Imaging Hepatocellular Carcinoma with Dynamic CT Before and After Transarterial Chemoembolization

Rationale and Objectives

The aim of this study was to determine the optimal arterial phase delay for computed tomography imaging of hepatocellular carcinoma (HCC) before and after transarterial chemoembolization (TACE) using a low iodine dose protocol.

Materials and Methods

A total of 39 patients with known HCC were imaged with dynamic computed tomography of the liver (40-second scan duration, 60 mL of contrast medium), both on the same day before TACE and 1 day after TACE. Time attenuation curves of vessels, nonmalignant liver parenchyma, and 62 HCCs were normalized to a uniform aortic contrast arrival and analyzed.

Results

Maximal arterial phase HCC to liver contrast was reached between 13 and 17 seconds after aortic contrast arrival, both before and after TACE.

Conclusions

Using our low iodine dose protocol, arterial phase imaging of HCC should be performed between 13 and 17 seconds after aortic contrast arrival, both before and after TACE.

Introduction

Transarterial chemoembolization (TACE) is the recommended first-line therapy for hepatocellular carcinoma (HCC) in intermediate stage of the disease (Barcelona Clinic Liver Cancer scoring system stage B) . It is the most common first-line treatment for HCC worldwide, and currently almost half of all TACE treatments are performed in Barcelona Clinic Liver Cancer stage C . Classic anatomic tumor response criteria are insufficient for treatment monitoring after TACE as they do not take into account tumor necrosis induced by treatment . Therefore, modified Response Evaluation Criteria in Solid Tumors (mRECIST) are generally applied for HCC today, using the reduction in viable tumor mass to assess treatment response. Viable tumor is defined as uptake of contrast agent in the arterial phase of computed tomography (CT) or magnetic resonance imaging .

Most HCCs show increased enhancement in the arterial phase . Absence of contrast uptake after TACE indicates therapy-induced tumor devascularization. However, complete devascularization is not always achieved and the amount of contrast enhancement in viable tumors can vary . Therefore, optimization of arterial contrast should be aimed at. Beside the contrast injection protocol, the scan timing is the essential parameter for the resulting tumor to liver contrast (TLC).

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Materials and methods

Study Population

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Transarterial Chemoembolization

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Dynamic CT of the Liver

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Image Processing

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ROI/VOI Placement

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Scan Time Normalization

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Data Analysis

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Results

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Table 1

Size and Perfusion Parameters of HCCs and Tumor-free Liver Before and After TACE

Parameters Pre-TACE Post-TACE HCC Size (cm) 3.7 ± 2.1 2.2 ± 1.0 ROI Analysis HCC ROI area (cm 2 ) 7.9 ± 8.5 2.5 ± 1.9 ALP (mL/100 mL/min) 59.1 ± 20.7 55.7 ± 17.1 PVP (mL/100 mL/min) 11.0 ± 11.4 9.6 ± 20.1 HPI (%) 89.3 ± 10.1 90.8 ± 14.9 Tumor-free liver ALP (mL/100 mL/min) 10.4 ± 6.3 12.3 ± 8.9 PVP (mL/100 mL/min) 64.3 ± 26.3 72.6 ± 19.9 HPI (%) 22.9 ± 16.9 20.5 ± 15.7 VOI analysis HCC VOI volume (cm 3 ) 21.7 ± 39.5 2.6 ± 2.3 ALP (mL/100 mL/min) 57.9 ± 19.5 54.2 ± 16.0 PVP (mL/100 mL/min) 11.1 ± 12.4 10.0 ± 17.3 HPI (%) 89.3 ± 10.1 90.1 ± 12.9 Tumor-free liver ALP (mL/100 mL/min) 10.3 ± 6.1 12.2 ± 8.7 PVP (mL/100 mL/min) 66.2 ± 24.6 72.2 ± 19.9 HPI (%) 22.6 ± 16.7 20.4 ± 16.0

ALP, arterial liver perfusion; HCC, hepatocellular carcinoma; HPI, hepatic perfusion index; PVP, portal venous liver perfusion; ROI, region of interest; SD, standard deviation; VOI, volume of interest.

Values are presented as the mean ± SD.

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Discussion

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Conclusions

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References

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Imaging Hepatocellular Carcinoma with Dynamic CT Before and After Transarterial Chemoembolization

Rationale and Objectives

Materials and Methods

Results

Conclusions

Introduction

Materials and methods

Study Population

Transarterial Chemoembolization

Dynamic CT of the Liver

Image Processing

ROI/VOI Placement

Scan Time Normalization

Data Analysis

Results

Discussion

Conclusions

References

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