The Role of Perfusion CT as a Follow-up Modality After Transcatheter Arterial Chemoembolization

Choi, Seung Hong; Chung, Jin Wook; Kim, Hyo Choel; Baek, Jin; Park, Chang Min; Jun, Suryoung; Kim, Min Uk; Lee, Eun Sun; Cho, Hye Rim; Jae, Hwan Jun; Lee, Whal; Park, Jae Hyung

doi:10.1097/rli.0b013e3181e07516

Cited by 55 publications

(37 citation statements)

References 41 publications

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“…However, the role of perfusion CT in predicting recurrence after local-regional treatment is uncertain until now. Indeed, Choi et al (90) reported that for the areas where the recurrence eventually occurred at 4 weeks after TACE, CT perfusion parameters obtained 1 week after TACE did not help predict future recurrence in their study using 14 rabbits the AEF, a value that is similar to HPI. AEF was defined as the ratio of the absolute increase of attenuation during the arterial phase to the absolute increment of attenuation during the portal venous phase: AEF = [(HU A-2HU U )/(HU P 2HU U )] x 100, where HU is the attenuation, A is arterial phase, P is portal phase, and U is unenhanced scan.…”

Section: Monitoring Therapeutic Effectsmentioning

confidence: 91%

“…Although there were some discrepancies among studies, there was a trend toward showing a decrease in blood flow, blood volume, HPI, and permeability, as well as an increase of MTT after treatment regardless of the imaging modality used (CT vs MR imaging), the therapeutic agent administered (standard chemotherapeutics vs antiangiogenic agents), type of liver tumors imaged (primary vs metastatic liver lesions), and the subject studied (human vs different animal models) (Figs 7, 8). For instance, Ren et al (86) recently showed the usefulness of CT perfusion for early response assessment following anticancer treatment in 100 mice with human colon cancer radiology.rsna.org n Radiology: Volume 272: Number 2-August 2014 also observed 1 week after TACE in another study with 14 rabbit VX2 liver tumors (90). In patients with HCC, Yang et al (91) demonstrated a significant decrease in HAP and HPI in HCCs at 4 weeks after TACE.…”

Section: Monitoring Therapeutic Effectsmentioning

confidence: 96%

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CT Perfusion of the Liver: Principles and Applications in Oncology

Kim¹,

Kamaya²,

Willmann³

2014

Radiology

171

135

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With the introduction of molecularly targeted chemotherapeutics, there is an increasing need for defining new response criteria for therapeutic success because use of morphologic imaging alone may not fully assess tumor response. Computed tomographic (CT) perfusion imaging of the liver provides functional information about the microcirculation of normal parenchyma and focal liver lesions and is a promising technique for assessing the efficacy of various anticancer treatments. CT perfusion also shows promising results for diagnosing primary or metastatic tumors, for predicting early response to anticancer treatments, and for monitoring tumor recurrence after therapy. Many of the limitations of early CT perfusion studies performed in the liver, such as limited coverage, motion artifacts, and high radiation dose of CT, are being addressed by recent technical advances. These include a wide area detector with or without volumetric spiral or shuttle modes, motion correction algorithms, and new CT reconstruction technologies such as iterative algorithms. Although several issues related to perfusion imagingsuch as paucity of large multicenter trials, limited accessibility of perfusion software, and lack of standardization in methods-remain unsolved, CT perfusion has now reached technical maturity, allowing for its use in assessing tumor vascularity in larger-scale prospective clinical trials. In this review, basic principles, current acquisition protocols, and pharmacokinetic models used for CT perfusion imaging of the liver are described. Various oncologic applications of CT perfusion of the liver are discussed and current challenges, as well as possible solutions, for CT perfusion are presented.q RSNA, 2014

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Section: Monitoring Therapeutic Effectsmentioning

confidence: 91%

Section: Monitoring Therapeutic Effectsmentioning

confidence: 96%

CT Perfusion of the Liver: Principles and Applications in Oncology

Kim¹,

Kamaya²,

Willmann³

2014

Radiology

171

135

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“…12,13 In this study, 3 weeks after tumour implantation, the TR showed an abundance of blood vessels, and 30-50% of the centre of the tumour was necrotic, which may have been due to a lack of nutrition. The four increased perfusion parameters of CT (BF, BV, PS and HAF) in the rim of the tumour revealed a high amount of perfusion in the tumour region, suggesting an abundance of blood vessels.…”

mentioning

confidence: 49%

Evaluation of neovascularization with spectral computed tomography in a rabbit VX2 liver model: a comparison with real-time contrast-enhanced ultrasound and molecular biological findings

