Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany.
Department of Radiology, Section of Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
Cancer Imaging. 2018 May 2;18(1):16. doi: 10.1186/s40644-018-0151-y.
To evaluate the benefits of arterial phase imaging and parenchymal blood volume (PBV) maps acquired by C-arm computed tomography during TACE procedure in comparison to cross-sectional imaging (CSI) using CT or MRI.
From January 2014 to December 2016, a total of 29 patients with HCC stage A or B (mean age 65 years; range 47 to 81 years, 86% male) were included in this study. These patients were referred to our department for TACE treatment and received peri-interventional C-arm CT. Dual phase findings of each lesion in terms of overall image quality, conspicuity, tumor size and feeding arteries were compared between arterial phase imaging and PBV using 5-point semi-quantitative Likert-scale, whereby pre-interventional CSI served as reference standard.
A significantly higher overall image quality of the PBV maps compared to arterial phase C-arm CT acquisitions (4.34 (±0.55) vs. 3.93 (±0.59), p = 0.0032) as well as a higher conspicuity of HCC lesions (4.27 ± 0.74 vs. 3.83 ± 1.08, p < 0.0001) was observed. Arterial phase imaging led to an overestimation of tumor size (mean size, 26.5 ± 15.9 mm) compared to PBV (24.9 ± 15.2 mm, p = 0.0004) as well as CSI (25.2 ± 15.1 mm), p = 0.021). Regarding detectability of tumor feeding arterial vessels, significantly more feeding vessels were detected in arterial phase C-arm CT (n = 1.67 ± 0.92 vessels) compared to PBV maps (n = 1.27 ± 0.63 vessels) (p = 0.0001). One lesion was missed in pre-interventional CT imaging, but detected by C-arm CT.
The combination of PBV maps and arterial phase images acquired by C-arm CT during TACE procedure enables precise detection of the majority of HCC lesions and tumor feeding arteries and has therefore the potential to improve patient outcome.
评估 C 臂 CT 在 TACE 术中动脉期成像和实质血容量（PBV）图与 CT 或 MRI 横断面成像（CSI）相比的优势。
2014 年 1 月至 2016 年 12 月，共纳入 29 例 HCC 分期 A 或 B 的患者（平均年龄 65 岁，范围 47-81 岁，86%为男性）。这些患者因 TACE 治疗被收入我院，并在介入治疗期间接受 C 臂 CT 检查。采用 5 分半定量 Likert 量表比较动脉期成像和 PBV 在总体图像质量、显影度、肿瘤大小和供血动脉方面的双期表现，以术前 CSI 为参考标准。
与动脉期 C 臂 CT 采集相比，PBV 图的总体图像质量显著提高（4.34（±0.55）比 3.93（±0.59），p=0.0032），HCC 病变的显影度也更高（4.27±0.74 比 3.83±1.08，p<0.0001）。与 PBV（24.9±15.2mm，p=0.0004）和 CSI（25.2±15.1mm，p=0.021）相比，动脉期成像导致肿瘤大小的高估（平均大小，26.5±15.9mm）。在检测肿瘤供血动脉方面，动脉期 C 臂 CT 检测到的供血血管数量明显多于 PBV 图（n=1.67±0.92 支比 n=1.27±0.63 支）（p=0.0001）。1 个病灶在术前 CT 成像中漏诊，但被 C 臂 CT 检测到。
在 TACE 术中，C 臂 CT 动脉期成像与 PBV 图相结合，能够精确检测到大多数 HCC 病灶和肿瘤供血动脉，因此有可能改善患者的预后。
