Gormez Aysegul, Eldem Fatma Gonca, Salanci Bilge Volkan, Bozkurt Murat Fani, Ugur Omer, Peynircioglu Bora
Department of Radiology, Faculty of Medicine, Hacettepe University, Turkey.
Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Turkey.
Pol J Radiol. 2020 Jan 14;85:e21-e28. doi: 10.5114/pjr.2020.92915. eCollection 2020.
The aims of the study were: 1) to compare two phases of dual-phase cone beam computed tomography (DP-CBCT) achieved before and after Yttrium-90 (Y) administration and to evaluate additional benefits during radioembolisation (RE) procedures; and 2) to compare DP-CBCT with pre-procedure contrast enhanced cross-sectional images in terms of tumour detection.
Twenty-three hepatocellular carcinoma patients undergoing RE treatment were scanned with DP-CBCT consisting of early arterial (EA) and late arterial (LA) phases before and after Y administration. The CT-like datasets were compared according to embolisation effect, enhancement patterns, lesion detectability, image quality, and artifacts by two interventional radiologists blinded to each other. The compatibility of the two radiologists was evaluated with kappa statistical analysis, and the difference between EA and LA phases was evaluated with marginal homogeneity test. Also, DP-CBCT images were compared with preprocedural cross-sectional images (CT/MRI).
For 23 patients 92 data were acquired. Thirteen patients showed a decrease on post-embolisation images both visually and on Hounsfield unit (HU) measurements. No statistical difference was found for tumour detection between EA and LA phases ( = 1.0). Tumour enhancement was visually superior at LA phases whereas EA phases were better for arterial mapping for selective catheterisation. DP-CBCT images were not inferior to preprocedural cross-sectional imaging findings.
DP-CBCT is a promising tool for predicting tumour response to therapy and is not inferior to preprocedural cross-sectional imaging in terms of tumour detection. It allows better assessment during RE procedures because early phases provide good mapping for superselective catheterisation whereas late phases are better for visualisation of tumour enhancement.
本研究的目的是：1）比较钇-90（Y）给药前后获得的双相锥束计算机断层扫描（DP-CBCT）的两个阶段，并评估放射性栓塞（RE）过程中的额外益处；2）在肿瘤检测方面，将DP-CBCT与术前增强横断面图像进行比较。
对23例接受RE治疗的肝细胞癌患者在Y给药前后进行了由早期动脉期（EA）和晚期动脉期（LA）组成的DP-CBCT扫描。由两名互不了解情况的介入放射科医生根据栓塞效果、强化模式、病变可检测性、图像质量和伪影对类CT数据集进行比较。用kappa统计分析评估两名放射科医生的一致性，用边际同质性检验评估EA期和LA期之间的差异。此外，将DP-CBCT图像与术前横断面图像（CT/MRI）进行比较。
23例患者共获取92份数据。13例患者栓塞后图像在视觉上和亨氏单位（HU）测量上均显示降低。EA期和LA期在肿瘤检测方面未发现统计学差异（ = 1.0）。LA期肿瘤强化在视觉上更优，而EA期在选择性插管的动脉成像方面更好。DP-CBCT图像不劣于术前横断面成像结果。
DP-CBCT是预测肿瘤治疗反应的一种有前景的工具，在肿瘤检测方面不劣于术前横断面成像。它在RE过程中能提供更好的评估，因为早期阶段为超选择性插管提供良好的成像，而晚期阶段更有利于肿瘤强化的可视化。
