Abstract
PurposeThe purpose of this study is to evaluate the use of density measurements in the diagnosis of an underlying residual tumor beyond iodine depositions after Lipiodol-based conventional transarterial chemoembolization (cTACE).Method and materialsThirty follow-up CT scans of 20 patients 6–12 weeks after Lipiodol-based cTACE, receiving a digital subtraction angiography at the same time, were analyzed. Reference for the detection of a residual tumor was the angiography, and a visible contrast enhancement was categorized as a residual tumor (n = 16 with residual tumor; n = 14 without residual tumor). The density of the iodine depositions was measured in all containing slices in non-contrast-, arterial- and portal venous-phase CT scans, with a slice thickness of 5.00 mm. The mean density of the iodine deposition during the portal venous phase was subtracted from the mean density of the arterial phase to calculate the density changes (a positive enhancement score represents washout in the portal venous phase). In addition, a quotient relating to the non-contrast measurement was evaluated.ResultsPatients with a residual tumor displayed significantly higher enhancement scores in favor of density reduction between the arterial and portal venous phases, compared to patients without a residual tumor (1.41 ± 3.59, n = 14 vs. -13.97 ± 2.88, n = 16; p-value < 0.01). Furthermore, 87.75% of patients with an enhancement score higher than -1.00 (n = 9) had a residual tumor, whereas 100.00% of patients with an enhancement score lower than -20.00 (n = 6) were shown to be tumor-free. The enhancement score quotient resulted in similar findings.ConclusionAfter cTACE in patients with hepatocellular carcinoma (HCC), the presence of a viable tumor correlated with enhancement scores based on the density measurements of iodine depositions in different phases of the CT scan. Low enhancement scores were associated with completely treated tumors and can aid the decision process to avoid possibly unnecessary angiographies.
Highlights
In 2018, hepatocellular carcinoma (HCC) was the fifth most common cause of cancer in men and the second most common cause of cancer-related death worldwide [1]
After conventional transarterial chemoembolization (TACE) (cTACE) in patients with hepatocellular carcinoma (HCC), the presence of a viable tumor correlated with enhancement scores based on the density measurements of iodine depositions in different phases of the computed tomographies (CTs) scan
Low enhancement scores were associated with completely treated tumors and can aid the decision process to avoid possibly unnecessary angiographies
Summary
In 2018, hepatocellular carcinoma (HCC) was the fifth most common cause of cancer in men and the second most common cause of cancer-related death worldwide [1]. It is associated with liver cirrhosis, Hepatitis B/C/D, alcohol abuse and obesity, reducing the operability and therapeutic options [2]. This leads to a poor median overall survival of 20 months after diagnosis [3].
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