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1.
Pierleone Lucatelli Renato Argirò Stefano Ginanni Corradini Luca Saba Carlo Cirelli Fabrizio Fanelli Carmelo Ricci Giovanni Battista Levi Sandri Carlo Catalano Mario Bezzi 《Journal of vascular and interventional radiology : JVIR》2017,28(7):978-986
Purpose
To compare image quality and diagnostic performance of cone-beam computed tomography (CT) and multidetector CT in the detection of hypervascular hepatocellular carcinoma (HCC) in patients with cirrhosis undergoing transarterial chemoembolization with drug-eluting embolic agents.Materials and Methods
Fifty-five consecutive patients referred for chemoembolization of hypervascular HCC were prospectively enrolled. Imaging included preprocedural multidetector CT within 1 month before planned treatment, intraprocedural cone-beam CT, and 1-month follow-up multidetector CT. Analysis of image quality was performed with calculations of lesion-to-liver contrast-to-noise ratio (LLCNR) and lesion-to-liver signal-to-noise-ratio (LLSNR). One-month follow-up multidetector CT was considered the reference standard for the detection of HCC nodules.Results
Median LLCNR values were 3.94 (95% confidence interval [CI], 3.06–5.05) for preprocedural multidetector CT and 6.90 (95% CI, 5.17–7.77) for intraprocedural cone-beam CT (P < .0001). Median LLSNR values were 11.53 (95% CI, 9.51–12.44) for preprocedural multidetector CT and 9.36 (95% CI, 8.12–10.39) for intraprocedural cone-beam CT (P < .0104). Preprocedural multidetector CT detected 115 hypervascular nodules with typical HCC behavior, and cone-beam CT detected 15 additional hypervascular nodules that were also visible on 1-month follow-up multidetector CT.Conclusions
Cone-beam CT has a significantly higher diagnostic performance compared with preprocedural multidetector CT in the detection of HCCs and can influence management of patients with cirrhosis by identifying particularly aggressive tumors. 相似文献2.
Leland Pung Moiz Ahmad Kerstin Mueller Jarrett Rosenberg Christopher Stave Gloria L. Hwang Rajesh Shah Nishita Kothary 《Journal of vascular and interventional radiology : JVIR》2017,28(3):334-341
Purpose
To review available evidence for use of cone-beam CT during transcatheter arterial chemoembolization in hepatocellular carcinoma (HCC) for detection of tumor and feeding arteries.Materials and Methods
Literature searches were conducted from inception to May 15, 2016, in PubMed (MEDLINE), Scopus, and Cochrane Central Register of Controlled Trials. Searches included “cone beam,” “CBCT,” “C-arm,” “CACT,” “cone-beam CT,” “volumetric CT,” “volume computed tomography,” “volume CT,” AND “liver,” “hepatic*,” “hepatoc*.” Studies that involved adults with HCC specifically and treated with transcatheter arterial chemoembolization that used cone-beam CT were included.Results
Inclusion criteria were met by 18 studies. Pooled sensitivity of cone-beam CT for detecting tumor was 90% (95% confidence interval [CI], 82%–95%), whereas pooled sensitivity of digital subtraction angiography (DSA) for tumor detection was 67% (95% CI, 51%–80%). Pooled sensitivity of cone-beam CT for detecting tumor feeding arteries was 93% (95% CI, 91%–95%), whereas pooled sensitivity of DSA was 55% (95% CI, 36%–74%).Conclusions
Cone-beam CT can significantly increase detection of tumors and tumor feeding arteries during transcatheter arterial chemoembolization. Cone-beam CT should be considered as an adjunct tool to DSA during transcatheter arterial chemoembolization treatments of HCC. 相似文献3.
