C-arm Cone-beam CT Parenchymal Blood Volume Imaging for Transarterial Chemoembolization of Hepatocellular Carcinoma: Implications for Treatment Planning and Response

Overview

Journal Eur Radiol Exp

Date 2019 May 31

PMID 31144237

Citations 1

Authors

Rory L ODonohoe

Richard G Kavanagh

Alexis M Cahalane

Diarmaid D Houlihan

Jeffrey W McCann

Edmund Ronan Ryan

Affiliations

Soon will be listed here.

Abstract

We report on the feasibility of C-arm cone-beam computed tomography (CBCT) parenchymal blood volume imaging (PBVI) performed immediately following transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) to assess the need for repeat treatment. Eighteen TACE procedures were included. A retrospective assessment was made for the presence or absence of residual disease requiring treatment on immediate post-TACE PBVI and on interval follow-up multidetector computed tomography (MDCT) or magnetic resonance imaging (MRI). In 9/18 cases, both PBVI and MDCT/MRI showed that no further treatment was required. In 6/18 cases, further treatment was required on both PBVI and MDCT/MRI. In three cases, PBVI showed that further treatment was not required but MDCT/MRI showed residual disease requiring repeat treatment. There were no cases with PBVI showing residual disease not detected on follow-up MDCT/MRI. The PBVI sensitivity for detecting disease requiring repeat TACE was 67% (95% confidence interval [CI] 30-93%), and specificity was 100% (95% CI 66-100%). The use of C-arm CBCT PBVI for the detection of residual viable tumor within a treated lesion immediately after TACE is feasible. It may allow repeat TACE to be planned without performing interval imaging with MDCT or MRI.

Citing Articles

The Role of Immediate Post-Procedural Cone-Beam Computed Tomography (CBCT) in Predicting the Early Radiologic Response of Hepatocellular Carcinoma (HCC) Nodules to Drug-Eluting Bead Transarterial Chemoembolization (DEB-TACE).

Fronda M, Mistretta F, Calandri M, Ciferri F, Nardelli F, Bergamasco L J Clin Med. 2022; 11(23).

PMID: 36498664 PMC: 9740708. DOI: 10.3390/jcm11237089.

References

Llovet J, Real M, Montana X, Planas R, Coll S, Aponte J . Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002; 359(9319):1734-9. DOI: 10.1016/S0140-6736(02)08649-X. View

Llovet J, Bruix J . Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology. 2003; 37(2):429-42. DOI: 10.1053/jhep.2003.50047. View

Gomaa A, Khan S, Toledano M, Waked I, Taylor-Robinson S . Hepatocellular carcinoma: epidemiology, risk factors and pathogenesis. World J Gastroenterol. 2008; 14(27):4300-8. PMC: 2731180. DOI: 10.3748/wjg.14.4300. View

Kloeckner R, Otto G, Biesterfeld S, Oberholzer K, Dueber C, Pitton M . MDCT versus MRI assessment of tumor response after transarterial chemoembolization for the treatment of hepatocellular carcinoma. Cardiovasc Intervent Radiol. 2009; 33(3):532-40. DOI: 10.1007/s00270-009-9728-y. View

Tognolini A, Louie J, Hwang G, Hofmann L, Sze D, Kothary N . Utility of C-arm CT in patients with hepatocellular carcinoma undergoing transhepatic arterial chemoembolization. J Vasc Interv Radiol. 2010; 21(3):339-47. DOI: 10.1016/j.jvir.2009.11.007. View

Lencioni R, Llovet J . Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010; 30(1):52-60. DOI: 10.1055/s-0030-1247132. View

Ippolito D, Bonaffini P, Ratti L, Antolini L, Corso R, Fazio F . Hepatocellular carcinoma treated with transarterial chemoembolization: dynamic perfusion-CT in the assessment of residual tumor. World J Gastroenterol. 2010; 16(47):5993-6000. PMC: 3007114. DOI: 10.3748/wjg.v16.i47.5993. View

