Korean J Radiol.  2013 Feb;14(1):51-60. 10.3348/kjr.2013.14.1.51.

Detection of Recurrent Hepatocellular Carcinoma in Cirrhotic Liver after Transcatheter Arterial Chemoembolization: Value of Quantitative Color Mapping of the Arterial Enhancement Fraction of the Liver

• Lee DH
• Lee JM
• Klotz E
• Kim SJ
• Kim KW
• Han JK
• Choi BI

• KMID: 1430044
• DOI: http://doi.org/10.3348/kjr.2013.14.1.51

Abstract

OBJECTIVE
To investigate the additional diagnostic value of color mapping of the hepatic arterial enhancement fraction (AEF) for detecting recurrent or residual hepatocellular carcinoma (HCC) in patients treated with transcatheter arterial chemoembolization (TACE).
MATERIALS AND METHODS
Seventy-six patients with 126 HCCs, all of whom had undergone previous TACE, and subsequently, underwent follow-up multiphasic liver CT scans, were included in this study. Quantitative color maps of the AEF of the whole liver were created, by using prototype software with non-rigid registration. The AEF was defined as the ratio of the attenuation increment during the arterial phase to the attenuation increment during the portal phase. Two radiologists independently analyzed the two image sets at a two-week interval, i.e., the multiphasic CT image set and the second image set of the AEF color maps and the CT images. The additional diagnostic value of the AEF color mapping was determined, by the use of the jackknife-alternative free-response receiver-operating-characteristic analysis. The sensitivity and positive predictive values for detecting HCCs of each image set were also evaluated and compared.
RESULTS
The reader-averaged figures of merit were 0.699 on the initial interpretation of the MDCT image set, and 0.831 on the second interpretation of the combined image set; the difference between the two interpretations was significant (p value < 0.001). The mean sensitivity for residual or recurrent HCC detection increased from 62.7% on the initial analysis to 82.1% on the second analysis using the AEF color maps (p value < 0.001). The mean positive predictive value for HCC detection was 74.5% on the initial analysis using MDCT, and 71.6% on the second analysis using AEF color mapping.
CONCLUSION
Quantitative color mapping of the hepatic AEF may have the possibility to increase the diagnostic performance of MDCT for the detection of recurrent or residual HCC without the potential risk of radiation-related hazards.

Keyword

Hepatocellular carcinoma; Transcatheter arterial chemoembolization; Arterial enhancement fraction of the liver; Recurrent hepatocellular carcinoma

MeSH Terms

Aged
Carcinoma, Hepatocellular/pathology/*radiography
*Chemoembolization, Therapeutic
Female
Humans
Liver Cirrhosis/*complications/radiography
Liver Neoplasms/pathology/*radiography
Male
Middle Aged
Neoplasm Recurrence, Local/pathology/*radiography
Predictive Value of Tests
ROC Curve
Radiographic Image Interpretation, Computer-Assisted
Retrospective Studies
Sensitivity and Specificity
Software
*Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Case showing that AEF color mapping improved sensitivity for detecting remotely recurrent HCC. A. Hepatic arterial (left) and portal venous phase (right) transverse CT images of segments VIII did not show evident arterial enhancing lesion or wash-out lesion in portal venous phase. B. However, quantitative color mapping of AEF reveals that nodular appearance increased AEF of segment VIII lesion (arrows) with better conspicuity; both reviewers detected and classified this lesion as remotely recurrent HCC during second interpretation session using combined AEF color mapping. C. Follow-up CT image after additional transcatheter arterial chemoembolization shows retained iodized oil uptake (arrow) at segment VIII of liver. AEF = arterial enhancement fraction, HCC = hepatocellular carcinoma

• 

  Fig. 2 Case showing that AEF color mapping improved sensitivity for detecting marginally recurrent HCC around area with retained iodized oil. A. Hepatic arterial (left) and portal venous phase (right) transverse CT images show small amount of retained iodized oil in segment I of liver. As arterial enhancement and wash-out were not evident in portal venous phase, both reviewers considered that there was no viable portion of this lesion. B. However, quantitative color mapping of AEF showed that nodular appearance increased AEF of this lesion (arrow) as well as its increased conspicuity; both reviewers classified this lesion as marginally recurrent HCC during second interpretation session using combined AEF color mapping. C. Follow-up CT image after additional transcatheter arterial chemoembolization shows additional retained iodized oil uptakes (arrow) in segment I of liver. AEF = arterial enhancement fraction, HCC = hepatocellular carcinoma

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