Mélanie Chiaradia Maria-Louisa Izamis Alessandro Radaelli Warner Prevoo Geert Maleux Todd Schlachter Julie Mayer Alain Luciani Hicham Kobeiter Vania Tacher 《Journal of vascular and interventional radiology : JVIR》2018,29(3):425-431
Purpose
To evaluate the performance of automated feeder detection (AFD) software (EmboGuide; Philips Healthcare, Best, The Netherlands) on hepatocellular carcinoma (HCC) tumors during transarterial chemoembolization.Materials and Methods
Forty-four first-time transarterial chemoembolization patients (37 men; mean age, 62 ± 11 years) were enrolled between May 2012 and July 2013. A total of 86 HCC lesions were treated (2.0 ± 1.4 lesions per patient; 27.6 ± 15.9 mm maximum diameter). One hundred forty-seven feeding arteries were found with digital subtraction angiography (DSA), cone-beam computed tomography (CT), and AFD software with the option of manual adjustment (MA). Three independent interventional radiologists analyzed the cone-beam CT images retrospectively with and without AFD and MA. Compared with the number of treated vessels, the number of true positives, false positives, false negatives, sensitivity, and interreader agreement were determined using clustered binary data analysis.Results
Cone-beam CT enabled detection of 100 ± 3.5 feeding arteries (70% sensitivity) with 68.6% agreement among readers. AFD software significantly improved detection to 127±0.6 feeding arteries (86% sensitivity, P = .008) with 99.7% reader agreement and reduced the number of false negatives from an average of 47 ± 3.5 to 20 ± 0.6 (P = .008). MA of the AFD results produced similar feeding artery detection rates (127 ± 5.1, 86% sensitivity, P = .8), with lower interreader agreement (91.6%) and slightly fewer false positives (16 ± 0.0 to 14 ± 2.5, P = .4).Conclusions
AFD software significantly improved feeding artery detection rates during transarterial chemoembolization of HCC lesions with better user reproducibility compared with cone-beam CT alone. In conjunction with DSA, AFD enables maximum feeding artery detection in this setting. 相似文献4.
Kyung Ah Kim Sun Young Choi Min Uk Kim Seung Yon Baek Sang Hui Park Kwon Yoo Tae Hun Kim Hwi Young Kim 《Journal of vascular and interventional radiology : JVIR》2019,30(3):358-369
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. 相似文献5.
Simon S. Martin Julian L. Wichmann Jan-Erik Scholtz Doris Leithner Tommaso D’Angelo Hendrik Weyer Christian Booz Lukas Lenga Thomas J. Vogl Moritz H. Albrecht 《Journal of vascular and interventional radiology : JVIR》2017,28(9):1257-1266
Purpose
To evaluate diagnostic accuracy of a noise-optimized virtual monoenergetic imaging (VMI+) reconstruction technique for detection of active arterial abdominal bleeding on dual-energy (DE) CT angiography compared with standard image reconstruction.Materials and Methods
DE CT angiography data sets of 71 patients (46 men; age 63.6 y ± 13.3) with suspected arterial bleeding of the abdomen or pelvis were reconstructed with standard linearly blended (F_0.5), VMI+, and traditional virtual monoenergetic imaging (VMI) algorithms in 10-keV increments from 40 to 100 keV. Attenuation measurements were performed in the descending aorta, area of hemorrhage, and feeding artery to calculate contrast-to-noise ratios (CNRs) in patients with active arterial bleeding. Based on quantitative image quality results, the best series for each reconstruction technique were chosen to analyze the diagnostic performance of 3 blinded radiologists.Results
DE CT angiography showed acute arterial bleeding in 36 patients. Mean CNR was superior in 40-keV VMI+ compared with VMI series (all P < .001), which showed highest CNRs in 70-keV VMI and F_0.5 (21.6 ± 7.9, 12.9 ± 4.7, and 10.4 ± 3.6) images. Area under the curve analysis for detection of arterial bleeding showed significantly superior (P < .001) results for 40-keV VMI+ (0.963) compared with 70-keV VMI (0.775) and F_0.5 (0.817) series.Conclusions
Diagnostic accuracy in patients with active arterial bleeding of the abdomen can be significantly improved using VMI+ reconstructions at 40 keV compared with standard linearly blended and traditional VMI series in DE CT angiography. 相似文献6.
