Intraprocedural 3D Quantification of Lipiodol Deposition on Cone-Beam CT Predicts Tumor Response After Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma

Abstract

Purpose To evaluate whether intraprocedural 3D quantification of Lipiodol deposition on cone-beam computed tomography (CBCT) can predict tumor response on follow-up contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE). Materials and Methods This IRB approved, retrospective analysis included 36 patients with 51 HCC target lesions, who underwent cTACE with CBCT. CE-MRI was acquired at baseline and 1 month after cTACE. Overall tumor volumes as well as intra-tumoral Lipiodol volumes on CBCT were measured and compared with the overall and necrotic (non-enhancing) tumor volumes on CE-MRI using the paired student’s t-test. Tumor response on CE-MRI was assessed using modified Response Evaluation Criteria in Solid Tumors (mRECIST). A linear regression model was used to correlate tumor volumes, Lipiodol volumes and the percentage of Lipiodol deposition on CBCT with the corresponding parameters on CE-MRI. Nonparametric spearman rank order correlation and trend test were used to correlate the percentage of Lipiodol deposition in the tumor with tumor response. Result A strong correlation between overall tumor volumes on CBCT and CE-MRI was observed (R2=0.986). In addition, a strong correlation was obtained between the volume of Lipiodol deposition on CBCT and tumor necrosis (in cm3) on CE-MRI (R2=0.960); and between the percentage of Lipiodol deposition and tumor necrosis (R2=0.979). Importantly, the extent of Lipiodol deposition (in percentage of total tumor volume) correlated strongly with tumor response on CE-MRI (Spearman rho=0.84, p<0.001). Conclusions Intraprocedural 3D quantification of Lipiodol deposition on CBCT can be used to predict tumor response on follow-up CE-MRI.

Performance of novel virtual parenchymal perfusion software visualizing embolized areas of transcatheter arterial chemoembolization for hepatocellular carcinoma

“…A preliminary study showed a strong correlation between the virtual perfusion territories on non-selective CBCTHA and the actual selective injection areas on selective CBCTHA with an average dice of 0.76, an average surface-to-surface distance of 4.4 mm, and an average volume error of 14%. 19 In the present study, the dimensions and volume of the VEA and REA correlated well in the majority of tumors. In our study protocol, however, all CBCT images were obtained in the expiratory phase, and CT images were obtained in the inspiratory phase.…”

“…The extraction of any vascular territory can be carried out instantly on the workstation. A preliminary study showed a strong correlation between the virtual perfusion territories on non‐selective CBCTHA and the actual selective injection areas on selective CBCTHA with an average dice of 0.76, an average surface‐to‐surface distance of 4.4 mm, and an average volume error of 14% …”

Utility of ‘dual phase’ cone beam computed tomography during radioembolisation in patients with hepatocellular carcinoma: what is really changing in flow dynamics before and after 90Y delivery?

“…This is the first study comparing these two couples of CBCT data achieved during RE with HCC patients. Previous studies done with TACE easily pointed out the post-embolisation effect as an expected outcome of the embolic nature of TACE [15,16]. There is only one RE study on DP-CBCT using quantitative measurement methods, which involved a liver metastasis patient group using arbitrary units (AU), in the English language literature [17].…”

Single injection dual phase CBCT technique ameliorates results of trans-arterial chemoembolization for hepatocellular cancer

“…Moreover, CBCT usage has been correlated with better procedural outcome: Wang et al (32) demonstrated a strong correlation between lipiodol deposition on CBCT and tumor necrosis (cm 3 ) assessed with enhanced MRI.…”