful in assessing treatment response in a variety of cancers through the evaluation in the arterial perfusion changes
The size of target lesions under assessment post-therapy was 3.5 ± 1.4 cm, 54 of which were located in the right hepatic lobe different segments; 64 patients were investigated after their first locoregional treatment session while the rest had several sessions before 3 ± 1
Treatment response of the target lesions was described according to CT perfusion results as responder and recurrent lesion activity based on perfusion parameters, and those results were confirmed through correlation with four phase CT or MRI studies based on Modified Response Evaluation Criteria in Solid Tumors (RECIST) (mRECIST) criteria as well as correlation with tumor markers levels

Summary

Introduction

Computed tomography (CT) perfusion was found to be useful in assessing treatment response in a variety of cancers through the evaluation in the arterial perfusion changes. We investigated the performance of CT perfusion parameters for assessment of hepatocellular carcinoma (HCC) response to radiofrequency ablation (RFA) and trans-arterial chemoembolization (TACE). The management of HCC relies mainly in disease stages, with ablation and trans-arterial chemoembolization offered to patients with early and intermediate stages [10]. According to several clinical trials, RFA and TACE had significantly improved the outcomes of survival of HCC patients, with manageable safety profile [11]. Both techniques are the most common approaches for HCC management in many centers. Assessment of patients’ response to RFA/ TACE is essential step in the management algorithms of HCC [2]. Several imaging-based modalities were proposed for accurate evaluation of patients’ response to loco regional treatment

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Discussion

Conclusion