The Role of Dual-Phase Cone-Beam CT in Predicting Short-Term Response after Transarterial Chemoembolization for Hepatocellular Carcinoma

Müller, Kerstin; Datta, Sanjit; Gehrisch, Sonja; Ahmad, Moiz; Mohammed, Mohammed Ahmed Abdelrazek; Rosenberg, Jarrett; Hwang, Gloria L.; Louie, John D.; Sze, Daniel Y.; Kothary, Nishita

doi:10.1016/j.jvir.2016.09.019

Cited by 7 publications

(10 citation statements)

References 20 publications

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“…Dual‐phase CTAs have been previously described for use in evaluating cerebral, portal, and cardiac vascular systems . The use of evaluating head and neck vasculature, especially in the setting of patients with vessel‐depleted neck is novel and, in our case series, appears promising.…”

Section: Discussionmentioning

confidence: 87%

Dual‐phase CT angiography for presurgical planning in patients with vessel‐depleted neck

Patel

Huang

et al. 2019

Head & Neck

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Background Microvascular reconstruction in vessel‐depleted necks is challenging due to limited availability of recipient vessels. We examine the utility of dual‐phase CT angiography (CTA), which delineates both arteries and veins, for preoperative planning in such difficult cases. Methods Retrospective chart review of a single surgeon from July 2013 to July 2017 in a tertiary referral center was performed. Patient characteristics, operative details, and surgical outcomes were examined. Results Thirteen patients met inclusion criteria. The operative plan was changed to a local flap for one patient as a result of imaging; free tissue transfer was performed for the remaining cases with 100% flap survival rate. Average operative time and ischemia time were 524 ± 110 minutes and 153 ± 47 minutes, respectively. Conclusions Dual‐phase CTA can evaluate potential venous and arterial recipient vessel and guide surgical explorations. As such, it may aid in presurgical planning for microvascular free tissue transfer in vessel‐depleted necks.

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Section: Discussionmentioning

confidence: 87%

Dual‐phase CT angiography for presurgical planning in patients with vessel‐depleted neck

Patel

Huang

et al. 2019

Head & Neck

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“…These corona enhancements may be related to the drainage area of the tumour. According to the theory of Kitao [ 24 ], blood flow from the tumour drains into the surrounding hepatic sinuses and forms the drainage area, which is characterized by continuous corona enhancement around the tumour in the late-enhancing phase [ 27 ]. The presence of a drainage area indicates that the perfusion of blood flow is still occurring inside the tumour.…”

Section: Discussionmentioning

confidence: 99%

Intraarterial contrast-enhanced ultrasound to predict the short-term tumour response of hepatocellular carcinoma to Transarterial chemoembolization with Lipiodol

et al. 2021

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Background Transarterial chemoembolization (TACE) is an effective locoregional therapy in hepatocellular carcinoma (HCC). However, it is difficult to predict the tumour response (TR) of TACE intraprocedurally. The aim of this study was to predict the TR after TACE (1–3 months) in HCC patients using intraprocedural intraarterial contrast enhanced ultrasound (IA-CEUS). Methods In this case-control study, consecutive patients who received TACE in our hospital from September 2018 to May 2019 were enrolled. IA-CEUS was performed before and after TACE. Postoperative contrast-enhanced liver MRI was performed 1–3 months after TACE as the gold standard. According to the modified Response Evaluation Criteria in Solid Tumours (mRECIST), ultrasonic manifestations were compared between the complete remission (CR) group and non-CR group by univariate and multivariate analyses. A logistic predictive model was established and validated, and its diagnostic efficiency was evaluated. Results Forty-four patients with sixty-one lesions were enrolled in the study. Multivariate analysis identified, the risk factors as a large lesion diameter (OR: 1.84; 95% confidence interval [CI]: 1.009, 3.080; P = 0.020), a larger dimension of non-enhancing area in superior mesenteric artery (SMA)-CEUS than the size in B-mode ultrasound preoperatively (OR: 3.379; 95% CI: 1.346,8.484; P = 0.010), presence of corona enhancement in hepatic artery (HA)-CEUS postoperatively (OR: 6.642; 95% CI: 1.214, 36.331; P = 0.029), and decreased corona enhancement thickness (per centimetre) postoperatively (OR: 0.025; 95% CI: 0.006,0.718; P = 0.025). The area under the receiver operating characteristic curve (AUROC) of the predictive model was 0.904 (95% CI: 0.804, 0.966; P < 0.001). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 81.08, 91.67, 85.25, 93.75, and 75.86%, respectively. Leave-one-out cross-validation (LOOCV) showed that the accuracy was 77.05%. Conclusions Intraprocedural IA-CEUS can be used to predict the TR in HCC patients after TACE.

