序贯双能锥形束 CT 能够在可降解淀粉微球 TACE 过程中对多灶性 HCC 的一个月治疗结果进行术中预测。
Sequential dual-phase cone-beam CT is able to intra-procedurally predict the one-month treatment outcome of multi-focal HCC, in course of degradable starch microsphere TACE.
机构信息
Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
出版信息
Radiol Med. 2019 Dec;124(12):1212-1219. doi: 10.1007/s11547-019-01076-y. Epub 2019 Aug 31.
OBJECTIVE
To evaluate the prognostic value of sequential dual-phase CBCT (DP-CBCT) imaging performed during degradable starch microsphere TACE (DSM-TACE) session in predicting the HCC's response to treatment, evaluate with modify response evaluation criteria in solid tumours (mRECIST) at 1-month multi-detector CT (MDCT) follow-up.
MATERIALS AND METHODS
Between January and May 2018, 24 patients (68.5 ± 8.5 year [45-85]) with HCC lesions (n = 96 [average 4/patient]) were prospectively enrolled. Imaging assessment included: pre-procedural MDCT, intra-procedural DP-CBCT performed before first and second DSM-TACEs and 1-month follow-up MDCT. Lesions' attenuation/pseudo-attenuation was defined as average value measured on ROIs (HU for MDCT; arbitrary unit called HU* for CBCT). Lesions' attenuation modification was correlated with the post-procedural mRECIST criteria at 1-month MDCT.
RESULTS
Eighty-two DSM-TACEs were performed. Lesion's attenuation values were: pre-procedural MDCT arterial phase (AP) 107.00 HU (CI 95% 100.00-115.49), venous phase (VP) 85.00 HU (CI 95% 81.13-91.74); and lesion's pseudo-attenuation were: first CBCT-AP 305.00 HU* (CI 95% 259.77-354.04), CBCT-VP 155.00 HU* (CI 95% 135.00-163.34). For second CBCT were: -AP 210.00 HU* (CI 95% 179.47-228.58), -VP 141.00 HU* (CI 95% 125.47-158.11); and for post-procedural MDCT were: -AP 95.00 HU (CI 95% 81.35-102.00), -VP 83.00 HU (CI 95% 78.00-88.00). ROC curve analysis showed that a higher difference pseudo-attenuation between first and second DP-CBCTs is related to treatment response. The optimal cut-off value of the difference between first and second CBCT-APs to predict complete response, objective response (complete + partial response) and overall disease control (objective response + stable disease) were > 206 HU* (sensitivity 80.0%, specificity 81.7%), > 72 HU* (sensitivity 79.5%, specificity 83.0%) and > - 7 HU* (sensitivity 91.6%, specificity 65.4%), respectively.
CONCLUSIONS
DP-CBCT can predict intra-procedurally, by assessing lesion pseudo-attenuation modification, the DSM-TACE 1-month treatment outcome.
目的
评估可降解淀粉微球 TACE（DSM-TACE）过程中序贯双期 CBCT（DP-CBCT）成像在预测 HCC 对治疗反应中的预后价值，并使用改良实体瘤反应评估标准（mRECIST）在 1 个月的多探测器 CT（MDCT）随访时评估。
材料与方法
2018 年 1 月至 5 月期间，前瞻性纳入 24 名（68.5±8.5 岁[45-85]）患有 HCC 病变的患者（n=96[平均 4/例]）。影像学评估包括：术前 MDCT、首次和第二次 DSM-TACE 前进行的术中 DP-CBCT 以及 1 个月随访 MDCT。病变的衰减/假性衰减定义为 ROI 上测量的平均值（MDCT 的 HU；CBCT 的任意单位称为 HU*）。病变的衰减变化与 1 个月 MDCT 后的术后 mRECIST 标准相关。
结果
共进行了 82 次 DSM-TACE。病变的衰减值分别为：术前 MDCT 动脉期（AP）为 107.00 HU（95%CI 95%为 100.00-115.49），静脉期（VP）为 85.00 HU（95%CI 95%为 81.13-91.74）；病变的假性衰减值分别为：首次 CBCT-AP 为 305.00 HU*（95%CI 95%为 259.77-354.04），CBCT-VP 为 155.00 HU*（95%CI 95%为 135.00-163.34）。对于第二次 CBCT 分别为：-AP 为 210.00 HU*（95%CI 95%为 179.47-228.58），-VP 为 141.00 HU*（95%CI 95%为 125.47-158.11）；对于术后 MDCT 分别为：-AP 为 95.00 HU（95%CI 95%为 81.35-102.00），-VP 为 83.00 HU（95%CI 95%为 78.00-88.00）。ROC 曲线分析显示，第一次和第二次 DP-CBCT 之间假性衰减的差异越大，与治疗反应相关。预测完全反应、客观反应（完全+部分反应）和总体疾病控制（客观反应+稳定疾病）的首次和第二次 CBCT-AP 之间差异的最佳截断值分别为>206 HU*（灵敏度 80.0%，特异性 81.7%）、>72 HU*（灵敏度 79.5%，特异性 83.0%）和>-7 HU*（灵敏度 91.6%，特异性 65.4%）。
结论
DP-CBCT 可通过评估病变假性衰减的变化，在术中预测 DSM-TACE 1 个月的治疗效果。
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