Zhou¹,

Gao²,

Han³

et al. 2015

BJR

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Objective: To validate the feasibility of using the parameters of spectral CT and CT perfusion and the dynamic features of real-time contrast-enhanced ultrasound (CEUS) to evaluate the vascularization of VX2 hepatic tumours. Methods: Spectral CT imaging, CT perfusion and CEUS analysis were performed on rabbits implanted with VX2 hepatic tumours, 7 and 14 days after implantation. The perfusion parameters of CT, normalized iodine concentration (NIC) and dynamic features of CEUS were measured in the rim of the tumour (TR) and the normal liver region. The expression of vascular endothelial growth factor (VEGF) and fibroblast growth factor 2 (FGF2) was also determined. Results: Increased perfusion parameters of CT were found in the TR. In addition, the NIC was elevated in TR during the arterial phase, and the peak intensity of the CEUS of the TR was reached significantly earlier than that on normal liver region. At 14 days, the perfusion parameters of CT (blood volume, permeability surface and hepatic arterial fraction) offered higher accuracy and stability in differentiating the TR from the normal liver region. Furthermore, CEUS was more accurate in diagnosing tumours ,1.0 cm in diameter. In addition, VEGF and FGF2 expression was higher in the TR and were positively correlated with CT and CEUS parameters, except mean transit time, rise time, washout time and peak time. Conclusion: Use of spectral CT with perfusion techniques, iodine-based material-decomposition analysis and dynamic CEUS changes may reflect the angiogenesis and haemodynamic information of hepatic tumours. Advances in knowledge: It is feasible to assess vascularization in hepatic cancer using CT or CEUS. INTRODUCTIONPrimary hepatic carcinoma is one of the most common malignant tumours, with a steadily increasing mortality rate over the past few years. 1 The newly emerging techniques of spectral CT imaging and CT perfusion reveal the haemodynamic features in the tumour tissues and play an important role in the detection and differential diagnosis of a solid mass in the liver.2,3 Dual-energy CT performed during two consecutive scans or with a dual X-ray source or dual-detector assembly has existed for a number of years. It was demonstrated that the additional information was provided by using dual-energy material separation technique, which had potential clinical applications.4,5 By revealing the blood supply and the haemodynamic features of the tumours, the real-time contrast-enhanced ultrasound (CEUS) provides high accuracy and specificity for diagnosing small hepatic tumours and enables the detection of early malignant diseases.

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“…The following parameters were used: 2461.2 mm detector configuration, a rotation time of 0.33 s, a cycle time of 1.5 s, coverage of 114 mm, 80 kVp and 100 mAs. 4 ml of non-ionic contrast material (iopromide; Ultravist 370; Bayer Schering Pharma, Berlin, Germany) was injected with a power injector (Medrad, Pittsburgh, PA) at a rate of 1 ml s 21 through a 22-gauge intravenous catheter inserted into the auricular vein [15,16]. Scanning was initiated 5 s after beginning the injection and continued for 96 s. Therefore, 64 contiguous sections were obtained at 1.5 s intervals.…”

Section: Radiological Studymentioning

confidence: 99%

Radiofrequency ablation combined with transcatheter arterial embolisation in rabbit liver: investigation of the ablation zone according to the time interval between the two therapies

Lee

Kim

et al. 2012

The British Journal of Radiology

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Objectives: This study was designed to evaluate the extent of the radiofrequency ablation zone in relation to the time interval between transcatheter arterial embolisation (TAE) and radiofrequency ablation (RFA) and, ultimately, to determine the optimal strategy of combining these two therapies for hepatocellular carcinoma. Methods: 15 rabbits were evenly divided into three groups: Group A was treated with RFA alone; Group B was treated with TAE immediately followed by RFA; and Group C was treated with TAE followed by RFA 5 days later. All animals underwent perfusion CT (PCT) scans immediately after RFA. Serum liver transaminases were measured to evaluate acute liver damage. Animals were euthanised for pathological analysis of ablated tissues 10 days after RFA. Non-parametric analyses were conducted to compare PCT indices, the RFA zone and liver transaminase levels among the three experimental groups. Results: Group B showed a significantly larger ablation zone than the other two groups. Arterial liver perfusion and hepatic perfusion index represented well the perfusion decrease after TAE on PCT. Although Group B showed the most elevated liver transaminase levels at 1 day post RFA, the enzymes decreased to levels that were not different from the other groups at 10 days post-RFA. Conclusions: When combined TAE and RFA therapy is considered, TAE should be followed by RFA as quickly as possible, as it can be performed safely without serious hepatic deterioration, despite the short interval between the two procedures.

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The Role of Perfusion CT as a Follow-up Modality After Transcatheter Arterial Chemoembolization

Abstract: We believe that perfusion CT is a feasible alternative modality for the successful early response assessment and early detection of a marginally recurred tumor after TACE. However, perfusion CT has limitations for the prediction of tumor recurrence after TACE.

Cited by 55 publications

References 41 publications

CT Perfusion of the Liver: Principles and Applications in Oncology

CT Perfusion of the Liver: Principles and Applications in Oncology

Evaluation of neovascularization with spectral computed tomography in a rabbit VX2 liver model: a comparison with real-time contrast-enhanced ultrasound and molecular biological findings

Radiofrequency ablation combined with transcatheter arterial embolisation in rabbit liver: investigation of the ablation zone according to the time interval between the two therapies

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