Ricardo Yamada Beatriz Bassaco Lea Dufour Heather Collins Michael Bret Anderson Christopher Hannegan Marcelo Guimaraes 《Journal of vascular and interventional radiology : JVIR》2019,30(3):390-395
Purpose
To assess the safety and efficacy of single-session transarterial embolization and radiofrequency (RF) ablation for hepatic tumors with the use of needle navigation software.Materials and Methods
Retrospective analysis was conducted of 24 patients with liver cancer undergoing embolization followed by RF ablation between May 2014 and August 2017. Twelve patients each underwent (i) embolization and computed tomography (CT)–guided RF ablation during different sessions (group 1) and (ii) embolization followed by RF ablation with cone-beam CT and Needle Assist software in 1 session (group 2). Median age (70.5 y [range, 58–78 y] vs 70.5 y [range, 50–82 y]; P = .76) and performance status (0/1) were comparable between groups. Median tumor size was significantly larger in group 2 (2 cm [range, 1.0–7.3 cm] vs 3.2 cm [range, 1.1–9.6 cm]; P < .03). Procedure time, effective dose, and number of scans were examined. Efficacy was assessed by modified Response Evaluation Criteria In Solid Tumors after 1 month. Safety was assessed by Society of Interventional Radiology adverse event classification.Results
Group 1 had a mean of 8.5 CT scans, vs a mean of 5.0 cone-beam CT scans in group 2 (P < .001). Median procedure times were 110 min in group 1 and 199.5 min in group 2 (P < .001). Median effective doses were 68.8 mSv in group 1 and 55.4 mSv in group 2 (P = .38). There was no difference in complete response between groups (66.7% vs 63.6%; P = 1).Conclusions
Transarterial embolization followed by RF ablation with cone-beam CT and needle guidance software in a single session seems to be safe and effective. 相似文献7.
Shiro Miyayama Masashi Yamashiro Natsuki Sugimori Rie Ikeda Kotaro Okimura Naoko Sakuragawa 《Journal of vascular and interventional radiology : JVIR》2019,30(1):10-18
Purpose
To evaluate the outcomes of conventional transarterial chemoembolization using guidance software for hepatocellular carcinoma (HCC) patients.Materials and Methods
One hundred two patients with treatment-naïve HCC with ≤ 7-cm and ≤ 5 lesions treated with conventional transarterial chemoembolization using guidance software were selected. Technical success was classified into 3 grades by computed tomography performed 1 week after transarterial chemoembolization: (i) A, complete embolization with a safety margin; (ii) B, entire tumor embolization without a safety margin; and (iii) C, incomplete embolization. Intrahepatic tumor recurrence was classified into 2 categories: local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Overall survival (OS) and tumor recurrence rates were calculated by the Kaplan-Meier method. Additionally, the incidences of LTP between grade A and B tumors, IDR with/without LTP, and OS with/without LTP were compared by the log-rank test.Results
One hundred fifty-six (82.1%) tumors were determined to be grade A, 26 (13.7%) were determined to be grade B, and 8 (4.2%) were determined to be grade C. The 1-, 3-, and 5-year LTP and IDR rates were 31.7%, 49.4%, and 59.4% and 33.9%, 58.2%, and 73.3%, respectively. LTP developed more frequently in grade B tumors than grade A tumors (P = .0016). IDR developed more frequently in patients with LTP than without LTP (P = .0004). The 1-, 3-, and 5-year OS rates were 96.1%, 71.1%, and 60%, respectively; the 1-, 3-, and 5-year OS rates in patients with/without LTP were 95.7%, 69.8%, and 59.3% and 96.2%, 71.6%, and 59.4%, respectively (P = .9984).Conclusions
Transarterial chemoembolization guidance software promotes the technical success of transarterial chemoembolization and excellent OS in HCC patients. 相似文献8.
Kerstin Müller Sanjit Datta Sonja Gehrisch Moiz Ahmad Mohammed Ahmed Abdelrazek Mohammed Jarrett Rosenberg Gloria L. Hwang John D. Louie Daniel Y. Sze Nishita Kothary 《Journal of vascular and interventional radiology : JVIR》2017,28(2):238-245
Purpose
To identify computational and qualitative features derived from dual-phase cone-beam CT that predict short-term response in patients undergoing transarterial chemoembolization for hepatocellular carcinoma (HCC).Materials and Methods
This retrospective study included 43 patients with 59 HCCs. Six features were extracted, including intensity of tumor enhancement on both phases and characteristics of the corona on the washout phase. Short-term response was evaluated by modified Response Evaluation Criteria in Solid Tumors on follow-up imaging, and extracted features were correlated to response using univariate and multivariate analyses.Results
Univariate and multivariate analyses did not reveal a correlation between absolute and relative tumor enhancement characteristics on either phase with response (arterial P = .21; washout P = .40; ? P = .90). On multivariate analysis of qualitative characteristics, the presence of a diffuse corona was an independent predictor of incomplete response (P = .038) and decreased the odds ratio of objective response by half regardless of tumor size.Conclusions
Computational features extracted from contrast-enhanced dual-phase cone-beam CT are not prognostic of response to transarterial chemoembolization in patients with HCC. HCCs that demonstrate a diffuse, patchy corona have reduced odds of achieving complete response after transarterial chemoembolization and should be considered for additional treatment with an alternative modality. 相似文献9.
