Feasibility of 4D CT Simulation with Synchronized Intravenous Contrast Injection in Hepatocellular Carcinoma

Overview

Journal Rep Pract Oncol Radiother

Specialty Oncology

Date 2020 Mar 21

PMID 32194348

Citations 9

Authors

Anil Gupta

Rishabh Kumar

Hanuman Prasad Yadav

Manik Sharma

Rose Kamal

Deepak Thaper

Prabir Banik

Shipra Gupta

Kartik Saroha

Sandeep Singh

Shiv Kumar Sarin

Affiliations

Soon will be listed here.

Abstract

Background: Delivering Stereotactic Body Radiotherapy (SBRT) for Hepatocellular Carcinoma (HCC) is challenging mainly for two reasons: first, motion of the liver occurs in six degrees of freedom and, second, delineation of the tumor is difficult owing to a similar density of HCC to that of the adjoining healthy liver tissue in a non-contrast CT scan. To overcome both these challenges simultaneously, we performed a feasibility study to synchronize intravenous contrast to obtain an arterial and a delayed phase 4D CT.

Materials And Methods: We included seven HCC patients of planned for SBRT. 4D CT simulation was performed with synchronized intravenous contrast based on the formula  T - (L/Detector Coverage × Cine Duration in Seconds). This was followed by a delayed 4D CT scan.

Results: We found that, with our protocol, it is feasible to obtain a 4DCT with an arterial and a delayed phase making it comparable to a diagnostic multi-phase CT. The peak HU of the 4D scan and diagnostic CT were similar (mean peak HU 134.2 vs 143.1, p value = 0.58 N.S). Whereas in comparison with a non-contrast CT a significant rise in the peak HU was seen (mean peak 134.2 vs 61.4 p value = .00003).

Conclusion: A synchronized contrast 4D CT simulation for HCC is safe and feasible. It results in good contrast enhancement comparable to a diagnostic 3D contrast CT scan.

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References

Liu C, Fan S . Nonresectional therapies for hepatocellular carcinoma. Am J Surg. 1997; 173(4):358-65. DOI: 10.1016/S0002-9610(96)00384-4. View

Chen G, Kung J, Beaudette K . Artifacts in computed tomography scanning of moving objects. Semin Radiat Oncol. 2004; 14(1):19-26. DOI: 10.1053/j.semradonc.2003.10.004. View

Lasley F, Mannina E, Johnson C, Perkins S, Althouse S, Maluccio M . Treatment variables related to liver toxicity in patients with hepatocellular carcinoma, Child-Pugh class A and B enrolled in a phase 1-2 trial of stereotactic body radiation therapy. Pract Radiat Oncol. 2015; 5(5):e443-e449. DOI: 10.1016/j.prro.2015.02.007. View

Furlan A, Marin D, Vanzulli A, Patera G, Ronzoni A, Midiri M . Hepatocellular carcinoma in cirrhotic patients at multidetector CT: hepatic venous phase versus delayed phase for the detection of tumour washout. Br J Radiol. 2010; 84(1001):403-12. PMC: 3473662. DOI: 10.1259/bjr/18329080. View

Liu J, Wang J, Zhao J, Xu Z, Jiang G . Use of combined maximum and minimum intensity projections to determine internal target volume in 4-dimensional CT scans for hepatic malignancies. Radiat Oncol. 2012; 7:11. PMC: 3283494. DOI: 10.1186/1748-717X-7-11. View

Bae K . Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology. 2010; 256(1):32-61. DOI: 10.1148/radiol.10090908. View

Platt J, Reige K, Ellis J . Aortic enhancement during abdominal CT angiography: correlation with test injections, flow rates, and patient demographics. AJR Am J Roentgenol. 1999; 172(1):53-6. DOI: 10.2214/ajr.172.1.9888738. View

Hong T, Bosch W, Krishnan S, Kim T, Mamon H, Shyn P . Interobserver variability in target definition for hepatocellular carcinoma with and without portal vein thrombus: radiation therapy oncology group consensus guidelines. Int J Radiat Oncol Biol Phys. 2014; 89(4):804-13. PMC: 4285340. DOI: 10.1016/j.ijrobp.2014.03.041. View

Rohlfing T, Maurer Jr C, ODell W, Zhong J . Modeling liver motion and deformation during the respiratory cycle using intensity-based nonrigid registration of gated MR images. Med Phys. 2004; 31(3):427-32. DOI: 10.1118/1.1644513. View

10.

Mancosu P, Bettinardi V, Passoni P, Gusmini S, Cappio S, Gilardi M . Contrast enhanced 4D-CT imaging for target volume definition in pancreatic ductal adenocarcinoma. Radiother Oncol. 2008; 87(3):339-42. DOI: 10.1016/j.radonc.2008.04.007. View

11.

Cardenes H, Price T, Perkins S, Maluccio M, Kwo P, Breen T . Phase I feasibility trial of stereotactic body radiation therapy for primary hepatocellular carcinoma. Clin Transl Oncol. 2010; 12(3):218-25. DOI: 10.1007/s12094-010-0492-x. View

12.

Shah S, Shukla A, Paunipagar B . Radiological features of hepatocellular carcinoma. J Clin Exp Hepatol. 2015; 4(Suppl 3):S63-6. PMC: 4284210. DOI: 10.1016/j.jceh.2014.06.009. View

13.

Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A . Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. DOI: 10.3322/caac.21492. View

14.

Llovet J, Burroughs A, Bruix J . Hepatocellular carcinoma. Lancet. 2003; 362(9399):1907-17. DOI: 10.1016/S0140-6736(03)14964-1. View

15.

Choi W, Xue M, Lane B, Kang M, Patel K, Regine W . Individually optimized contrast-enhanced 4D-CT for radiotherapy simulation in pancreatic ductal adenocarcinoma. Med Phys. 2016; 43(10):5659. PMC: 5035305. DOI: 10.1118/1.4963213. View

16.

Helou J, Karotki A, Milot L, Chu W, Erler D, Chung H . 4DCT Simulation With Synchronized Contrast Injection in Liver SBRT Patients. Technol Cancer Res Treat. 2015; 15(1):55-9. DOI: 10.1177/1533034615572341. View

17.

Hatfield M, Beres R, Sane S, Zaleski G . Percutaneous imaging-guided solid organ core needle biopsy: coaxial versus noncoaxial method. AJR Am J Roentgenol. 2008; 190(2):413-7. DOI: 10.2214/AJR.07.2676. View

18.

Beddar A, Briere T, Balter P, Pan T, Tolani N, Ng C . 4D-CT imaging with synchronized intravenous contrast injection to improve delineation of liver tumors for treatment planning. Radiother Oncol. 2008; 87(3):445-8. DOI: 10.1016/j.radonc.2007.12.009. View

19.

Tsang M . Stereotactic body radiotherapy: current strategies and future development. J Thorac Dis. 2016; 8(Suppl 6):S517-27. PMC: 4990666. DOI: 10.21037/jtd.2016.03.14. View

20.

Zaydfudim V, Vachharajani N, Klintmalm G, Jarnagin W, Hemming A, Doyle M . Liver Resection and Transplantation for Patients With Hepatocellular Carcinoma Beyond Milan Criteria. Ann Surg. 2016; 264(4):650-8. PMC: 5279918. DOI: 10.1097/SLA.0000000000001866. View