Department of Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt.
BMC Med Imaging. 2024 Sep 18;24(1):250. doi: 10.1186/s12880-024-01408-z.
BACKGROUND: Accurate detection of Hepatocellular carcinoma (HCC) feeding vessels during transcatheter arterial chemoembolization (TACE) is important for an effective treatment, while limiting non-target embolization. This study aimed to investigate the feasibility and accuracy of pre-TACE three dimensional (3D) CT angiography for tumor-feeding vessels detection compared to DSA. METHODS: Sixty-nine consecutive patients referred for TACE from May 2022 to May 2023 were included. (3D) CT images were reconstructed from the pre-TACE diagnostic multiphasic contrast enhanced CT images and compared with non-selective digital subtraction angiography (DSA) images obtained during TACE for detection of HCC feeding vessels. A "Ground truth" made by consensus between observers after reviewing all available pre-TACE CT images, and DSA and CBCT images during TACE to detect the true feeding vessels was the gold standard. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy and ROC curve with AUC were calculated for each modality and compared. RESULTS: A total of 136 active HCCs were detected in the 69 consecutive patients included in the study. 185 feeding arteries were detected by 3D CT and DSA and included in the analysis. 3D CT detection of feeding arteries revealed mean sensitivity, specificity, PPV, NPV and accuracy of 91%, 71%, 98%, 36%, and 90%, respectively, with mean AUC = 0.81. DSA detection of feeding arteries revealed mean sensitivity, specificity, PPV, NPV, and accuracy of 80%, 58%, 96.5%, 16.5% and 78%, respectively, with mean AUC = 0.69. CONCLUSIONS: Pre-TACE 3D CT angiography has shown promise in improving the detection of HCC feeding vessels compared to DSA. However, further studies are required to confirm these findings across different clinical settings and patient populations. TRIAL REGISTRATION: This study was prospectively registered at Clinicaltrials.gov with ID NCT05304572; Date of registration: 2-4-2022.
背景：在经导管动脉化疗栓塞术（TACE）期间准确检测肝细胞癌（HCC）的供养血管对于有效治疗至关重要，同时限制非靶向栓塞。本研究旨在探讨与数字减影血管造影术（DSA）相比，TACE 前三维（3D）CT 血管造影术检测肿瘤供养血管的可行性和准确性。
方法：纳入 2022 年 5 月至 2023 年 5 月期间因 TACE 就诊的 69 例连续患者。从 TACE 前诊断性多期增强 CT 图像重建（3D）CT 图像，并与 TACE 期间获得的非选择性数字减影血管造影术（DSA）图像进行比较，以检测 HCC 的供养血管。观察者在回顾所有可用的 TACE 前 CT 图像、DSA 和 CBCT 图像后，通过共识制定出“金标准”来检测真正的供养血管。计算每种模态的敏感性、特异性、阴性预测值（NPV）、阳性预测值（PPV）、准确性和 ROC 曲线及其 AUC，并进行比较。
结果：在纳入的 69 例连续患者中，共检测到 136 个活跃的 HCC。通过 3D CT 和 DSA 检测到 185 条供养动脉，并纳入分析。3D CT 检测供养动脉的敏感性、特异性、PPV、NPV 和准确性分别为 91%、71%、98%、36%和 90%，平均 AUC 为 0.81。DSA 检测供养动脉的敏感性、特异性、PPV、NPV 和准确性分别为 80%、58%、96.5%、16.5%和 78%，平均 AUC 为 0.69。
结论：与 DSA 相比，TACE 前 3D CT 血管造影术在提高 HCC 供养血管检测方面显示出了一定的潜力。然而，需要进一步的研究来证实这些发现在不同的临床环境和患者人群中的适用性。
试验注册：本研究前瞻性地在 Clinicaltrials.gov 上注册，ID 为 NCT05304572；注册日期：2022 年 4 月 2 日。
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