Quantitative dual-energy CT for evaluating hepatocellular carcinoma after transarterial chemoembolization

Xiaofei Yue,Xuehan Hu,Ming Yang,Songlin Song,Qian Li,Chunyuan Cen,Yuting Lu,Qiqi Jiang,Kun Qian,Ping Han

doi:10.1038/s41598-021-90508-9

Abstract

We aimed to investigate the role of the quantitative parameters of dual-energy computed tomography (DECT) in evaluating patients with hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE). We retrospectively identified 80 HCC patients (mean age, 56 years; 61 men) treated by TACE who received contrast-enhanced DECT and were retreated by TACE within 7 days between November 2018 and December 2019. Taking digital subtraction angiography (DSA) and CT images as reference standard, two readers measured and calculated the values of normalized iodine concentration at arterial phase (NICAP), normalized iodine concentration at portal venous phase (NICPP), iodine concentration difference (ICD), arterial iodine fraction (AIF) and slope of the spectral Hounsfield unit curve (λHu) by placing matched regions of interests (ROIs) within the tumor active area (TAA), adjacent normal hepatic parenchyma (ANHP) and tumor necrotic area (TNA). Differences between the parameters were analyzed by the Kruskal–Wallis H test. Receiver operating characteristic analysis of the parameters performance in differentiating the three tissues types was performed. AIF exhibited a good performance in distinguishing TAA (0.93 ± 0.31) and ANHP (0.18 ± 0.14), the areas under the receiver operating characteristic curve (AUC) was 0.989, while the λHu exhibited an excellent performance in distinguishing TAA (3.32 ± 1.24) and TNA (0.29 ± 0.27), with an AUC of 1.000. In conclusion, quantitative DECT can be effectively used to evaluate the tumor viability in HCC patients treated by TACE.

Highlights

Abbreviations HCC Hepatocellular carcinoma transarterial chemoembolization (TACE) Transarterial chemoembolization normalized iodine concentration at arterial phase (NICAP) Normalized iodine concentration at arterial phase normalized iodine concentration at portal venous phase (NICPP) Normalized iodine concentration at portal venous phase λHu Slope of spectral Hounsfield unit curve iodine concentration difference (ICD) Iodine concentration difference arterial iodine fraction (AIF) Arterial iodine fraction tumor active area (TAA) Tumor active area adjacent normal hepatic parenchyma (ANHP) Adjacent normal hepatic parenchyma tumor necrotic area (TNA) Tumor necrotic area
The purpose of this study was to quantitatively differentiate the tumor active area (TAA), adjacent normal hepatic parenchyma (ANHP) and tumor necrotic area (TNA) after TACE using dual-energy computed tomography (DECT) parameters, providing an alternative method for the follow-up of patients with HCC and that may be used as a supplement to Liver Imaging Reporting and Data System (LI-RADS) v2018
We found that the DECT parameters, especially λHu at the arterial phase and NICAP, showed high efficiency for discriminating the different tissues in patients with HCC, with an AUC values of 0.987 and 0.988, for the recognition of the TAA and ANHP, respectively, and an AUC values of 1.000, and 0.997 for the recognition of the TAA and TNA, respectively

Summary

Introduction

Abbreviations HCC Hepatocellular carcinoma TACE Transarterial chemoembolization NICAP Normalized iodine concentration at arterial phase NICPP Normalized iodine concentration at portal venous phase λHu Slope of spectral Hounsfield unit curve ICD Iodine concentration difference AIF Arterial iodine fraction TAA Tumor active area ANHP Adjacent normal hepatic parenchyma TNA Tumor necrotic area. Hepatocellular carcinoma (HCC) is a common malignant tumor. TACE is the first-line treatment for the intermediate stage of HCC according to the BCLC s ystem[5]. Imaging evaluation after TACE is very important. The revised Response Evaluation Criteria in Solid Tumors (mRECIST) proposed in 20107 and the Liver Imaging Reporting and Data System (LI-RADS) version 2 0188 both set standards for the treatment response of liver cancer. The treatment response standards of both protocols are based on imaging features rather than a quantitative evaluation. The mixed energy image of a conventional CT scan may give rise to ray beam-hardening artifacts, and the high density of lipiodol deposition may cause a shielding effect on adjacent structures that affects the visual observation and evaluation

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