Spectral CT Imaging-Based Quantification of Iodized Oil Retention following Chemoembolization: Phantom and Animal Studies

Multifunctionality of Iodinated Halogen-Bonded Polymer: Biodegradability, Radiopacity, Elasticity, Ductility, and Self-Healing Ability

A polymer with high contents of ester bonds and iodine atoms was synthesized, exhibiting sufficient biodegradability and radioactivity for biomedical applications. The iodine moieties of the synthesized polyester can generate halogen bonding between molecules, which may develop additional functional properties through the bonding. In this study, poly(glycerol adipate) (PGA) was selected and synthesized as a polyester, which was then adequately conjugated with three different types of iodine compounds via the hydroxy groups of PGA. It was found that the iodine compounds could effectively work as donors of halogen bonding. The thermal analysis by differential scanning calorimetry (DSC) revealed that the glass transition temperature increased with the increase in the strength of interactions caused by π-π stacking and halogen bonding, eventually reaching 49.6 °C for PGA with triiodobenzoic groups. An elastomeric PGA with monoiodobenzoic groups was also obtained, exhibiting a high self-healing ability at room temperature because of the reconstruction of halogen bonding. Such multifaceted performance of the synthesized polyester with controllable thermal/mechanical properties was realized by halogen bonding, leading to a promising biomaterial with multifunctionality.

C-Arm Computed Tomographic Image Fusion for Repetitive Transarterial Chemoembolization of Hepatocellular Carcinoma

OBJECTIVE

The aim of this study was to evaluate the potential implications of fusion imaging with C-arm computed tomography (CACT) scans for repetitive conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma.

MATERIALS AND METHODS

Fifty-six cTACE sessions were performed using fusion CACT images from September 2020 to June 2021 in a tertiary referral center, and the data were retrospectively analyzed. Fusion of unenhanced and enhanced CACT images was considered when previously accumulated iodized oil hampered the identification of local tumor progression or intrahepatic distant metastasis (indication A), when a tumor was supplied by multiple arteries with different origins from the aorta and missing tumor enhancement was suspected (indication B), or when iodized oil distribution on immediate post-cTACE CACT images needed to be precisely compared with the pre-cTACE images (indication C). Fusion image quality, initial tumor response, time to local progression (TTLP) of index tumors, and time to progression (TTP) were evaluated.

RESULTS

The fusion quality was satisfactory with a mean misregistration distance of 1.4 mm. For the 40 patients with indication A, the initial tumor responses at 3 months were nonviable, equivocal, and viable in 27 (67.5%), 4 (10.0%), and 9 (22.5%) index tumors, respectively. The median TTLP and TTP were 14.8 months and 4.5 months, respectively. For 10 patients with indication B, the median TTLP and TTP were 8.3 months and 2.6 months, respectively. Among the 6 patients with indication C, 2 patients were additionally treated at the same cTACE session after confirming incomplete iodized oil uptake on fusion imaging.

CONCLUSIONS

Fusion CACT images are useful in patients with hepatocellular carcinoma undergoing repetitive cTACE.

Spectral CT-Based Iodized Oil Quantification to Predict Tumor Response Following Chemoembolization of Hepatocellular Carcinoma

PURPOSE

To quantify iodized oil retention in tumors after transarterial chemoembolization using spectral computed tomography (CT) imaging in patients with hepatocellular carcinoma (HCC) and evaluate its performance in predicting 12-month tumor responses.

MATERIALS AND METHODS

From September 2017 to December 2018, 111 patients with HCC underwent initial conventional transarterial chemoembolization. Immediately after the procedure, unenhanced CT was performed using a spectral CT scanner, and the iodized oil densities in index tumors were measured. In tumor-level analyses, a threshold level of iodized oil density in the tumors was calculated using clustered receiver operating characteristic curve analyses to predict the 12-month tumor responses. In patient-level analyses, significant factors associated with a 12-month complete response, including the presence of tumors below the threshold value (ie, suspected residual tumors), were evaluated by logistic regression.

RESULTS

Forty-eight HCCs in 39 patients were included in the analyses. The lower 10th percentile of the iodine density was identified as the threshold for determining the 12-month nonviable responses. The area under the curve of the iodine density measurements in predicting the 12-month nonviable responses was 0.893 (95% confidence interval, 0.797-0.989). The threshold value of the iodine density of 10.68 mg/mL yielded a sensitivity of 82.76% and specificity of 94.74% (P < .001). In the patient-level analysis, the 12-month complete response was significantly associated with the presence of a suspected residual tumor, with an odds ratio of 72.0 (95% confidence interval, 7.273-712.770).

CONCLUSIONS

Spectral CT imaging using quantitative analysis of the iodized oil retention in target HCCs can predict tumor responses after a conventional transarterial chemoembolization procedure.