Lucatelli Pierleone, Argirò Renato, Ginanni Corradini Stefano, Saba Luca, Cirelli Carlo, Fanelli Fabrizio, Ricci Carmelo, Levi Sandri Giovanni Battista, Catalano Carlo, Bezzi Mario
Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy; Vascular and Interventional Radiology Unit, University of Siena, Siena, Italy.
Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy; Department of Radiology, Interventional Radiology Unit, Ospedale Madre Giuseppina Vannini, Rome, Italy; Vascular and Interventional Radiology Unit, University of Siena, Siena, Italy.
J Vasc Interv Radiol. 2017 Jul;28(7):978-986. doi: 10.1016/j.jvir.2017.03.008. Epub 2017 May 9.
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.
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.
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.
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.
比较锥形束计算机断层扫描（CT）和多排探测器CT在检测接受载药栓塞剂经动脉化疗栓塞的肝硬化患者的富血管肝细胞癌（HCC）中的图像质量和诊断性能。
前瞻性纳入55例因富血管HCC接受化疗栓塞的连续患者。成像包括计划治疗前1个月内的术前多排探测器CT、术中锥形束CT以及1个月随访多排探测器CT。通过计算病变与肝脏的对比噪声比（LLCNR）和病变与肝脏的信噪比（LLSNR）进行图像质量分析。1个月随访多排探测器CT被视为检测HCC结节的参考标准。
术前多排探测器CT的LLCNR中位数为3.94（95%置信区间[CI]，3.06 - 5.05），术中锥形束CT为6.90（95%CI，5.17 - 7.77）（P <.0001）。术前多排探测器CT的LLSNR中位数为11.53（95%CI，9.51 - 12.44），术中锥形束CT为9.36（95%CI，8.12 - 10.39）（P <.0104）。术前多排探测器CT检测到115个具有典型HCC表现的富血管结节，锥形束CT检测到另外15个富血管结节，这些结节在1个月随访多排探测器CT上也可见。
在检测HCC方面，锥形束CT与术前多排探测器CT相比具有显著更高的诊断性能，并且可以通过识别特别侵袭性的肿瘤来影响肝硬化患者的治疗管理。
