Identifying Feeding Arteries During TACE of Hepatic Tumors: Comparison of C-Arm CT and Digital Subtraction Angiography

Abstract

This study compares the diagnostic accuracy of C-arm CT with digital subtraction angiography (DSA) in identifying tumor-feeding arteries during superselective transarterial chemoembolization (TACE). Thirty-three consecutive patients with hepatocellular carcinoma (HCC) underwent superselective TACE using a flat-detector angiographic system. Angiographic operators determined which feeding arteries were potentially supplying the target tumor. When two or more feeding arteries were possible, all were included. Superselective DSA and C-arm CT were sequentially performed for each studied artery. Four independent observers separately viewed the DSA and C-arm CT images and used a 5-point grading scale to determine whether a studied artery supplied the target tumor. Diagnostic performance was compared using receiver operating characteristic (ROC) analysis. Sensitivity, specificity, and accuracy were calculated for arteries rated as definite or probable tumor feeders. Iodized oil accumulation on follow-up CT was the reference standard. We examined 58 possible feeding arteries in 33 patients. Among the studied arteries, follow-up CT confirmed that 33 were verified tumor-feeding arteries, and the remaining 25 were not. C-arm CT resulted in a significantly larger area under the ROC curve (A(z) = 0.995) compared with DSA (A(z) = 0.841). The sensitivity, specificity, and accuracy of C-arm CT (96.9%, 97.0%, and 96.9%, respectively) were significantly higher than those for DSA (77.2%, 73.0%, and 75.4%). C-arm CT is superior to DSA for identifying tumor-feeding arteries during superselective TACE for HCC.