10.
《Journal of vascular and interventional radiology : JVIR》2022,33(3):324-332.e2
PurposeTo show that a deep learning (DL)–based, automated model for Lipiodol (Guerbet Pharmaceuticals, Paris, France) segmentation on cone-beam computed tomography (CT) after conventional transarterial chemoembolization performs closer to the “ground truth segmentation” than a conventional thresholding-based model.Materials and MethodsThis post hoc analysis included 36 patients with a diagnosis of hepatocellular carcinoma or other solid liver tumors who underwent conventional transarterial chemoembolization with an intraprocedural cone-beam CT. Semiautomatic segmentation of Lipiodol was obtained. Subsequently, a convolutional U-net model was used to output a binary mask that predicted Lipiodol deposition. A threshold value of signal intensity on cone-beam CT was used to obtain a Lipiodol mask for comparison. The dice similarity coefficient (DSC), mean squared error (MSE), center of mass (CM), and fractional volume ratios for both masks were obtained by comparing them to the ground truth (radiologist-segmented Lipiodol deposits) to obtain accuracy metrics for the 2 masks. These results were used to compare the model versus the threshold technique.ResultsFor all metrics, the U-net outperformed the threshold technique: DSC (0.65 ± 0.17 vs 0.45 ± 0.22, P < .001) and MSE (125.53 ± 107.36 vs 185.98 ± 93.82, P = .005). The difference between the CM predicted and the actual CM was 15.31 mm ± 14.63 versus 31.34 mm ± 30.24 (P < .001), with lesser distance indicating higher accuracy. The fraction of volume present ([predicted Lipiodol volume]/[ground truth Lipiodol volume]) was 1.22 ± 0.84 versus 2.58 ± 3.52 (P = .048) for the current model’s prediction and threshold technique, respectively.ConclusionsThis study showed that a DL framework could detect Lipiodol in cone-beam CT imaging and was capable of outperforming the conventionally used thresholding technique over several metrics. Further optimization will allow for more accurate, quantitative predictions of Lipiodol depositions intraprocedurally. 相似文献
11.
Luke R. Wilkins James R. Stone Jaime Mata Alisha Hawrylack Ewa Kubicka David L. Brautigan 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1467-1471
There are many shortcomings of current animal models as surrogates of hepatocellular carcinoma that handicap preclinical testing of embolization agents. The present study explores the feasibility of using the woodchuck (Marmota monax) as an animal model for the testing of novel embolization agents. Four woodchucks underwent magnetic resonance imaging, angiography, and left lobar hepatic artery particle embolization. Percutaneous access, arteriography, and lobar embolization were successful in all animals, with angiographic stasis obtained in the target vessel with minimal reflux of embolic material. These results support the feasibility of the woodchuck as an animal model for preclinical testing of embolization agents. 相似文献
12.
Stephen H. Gray Jared A. White Peng Li Meredith L. Kilgore David T. Redden Ahmed K. Abdel Aal Heather N. Simpson Brendan McGuire Devin E. Eckhoff Derek A. Dubay 《Journal of vascular and interventional radiology : JVIR》2017,28(2):231-237.e2
Purpose
To measure transarterial chemoembolization utilization and survival benefit among patients with hepatocellular carcinoma (HCC) in the Surveillance, Epidemiology, and End Results (SEER) patient population.Materials and Methods
A retrospective study identified 37,832 patients with HCC diagnosed between 1991 and 2011. Survival was estimated by Kaplan–Meier method and compared by log-rank test. Propensity-score matching was used to address an imbalance of covariates.Results
More than 75% of patients with HCC did not receive any HCC-directed treatment. Transarterial chemoembolization was the most common initial therapy (15.9%). Factors associated with the use of chemoembolization included younger age, more HCC risk factors, more comorbidities, higher socioeconomic status, intrahepatic tumor, unifocal tumor, vascular invasion, and smaller tumor size (all P < .001). Median survival was improved in patients treated with chemoembolization compared with those not treated with chemoembolization (20.1 vs 4.3 mo; P < .0001). Similar findings were demonstrated in propensity-scoring analysis (14.5 vs 4.2 mo; P < .0001) and immortal time bias sensitivity analysis (9.5 vs 3.6 mo; P < .0001). There was a significantly improved survival hazard ratio (HR) in patients treated with chemoembolization (HR, 0.42; 95% confidence interval, 0.39–0.45).Conclusions
Patients with HCC treated with transarterial chemoembolization experienced a significant survival advantage compared with those not treated with transarterial chemoembolization. More than 75% of SEER/Medicare patients diagnosed with HCC received no identifiable oncologic treatment. There is a significant public health need to increase awareness of efficacious HCC treatments such as transarterial chemoembolization. 相似文献13.
