Abstract
BackgroundTo investigate accuracy of intraprocedural cone beam computed tomography (CBCT) compared to fluoroscopy for detection of lipiodol retention pattern during conventional transarterial chemoembolization (cTACE) of hepatocellular carcinoma (HCC) and its correlation with short-term response.MethodsBetween September 2013 and July 2014, 29 patients with HCC underwent chemoembolization of 51 tumors (mean diameter 28.1 mm, range 10.0–136.3 mm). Lipiodol retention pattern was assessed by CBCT at the endpoint of cTACE compared by fluoroscopy. Depending on the pattern of tumor covered by lipiodol three classes were defined: complete (more than 90 %, no peripheral defects), moderate (50–90 %, some with or without peripheral defects), and poor (less than 50 %). Tumor response was assessed by modified Response Evaluation Criteria in Solid Tumors (mRECIST) based on follow-up contrast enhanced (CE) computed tomography (CT) or magnetic resonance imaging (MRI) obtained 4–6 weeks post-cTACE. Correlations between lipiodol retention patterns on CBCT and fluoroscopy as well as tumor response were assessed using multivariate logistic regression.ResultsOf 51 hepatic tumors, 40 (78.4 %) had complete response (CR); 8 (15.7 %) had partial response (PR); 1 (2.0 %) had stable disease (SD); and 2 (3.9 %) had progressive disease (PD). The degree of lipiodol retention scored excellent, moderate, and poor, in fluoroscopic images vs CBCT images were 23 (45.1 %) vs 39 (76.5 %), 19 (37.3 %) vs 11 (21.6 %), and 9 (17.6 %) vs 1 (2.0 %), respectively. Lipiodol retention assessment with CBCT (Az = 0.75) is more accurate than fluoroscopy (Az = 0.54) in predicting target tumor response. Other than lipiodol retention pattern assessed with CBCT (p = 0.01), tumor size (p = 0.04) is an independent predictors of CR.ConclusionCBCT is more accurate than fluoroscopy in classification of lipiodol retention pattern in HCC tumors at the time of cTACE. CBCT could be used as a reliable intra precedural monitoring modality of cTACE.
Highlights
To investigate accuracy of intraprocedural cone beam computed tomography (CBCT) compared to fluoroscopy for detection of lipiodol retention pattern during conventional transarterial chemoembolization of hepatocellular carcinoma (HCC) and its correlation with short-term response
The goal of this study was to investigate whether gross lipiodol retention pattern on CBCT imaging immediately after conventional transarterial chemoembolization (cTACE) of hepatocellular carcinoma can be used as predictor of tumor response by modified Response Evaluation Criteria in Solid Tumors (mRECIST), and whether this could be used as a reliable intra procedural monitoring modality
In this study we demonstrated the lipiodol retention pattern on CBCT immediately after cTACE can be used to predict the short-term tumor response at 4–6 weeks follow-up in HCC patient by mRECIST
Summary
To investigate accuracy of intraprocedural cone beam computed tomography (CBCT) compared to fluoroscopy for detection of lipiodol retention pattern during conventional transarterial chemoembolization (cTACE) of hepatocellular carcinoma (HCC) and its correlation with short-term response. Intraprocedural image monitoring is important to assess the endpoint of TACE and application of additional treatment if needed while the patient is still in the angiography suite. Visualizing distribution of lipiodol after chemoembolization by fluoroscopy or computed tomography (CT) scan ensures tumor targeting [10]. Computed tomography is more accurate to depict cross-sectional lipiodol distribution [12], but it is cumbersome to transfer patients from the angiography suite to the CT suite since the hybrid angiography-CT systems are not always available
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