J Korean Soc Radiol.  2018 Aug;79(2):68-76. 10.3348/jksr.2018.79.2.68.

Detection of Recurrent/Residual Hepatocellular Carcinoma: Single-Center Retrospective Comparative Study Between Parenchymal Blood Volume Mapping Using Cone Beam CT and Multiphase Dynamic CT

• Kim NR
• Kim JD
• Han HY
• Kim HJ

• KMID: 2416391
• DOI: http://doi.org/10.3348/jksr.2018.79.2.68

Abstract

PURPOSE
To evaluate the usefulness of cone beam computed tomography (CT)-based parenchymal blood volume (PBV) mapping for the detection of marginal recurrence or residual hepatocellular carcinoma, after transcatheter arterial chemoembolization (TACE), and to compare it with multiphase dynamic CT (MDCT).
MATERIALS AND METHODS
From March 2015 to October 2016, 26 patients with 49 iodized nodules who underwent TACE and a pre-interventional MDCT scan were enrolled in our study. We evaluated the diagnostic efficacies of PBV mapping using cone beam CT and MDCT in the detection of marginal recurrences or viable tumors.
RESULTS
The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of PBV mapping and MDCT were 100%, 96.7%, 94.7%, and 100%, and 77.9%, 93.5%, 87.5%, and 87.8%, respectively. The overall sensitivity for identifying local marginal recurrence was higher for PBV mapping than for MDCT (p < 0.005). The performances of PBV mapping and MDCT in the diagnosis of local marginal recurrence were significantly different (p = 0.037, McNemar test).
CONCLUSION
Compared with MDCT, PBV mapping can significantly increase the detection of marginal recurrence or residual tumor after TACE because it is free of beam-hardening artifact. PBV mapping should be considered as a feasible modality-related tool for patients who have undergone chemoembolization.

MeSH Terms

Artifacts
Blood Volume*
Carcinoma, Hepatocellular*
Chemoembolization, Therapeutic
Cone-Beam Computed Tomography*
Diagnosis
Humans
Multidetector Computed Tomography
Neoplasm, Residual
Recurrence
Retrospective Studies*
Sensitivity and Specificity

Figure

• 

  Fig. 1 A 71-year-old male patient who had undergone a single transarterialchemoembolization treatment. A. Axial image of the arterial-phase CT scan show a tiny defect at the margin of the iodized oil-containing nodule at S8 of the liver, although no significant enhancing portion was seen. B. Axial images of the delay-phase CT scan show a tiny defect at the margin of the iodized oil-containing nodule at S8 of the liver, although no significant wash-out portion was seen. C. Parenchymal blood volume mapping using cone beam CT shows increased blood flow (arrow). D. Selective arteriogram demonstrating an enhancing residual marginal tumor (arrow). CT = computed tomography

• 

  Fig. 2 A 54-year-old male patient who had undergone a single transarterial chemoembolization treatment. A. Axial images of the arterial-phase CT scan show defect within the iodized nodule at S6 of the liver, but no definite enhancing viable tumor focus was visible (arrow). B. Axial images of the delay-phase CT scan show defect within the iodized nodule at S6 of the liver, but no definite wash-out portion is seen. C. Parenchymal blood volume mapping using cone beam CT shows an area of increased blood flow (arrow). D. After selective chemoembolization to a branch of the S6 artery, the viable tumor is confirmed by uptake of dense iodized oil (arrow). CT = computed tomography

• 

  Fig. 3 A 48-year-old male patient who had undergone a single transarterial chemoembolization treatment. A, B. Axial images of the arterial and delayed phase CT scan images show large defects within the iodized nodule, but no definite enhancing viable tumor focus is visible (arrows). C. Parenchymal blood volume mapping using cone beam CT shows an area of increased blood flow (arrow). D. After transarterial chemoembolization, the follow up CT shows lipiodol uptake at a previously defective area that was confirmed as viable tumor. CT = computed tomography

• 

  Fig. 4 A 65-year-old female patient who had undergone fourth transarterial chemoembolization treatment. A. Parenchymal blood volume mapping using cone beam CT shows an area of increased blood flow (arrow). B. Axial images of the arterial phase CT scan image show no arterial enhancement. C. 6 months later, arterial phase CT scan image show arterial enhancement (arrow). D. After selective chemoembolization to a branch of the S3 artery, the viable tumor is confirmed by uptake of dense iodized oil (arrow). CT = computed tomography

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