Ethan Yiyang Lin Rheun-Chuan Lee Wan-Yuo Guo Frank Chun-Hsien Wu Sonja Gehrisch Markus Kowarschik 《Journal of vascular and interventional radiology : JVIR》2018,29(10):1362-1368
Purpose
To evaluate feasibility of using three-dimensional (3D) quantitative color-coding analysis (QCA) to quantify substasis endpoints after transcatheter arterial chemoembolization of hepatocellular carcinoma (HCC).Materials and Methods
This single-institution prospective study included 20 patients with HCC who had undergone segmental or subsegmental transcatheter arterial chemoembolization between December 2015 and March 2017. The chemoembolization endpoint was a sluggish anterograde tumor-feeding arterial flow without residual tumor stains. Contrast medium bolus arrival time (BAT) was used as an indicator of arterial flow. BAT of the proper hepatic artery was obtained as a reference point. BATs of the proximal right lobar artery, proximal left lobar artery, and segmental artery that received embolization were analyzed before and after chemoembolization. Wilcoxon signed rank test was used to evaluate the difference between BATs before and after chemoembolization.Results
BATs before and after chemoembolization of the segmental artery that received embolization were 0.47 seconds (interquartile range [IQR], 0.31–0.70 s) and 1.04 seconds (IQR, 0.78–2.01 s; P < .001), respectively. BATs before and after chemoembolization of the proximal left lobar hepatic artery (0.35 s [IQR, 0.11–0.55] and 0.13 s [IQR, 0.05–0.32], P = .025) and right lobar hepatic artery (0.23 s [IQR, 0.13–0.65] and 0.22 s [IQR, 0.08–0.39], P = .027) exhibited no significant change.Conclusions
3D QCA is a feasible method for quantifying sluggish segmental arterial flow after transcatheter arterial chemoembolization in patients with HCC. 相似文献14.
《Journal of vascular and interventional radiology : JVIR》2014,25(9):1369-1379
PurposeTo analyze image quality and the factors that determine it for cone-beam computed tomography (CT) hepatic arteriography in chemoembolization for hepatocellular carcinoma (HCC).Materials and MethodsFrom September 2009–December 2010, 399 consecutive patients referred for chemoembolization of HCC were scheduled for cone-beam CT scan. There were 12 patients (3%) excluded because of difficulty with breath-hold. Of the 387 patients who underwent cone-beam CT hepatic arteriography, 100 patients were ultimately included in the study according to inclusion criteria. Maximum intensity projection images were scored for image quality of each segmental hepatic artery. Potential determining factors for image quality were diaphragmatic motion, portal vein enhancement, and hepatic artery-to-parenchyma enhancement ratio. The flow rate of contrast media, x-ray delay, and location of the catheter tip were also evaluated.ResultsIt was possible to trace at least subsegmental hepatic arteries in 625 of 700 segments (89.3%) on cone-beam CT hepatic arteriography. Diaphragmatic motion, prominent portal vein enhancement, and low hepatic artery-to-parenchyma enhancement ratio worsened image quality (P < .001, P = .022, and P = .017). Owing to cardiac motion artifacts, image quality of the left lateral segments (S2 and S3) was poorer compared with the remaining hepatic segments (S4–S8).ConclusionsIn most cases, the quality of cone-beam CT hepatic arteriography images was good enough to trace subsegmental hepatic arteries at a minimum. Respiratory and cardiac motion, portal vein enhancement, and hepatic artery-to-parenchyma enhancement ratio significantly affected the image quality of cone-beam CT hepatic arteriography. 相似文献
15.