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“…The HCC drainage area is dominated by the drainage veins around the tumor, which is the intermediate link between the tumor and the peripheral portal veins. The vascular characteristics of the drainage area during cTACE are closely correlated to tumor grade and curative effect and is an important circulatory pathway for intrahepatic and extrahepatic metastasis of a tumor ( 12 ). When evaluating the curative effect of the cTACE on the HCC, we should not only pay attention to the characteristics of intra-tumor enhancement but also to the characteristics of the tumor drainage area enhancement.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with intravenous CEUS, digital subtraction angiography (DSA), multidetector CT (MDCT), cone-beam computed tomography (CBCT), and magnetic resonance imaging (MRI), IA-CEUS can dynamically observe the change of microcirculation of the whole tumor of HCC in real-time, including the changes in blood flow from the artery to the tumor, intratumoral perfusion, and the local drainage area around the tumor. However, the change of tumor microcirculation after TACE is closely related to the success rate of embolization, short-term and long-term curative effects, and recurrence ( 4 , 11 , 12 ). Therefore, it is of great clinical significance in predicting a curative effect to observe the changes of tumor microcirculation with IA-CEUS immediately after TACE.…”

Section: Introductionmentioning

confidence: 99%

The value of intra-procedural transcatheter intraarterial contrast-enhanced ultrasonography (IA-CEUS) in predicting the short-term efficacy of conventional transarterial chemoembolization (cTACE)

Xiang¹,

Wang²,

Li³

et al. 2020

Transl Cancer Res TCR

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Background This study aimed to evaluate whether corona enhancement and intratumor perfusion features of intra-procedural transcatheter intraarterial contrast-enhanced ultrasonography (IA-CEUS) predict short-term tumor response on follow-up contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE). Methods This trial included 39 patients with 51 HCC target lesions who underwent cTACE with IA-CEUS. The maximum cross-sectional area ratio of intratumor perfusion between pre- and post-procedure, as well as the peak value and sickness of corona enhancement immediately post-cTACE were measured respectively. Tumor response at MRI was assessed according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) guidelines. Nonparametric Spearman rank-order correlation was used to correlate the maximum cross-sectional area ratio of intratumor perfusion, the peak value, and sickness of corona enhancement of IA-CEUS immediately after cTACE with tumor response. Results The results showed that 39 patients with 51 target lesions were assessed for tumor response. Complete remission (CR), partial remission (PR), stable disease (SD), and progressive disease (PD) were 22 (43.1%), 14 (27.5%), 10 (19.6%), and 5 (9.8%), respectively. The maximum cross-sectional area ratio of intratumor perfusion moderately correlated with tumor response on CE-MRI (Spearman rho =0.513, P<0.001). Furthermore, the peak value and sickness of corona enhancement showed a good correlation with tumor response on CE-MRI respectively (Spearman rho =0.671, P<0.001, rho =0.704, P<0.001). Conclusions Intra-procedural transcatheter IA-CEUS may predict short-term tumor response in cTACE of HCC. The feature of corona enhancement immediately post-cTACE also showed a more accurate prediction when compared with the feature of intratumor infusion (rho =0.671).

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The Role of Dual-Phase Cone-Beam CT in Predicting Short-Term Response after Transarterial Chemoembolization for Hepatocellular Carcinoma

Cited by 7 publications

References 20 publications

Dual‐phase CT angiography for presurgical planning in patients with vessel‐depleted neck

Dual‐phase CT angiography for presurgical planning in patients with vessel‐depleted neck

Intraarterial contrast-enhanced ultrasound to predict the short-term tumour response of hepatocellular carcinoma to Transarterial chemoembolization with Lipiodol

The value of intra-procedural transcatheter intraarterial contrast-enhanced ultrasonography (IA-CEUS) in predicting the short-term efficacy of conventional transarterial chemoembolization (cTACE)

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