Abstract
PurposeIt is well recognized that therapeutic irradiation can result in bone damage. However, long-term bone toxicity associated with computed tomography (CT) performed during interventional angiography has received little attention. The purpose of this study was to determine the prevalence of osteoporosis and trabecular microstructural changes in patients after transarterial chemoembolization (TACE) for hepatocellular carcinoma therapy using an interventional-CT system.Materials and MethodsSpinal microarchitecture was examined by 64-detector CT in 81 patients who underwent TACE, 35 patients with chronic hepatitis, and 79 controls. For each patient, the volumetric CT dose index (CTDIv) during TACE (CTDIv (TACE)), the dose-length product (DLP) during TACE (DLP (TACE)), and CTDIv and DLP of routine dynamic CT scans (CTDIv (CT) and DLP (CT), respectively), were calculated as the sum since 2008. Using a three dimensional (3D) image analysis system, the tissue bone mineral density (tBMD) and trabecular parameters of the 12th thoracic vertebra were calculated. Using tBMD at a reported cutoff value of 68 mg/cm3, the prevalence of osteoporosis was assessed.ResultsThe prevalence of osteoporosis was significantly greater in the TACE vs. the control group (39.6% vs. 18.2% for males, P<0.05 and 60.6% vs. 34.8% for females, P<0.01). Multivariate regression analysis demonstrated that sex, age, and CTDIv (CT) significantly affected the risk of osteoporosis. Of these indices, CTDIv (CT) had the highest area under the curve (AUC) (0.735). Correlation analyses of tBMD with cumulative radiation dose revealed weak correlations between tBMD and CTDIv (CT) (r 2 = 0.194, P<0.001).ConclusionThe prevalence of osteoporosis was significantly higher in post TACE patients than in control subjects. The cumulative radiation dose related to routine dynamic CT studies was a significant contributor to the prevalence of osteoporosis.
Highlights
The number of computed tomography (CT)-guided interventional procedures has increased because they are less invasive and more cost-effective than open surgery [1,2,3]
The prevalence of osteoporosis was significantly greater in the transarterial chemoembolization (TACE) vs. the control group (39.6% vs. 18.2% for males, P,0.05 and 60.6% vs. 34.8% for females, P,0.01)
Multivariate regression analysis demonstrated that sex, age, and CTDIv (CT) significantly affected the risk of osteoporosis
Summary
The number of computed tomography (CT)-guided interventional procedures has increased because they are less invasive and more cost-effective than open surgery [1,2,3]. Transarterial embolization therapies involve the transcatheter delivery of solid particles into an artery feeding a target tumor for the purpose of blocking its blood supply. These therapies include bland embolization, transarterial chemoembolization (TACE), and chemoembolization using drug-eluting beads. Two-dimensional or three-dimensional CT images are acquired to generate a road map of the targets and their positions relative to the interventional instruments. This valuable information provides guidance for the operator to locate the target, plan an interventional path, adjust the interventional instruments, and evaluate the efficacy of the procedure. Age (years) BMI (kg/m2) Radiation exposure CTDIv (CT) (mGy) CTDIv (TACE) (mGy) DLP (CT) (mGy6cm) DLP (TACE) (mGy6cm) Entrance skin dose (mGy)
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