Jong Eun Lee Jin Woong Kim Hyoung Ook Kim Byung Chan Lee Young Hoe Hur Sung Bum Cho Yong Soo Cho Hyun Ju Seon DongHun Kim 《Journal of vascular and interventional radiology : JVIR》2019,30(3):370-379.e4
Purpose
To evaluate the effects of the degree of ethiodized oil accumulation achieved by transarterial chemoembolization followed by radiofrequency (RF) ablation on the treatment efficacy for a single intermediate-sized hepatocellular carcinoma (HCC).Materials and Methods
A total of 153 consecutive patients who underwent chemoembolization and RF ablation for a single intermediate-sized HCC (2–5 cm) were included. On the basis of the degree of ethiodized oil accumulation in HCC on cone-beam CT images, patients who underwent chemoembolization and RF ablation were classified into 2 groups: compact accumulation (≥ 75%) and noncompact accumulation (< 75%). The rates of cumulative local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) were compared between groups.Results
Of the 153 patients, 89 were classified into the compact ethiodized oil accumulation group and 64 in the noncompact ethiodized oil accumulation group. There were no significant differences in patient demographic or HCC characteristics between groups except for the incidence of liver cirrhosis (P = .038) and the tumor margin morphology (P = .008). The cumulative LTP rate was significantly lower in the compact accumulation group than in the noncompact accumulation group (P = .013). There were no significant differences in the incidences of complications, DFS rates (P = .055), or OS rates (P = .184).Conclusions
The degree of ethiodized oil accumulation does not play a role in decreasing the OS or DFS rate after chemoembolization and RF ablation for intermediate-sized HCC; however, it may contribute to reducing the rate of LTP. 相似文献16.
Kothary N Abdelmaksoud MH Tognolini A Fahrig R Rosenberg J Hovsepian DM Ganguly A Louie JD Kuo WT Hwang GL Holzer A Sze DY Hofmann LV 《Journal of vascular and interventional radiology : JVIR》2011,22(11):1535-1543
Purpose
To prospectively evaluate the impact of C-arm CT on radiation exposure to hepatocellular carcinoma (HCC) patients treated by chemoembolization.Materials and Methods
Patients with HCC (N = 87) underwent digital subtraction angiography (DSA; control group) or combined C-arm CT/DSA (test group) for chemoembolization. Dose-area product (DAP) and cumulative dose (CD) were measured for guidance and treatment verification. Contrast agent volume and C-arm CT utility were also measured.Results
The marginal DAP increase in the test group was offset by a substantial (50%) decrease in CD from DSA. Use of C-arm CT allowed reduction of DAP and CD from DSA imaging (P = .007 and P = .017). Experienced operators were more efficient in substituting C-arm CT for DSA, resulting in a negligible increase (7.5%) in total DAP for guidance, compared with an increase of 34% for all operators (P = .03). For treatment verification, DAP from C-arm CT exceeded that from DSA, approaching that of conventional CT. The test group used less contrast medium (P = .001), and C-arm CT provided critical or supplemental information in 20% and 17% of patients, respectively.Conclusions
Routine use of C-arm CT can increase stochastic risk (DAP) but decrease deterministic risk (CD) from DSA. However, the increase in DAP is operator-dependent, thus, with experience, it can be reduced to under 10%. C-arm CT provides information not provided by DSA in 33% of patients, while decreasing the use of iodinated contrast medium. As with all radiation-emitting modalities, C-arm CT should be used judiciously. 相似文献17.
《Journal of vascular and interventional radiology : JVIR》2014,25(9):1380-1388
PurposeTo evaluate the role of C-arm computed tomography (CT) performed at the proper hepatic artery or equivalent in patients with caudate-lobe hepatocellular carcinoma (HCC) for the detection of tumor-feeding arteries during chemoembolization.Materials and MethodsFrom July 2009 to June 2012, 1,785 patients received initial chemoembolization at a single institution. Among them, 52 patients with caudate HCC underwent initial chemoembolization with the use of C-arm CT. C-arm CT images were obtained at the proper hepatic artery or equivalent. Two radiologists reviewed the C-arm CT scans and angiograms in consensus. The cumulative local recurrence rate was calculated by the Kaplan–Meier method.ResultsTumor-feeding arteries were single (n = 31), double (n = 12), triple (n = 6), and quadruple (n = 3). Seventy-nine tumor-feeding arteries and their origins in 48 patients were demonstrated on C-arm CT. In four patients (7.7%), five tumor-feeding arteries were not clearly indicated on C-arm CT because of poor image quality caused by failure of the patients to hold their breath. Selective chemoembolization via tumor-feeding arteries was successful in 45 patients (87%). The cumulative local recurrence rates at 6 months, 1 year, and 3 years were 19.4%, 32.8%, and 35.8%, respectively. Nonselective chemoembolization of tumor-feeding arteries of caudate-lobe HCC was a significantly important factor in higher cumulative local recurrence rates (hazard ratio, 3.916; 95% confidence interval, 1.367–11.216; P = .011).ConclusionC-arm CT obtained at the proper hepatic artery or equivalent level can demonstrate most tumor-feeding arteries supplying HCCs in the caudate lobe. 相似文献
18.
