The Efficacy of Cone-Beam CT–Based Liver Perfusion Mapping to Predict Initial Response of Hepatocellular Carcinoma to Transarterial Chemoembolization

Kyung Ah Kim, Sun Young Choi, Min Uk Kim, Seung Yon Baek, Sang Hui Park, Kwon Yoo, Tae Hun Kim, Hwi Young Kim

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Purpose: To evaluate efficacy of cone-beam CT–based liver perfusion mapping obtained immediately following conventional transarterial chemoembolization of hepatocellular carcinoma (HCC) for assessing tumor vascularity, technical success of chemoembolization, and treatment response. Materials and Methods: From July 2015 to June 2016, 35 patients with 57 HCCs who underwent cone-beam CT with post-processing software via conventional transarterial chemoembolization for HCC and follow-up examination were included. Three reviewers evaluated technical success on angiography, unenhanced cone-beam CT, contrast-enhanced cone-beam CT, and cone-beam CT–based liver perfusion mapping after transarterial chemoembolization per tumor and per patient. Parenchymal blood volume (PBV) was measured. Treatment response was determined on follow-up CT, MR imaging, or histopathology according to modified Response Evaluation Criteria In Solid Tumors. Diagnostic performance for detection of a viable tumor was evaluated using multiple logistic regression with C-statistics. Results: Treatment response was 38, 17, 2, and 0 for complete response, partial response, stable disease, and progressive disease per tumor and 18, 15, 2, and 0 per patient. In multiple logistic regression, unenhanced cone-beam CT, contrast-enhanced cone-beam CT, cone-beam CT–based liver perfusion mapping, mean value of PBV, and maximum value of PBV of tumor were significant in response assessment for per tumor and per patient (per tumor, all P <.001; per patient, P =.015, P =.001, P <.001, P =.020, and P =.032). Mean value of PBV of tumor was excellent for evaluating technical success with the highest C-statistic (0.880 and 0.920 for per tumor and per patient), followed by that of visual assessment of cone-beam CT–based liver perfusion mapping (0.864 and 0.908). Conclusions: Cone-beam CT–based liver perfusion mapping provided reliable images to evaluate technical success after transarterial chemoembolization of HCC by qualitative visual assessment and quantitative perfusion values.

Original languageEnglish
Pages (from-to)358-369
Number of pages12
JournalJournal of Vascular and Interventional Radiology
Volume30
Issue number3
DOIs
StatePublished - Mar 2019

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