C-arm computed tomography and volume perfusion computed tomography (VPCT)-based assessment of blood volume changes in hepatocellular carcinoma in prediction of midterm tumor response to transarterial chemoembolization: a single center retrospective trial

Abstract

BackgroundThis study aims to evaluate immediate changes in perfusion parameters in hepatocellular carcinoma (HCC) to transarterial chemoembolization (TACE) in C-arm computed tomography (CT) and volume perfusion CT (VPCT) and prediction of midterm tumor response.MethodsTwenty-five patients (median age 66, range 61 to 75 years) with 62 HCC lesions undergoing TACE received immediate pre- and post-interventional assessment by C-arm CT and VPCT. Cross-sectional imaging was analyzed at baseline and approximately 12 weeks after TACE according to modified RECIST criteria. Outcome was defined as objective response (OR, > 30 % reduction of viable tumor) or non-OR. Perfusion parameters were evaluated in C-arm CT [parenchymal blood volume (PBV)] and VPCT [blood volume (BV) and blood flow (BF)]. Ratios of perfusion parameters before and after TACE within the tumor and the non-affected liver parenchyma were calculated.ResultsCorrelation between tumor PBV and BV revealed a moderate correlation (rho = 0.45, p = 0.005). In non-affected liver parenchyma, a significant decrease in PBV was seen, compared to a significant increase in BF and BV. Perfusion ratios in HCC lesions were significantly (p < 0.05) increased in OR group compared to non-OR patients in C-arm CT and VPCT: PBV ratio (0.95 (0.06) to 0.67 (0.38), BV ratio 0.63 (0.34) to 0.15 (0.6), and BF ratio 0.6 (0.32) to 0.22 (0.51). Logistic regression including PBV and BF allowed prediction of OR (sensitivity 88 %/specificity of 83 %).ConclusionsPerfusion parameters acquired by C-arm CT and VPCT cannot simply be substituted by each other, but show similar capability in prediction of midterm tumor response.

Efficacy and safety profile of drug-eluting beads transarterial chemoembolization by CalliSpheres® beads in Chinese hepatocellular carcinoma patients

“…Although criteria have been made for the prognosis of HCC patients, such as BCLC stage for risk stratify and Child-pugh class for liver function staging, predictive factors for treatment response of DEB-TACE are still not well established. C-arm CT and volume perfusion CT (VPCT) for blood volume assessment have been reported by a prior study that they are able to predict the midterm tumor response of patients [ 21 ]. Furthermore, a study illustrates that tumor heterogeneity and tumor enhancement more than 50% are correlated with CR in HCC patients after DEB-TACE therapy [ 22 ].…”

A clinically oriented computer model for radiofrequency ablation of hepatic tissue with internally cooled wet electrode

“…As tumour blood perfusion coefficient (x b ) has been reported within a wide range of values: 0.0027 s -1 [32], 0.0053 s -1 [43], 0.0069 s -1 [45], 0.0096 s -1 [33], 0.011 s -1 (63.8 mL/100g min À1 , [46]) and 0.009 s -1 (510 mL kg À1 min À1 , [30]), we chose a value of 0.009 s -1 as it was the reference we used for healthy tissue and agreed with Aramburu et al [45], who suggested that perfusion in healthy tissue is different from that of tumour tissue. While healthy tissue is supplied through the portal vein and hepatic artery, a tumour is exclusively supplied from the hepatic artery, which could mean the blood perfusion rate is higher in healthy tissue than in the tumour.…”

“…Again, we assessed the time-step suitability by an analogous sensitivity analysis. Table 1 shows the parameter values used in the model [29][30][31][32][33][34][35][36][37][38][39][40][41]. Healthy liver electrical conductivity (r) was set to 0.2 S m À1 at a reference temperature of 37 C, within the range of values reported in the literature: 0.132 S m À1 [29], 0.143 S/m [30] and 0.260 S m À1 [42].…”

“…This assumption led to lower initial tissue impedance and matched the clinical values (see Section 3.1 Clinical results). [35] 1080 [29] 1045 [31] 1045 [31] GP 370 [29] 370 [29] 370 [29] Specific heat (J kg À1 K À1 ) LP 1045 [35] 480 [35] 3455 [29] 3760 [31] 3760 [31] GP 2156 [29] 2156 [29] 2156 [ [40] 5.316Á10 50 [41] 5.316Á10 50 [41] Activation energy (J mol À1 ) 2.577Á10 5 [40] 3.238Á10 5 [41] 3.238Á10 5 [41] Blood perfusion (s -1 ) 0.016 [30] 0.009 [30,33] 0.009 [30,33] Electrical conductivity of tissue was measured at 37 C; LP: water in liquid phase; GP: water in gas phase.…”

Correlation of C-arm CT acquired parenchymal blood volume (PBV) with 99mTc-macroaggregated albumin (MAA) SPECT/CT for radioembolization work-up

“…PBV has been shown to correlate with other parameters of perfusion measurement like volume perfusion CT [ 14 ] and to enable the visual and quantitative assessment of tumor-perfusion directly during the angiographic work-up procedure. Furthermore, the acquisition of 3D C-arm CTs improve the detection of aberrant vessels and identification of vascular territory supply compared to regular digital subtraction angiography images and has become part of the routine work-up in various centers [ 15 – 17 ].…”