《Journal of vascular and interventional radiology : JVIR》2022,33(10):1222-1229.e1
PurposeTo evaluate differences in waitlist mortality and dropout in liver transplant candidates with hepatocellular carcinoma (HCC) who undergo radiofrequency (RF) ablation versus transarterial chemoembolization (TACE).Material and MethodsFrom 2004 to 2013, 11,824 patients with HCC in the Scientific Registry of Transplant Recipients who underwent RF ablation or TACE were included and followed until December 31, 2019, or 5 years, whichever came first, and were stratified by the Milan criteria. Competing risk and Cox regression analyses to compare waitlist mortality and dropout were performed using adjusted hazard ratios (asHRs, with RF ablation group as reference). Regression models were adjusted for age, race, sex, calculated Model for End-Stage Liver Disease score, tumor size, and number.ResultsThere was no difference in waitlist mortality and dropout for patients outside the Milan criteria (n = 1,226) who underwent TACE (19.2%) or RF ablation (19.0%) (asHR, 0.91; 95% CI, 0.79–1.03). There was also no difference for patients inside the Milan criteria (n = 10,598) in waitlist mortality/dropout (TACE 13.4% vs RF ablation 12.9%) (asHR, 1.29; 95% CI, 0.79–2.09). A subgroup analysis within the Milan criteria demonstrated no difference between TACE and RF ablation treatments in patients with a single tumor of ≤3 cm (asHR, 0.92; 95% CI, 0.77–1.10), with a single tumor of >3 cm (asHR, 1.03; 95% CI, 0.79–1.34), or with >1 tumor (asHR, 0.89; 95% CI, 0.72–1.09).ConclusionsUsing the national registry data, no difference was found in waitlist mortality and dropout for transplant candidates with HCC who received TACE versus RF ablation. 相似文献
19.
《Journal of vascular and interventional radiology : JVIR》2014,25(5):739-746
PurposeTo prospectively determine the feasibility of flat-detector (FD) computed tomography (CT) perfusion to measure hepatic blood volume (BV) in the angiography suite in patients with hepatocellular carcinoma (HCC).Materials and MethodsTwenty patients with HCC were investigated with conventional multislice and FD CT perfusion. CT perfusion was carried out on a multislice CT scanner, and FD CT perfusion was performed on a C-arm angiographic system, before transarterial chemoembolization procedures. BV values of conventional and FD CT perfusion were measured within tumors and liver parenchyma. The arterial perfusion portion of CT perfusion BV was extracted from CT perfusion BV by multiplying it by a hepatic perfusion index. Relative values (RVs) for CT perfusion arterial BV and FD CT perfusion BV (FD BV) were defined by dividing BV of tumor by BV of parenchyma. Relationships between BV and RV values of these two techniques were analyzed.ResultsIn all patients, both perfusion procedures were technically successful, and all 33 HCCs larger than 10 mm were identified with both imaging methods. There were strong correlations between the absolute values of FD BV and CT perfusion arterial BV (tumor, r = 0.903; parenchyma, r = 0.920; both P < .001). Bland–Altman analysis showed a mean difference of −0.15 ± 0.24 between RVs for CT perfusion arterial BV and FD BV.ConclusionsThe feasibility of FD CT perfusion to assess BV values of liver tumor and surrounding parenchyma in the angiographic suite was demonstrated. 相似文献
20.
Mahmoud Abdel Latif Galal El HawaryAdel El Badrawy Hatem El Alfy 《The Egyptian Journal of Radiology and Nuclear Medicine》2014