Iwazawa J, Ohue S, Hashimoto N, Muramoto O, Mitani T . Survival after C-arm CT-assisted chemoembolization of unresectable hepatocellular carcinoma. Eur J Radiol. 2012; 81(12):3985-92. DOI: 10.1016/j.ejrad.2012.08.012. View

Loffroy R, Lin M, Yenokyan G, Rao P, Bhagat N, Noordhoek N . Intraprocedural C-arm dual-phase cone-beam CT: can it be used to predict short-term response to TACE with drug-eluting beads in patients with hepatocellular carcinoma?. Radiology. 2012; 266(2):636-48. PMC: 3558876. DOI: 10.1148/radiol.12112316. View

10.

Fiorella D, Turk A, Chaudry I, Turner R, Dunkin J, Roque C . A prospective, multicenter pilot study investigating the utility of flat detector derived parenchymal blood volume maps to estimate cerebral blood volume in stroke patients. J Neurointerv Surg. 2013; 6(6):451-6. PMC: 4112493. DOI: 10.1136/neurintsurg-2013-010840. View

11.

Zhuang Z, Zhang X, Han J, Beilner J, Deuerling-Zheng Y, Chi J . Hepatic blood volume imaging with the use of flat-detector CT perfusion in the angiography suite: comparison with results of conventional multislice CT perfusion. J Vasc Interv Radiol. 2014; 25(5):739-46. DOI: 10.1016/j.jvir.2014.01.021. View

12.

Ippolito D, Fior D, Bonaffini P, Capraro C, Leni D, Corso R . Quantitative evaluation of CT-perfusion map as indicator of tumor response to transarterial chemoembolization and radiofrequency ablation in HCC patients. Eur J Radiol. 2014; 83(9):1665-71. DOI: 10.1016/j.ejrad.2014.05.040. View

13.

Forner A, Gilabert M, Bruix J, Raoul J . Treatment of intermediate-stage hepatocellular carcinoma. Nat Rev Clin Oncol. 2014; 11(9):525-35. DOI: 10.1038/nrclinonc.2014.122. View

14.

Peynircioglu B, Hizal M, Cil B, Deuerling-Zheng Y, von Roden M, Hazirolan T . Quantitative liver tumor blood volume measurements by a C-arm CT post-processing software before and after hepatic arterial embolization therapy: comparison with MDCT perfusion. Diagn Interv Radiol. 2014; 21(1):71-7. PMC: 4463359. DOI: 10.5152/dir.2014.13290. View

15.

Vogl T, Schaefer P, Lehnert T, Nour-Eldin N, Ackermann H, Mbalisike E . Intraprocedural blood volume measurement using C-arm CT as a predictor for treatment response of malignant liver tumours undergoing repetitive transarterial chemoembolization (TACE). Eur Radiol. 2015; 26(3):755-63. DOI: 10.1007/s00330-015-3869-y. View

16.

Vincenzi B, Di Maio M, Silletta M, DOnofrio L, Spoto C, Piccirillo M . Prognostic Relevance of Objective Response According to EASL Criteria and mRECIST Criteria in Hepatocellular Carcinoma Patients Treated with Loco-Regional Therapies: A Literature-Based Meta-Analysis. PLoS One. 2015; 10(7):e0133488. PMC: 4521926. DOI: 10.1371/journal.pone.0133488. View

17.

Syha R, Grozinger G, Grosse U, Maurer M, Zender L, Horger M . Parenchymal Blood Volume Assessed by C-Arm-Based Computed Tomography in Immediate Posttreatment Evaluation of Drug-Eluting Bead Transarterial Chemoembolization in Hepatocellular Carcinoma. Invest Radiol. 2015; 51(2):121-6. DOI: 10.1097/RLI.0000000000000215. View

18.

Syha R, Grozinger G, Grosse U, Maurer M, Zender L, Horger M . C-arm computed tomography parenchymal blood volume measurement in evaluation of hepatocellular carcinoma before transarterial chemoembolization with drug eluting beads. Cancer Imaging. 2015; 15:22. PMC: 4696182. DOI: 10.1186/s40644-015-0057-x. View