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A Motion Artifact Correction Algorithm for Cone-Beam CT in Patients with Hepatic Malignancies Treated with Transarterial Chemoembolization. J Vasc Interv Radiol 2022; 33:1367-1374.e2. [PMID: 35842027 DOI: 10.1016/j.jvir.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/15/2022] [Accepted: 07/03/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the effect of a motion artifact correction algorithm (MACA) on cone-beam computed tomography (CT) during transarterial chemoembolization for hepatic malignancies. MATERIALS AND METHODS From June 2020 to March 2021, 42 patients with mild-to-severe motion artifacts detected using single cone-beam CT scans were evaluated retrospectively. The image quality of native and motion-corrected data was compared. The maximum intensity, sharpness, and full width at half maximum (FWHM) of 5 segmental hepatic arteries were quantitatively measured. The overall quality of maximum intensity projection (MIP) images, conspicuity of tumor-supplying arteries, and need for selective angiography to ascertain the vascular anatomy were qualitatively evaluated by multiple readers. Paired t and Wilcoxon signed rank tests were used to compare the parameters. RESULTS The mean maximum intensity and sharpness increased from 2,792.01 HU ± 451.36 to 3,148.40 HU ± 594.46 and from 0.31 ± 0.02/mm to 0.34 ± 0.02/mm, respectively, using the MACA (both P < .001). The MACA decreased the mean FWHM from 2.02 mm ± 0.27 to 1.78 mm ± 0.26 (P < .001). The overall quality of the MIP images and the conspicuity of the tumor-supplying artery were enhanced from 2.5 to 3.0 points and from 3.0 to 4.0 points, respectively (both P < .001). Selective angiography was expected to be omitted in 7 cases (16.7%, 7/42) after using the MACA. CONCLUSIONS The MACA significantly improved both quantitative and qualitative image quality of cone-beam CT in selected patients with motion artifacts during transarterial chemoembolization for hepatic malignancies.
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Floridi C, Cellina M, Irmici G, Bruno A, Rossini N, Borgheresi A, Agostini A, Bruno F, Arrigoni F, Arrichiello A, Candelari R, Barile A, Carrafiello G, Giovagnoni A. Precision Imaging Guidance in the Era of Precision Oncology: An Update of Imaging Tools for Interventional Procedures. J Clin Med 2022; 11:jcm11144028. [PMID: 35887791 PMCID: PMC9322069 DOI: 10.3390/jcm11144028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/02/2022] [Accepted: 07/08/2022] [Indexed: 02/05/2023] Open
Abstract
Interventional oncology (IO) procedures have become extremely popular in interventional radiology (IR) and play an essential role in the diagnosis, treatment, and supportive care of oncologic patients through new and safe procedures. IR procedures can be divided into two main groups: vascular and non-vascular. Vascular approaches are mainly based on embolization and concomitant injection of chemotherapeutics directly into the tumor-feeding vessels. Percutaneous approaches are a type of non-vascular procedures and include percutaneous image-guided biopsies and different ablation techniques with radiofrequency, microwaves, cryoablation, and focused ultrasound. The use of these techniques requires precise imaging pretreatment planning and guidance that can be provided through different imaging techniques: ultrasound, computed tomography, cone-beam computed tomography, and magnetic resonance. These imaging modalities can be used alone or in combination, thanks to fusion imaging, to further improve the confidence of the operators and the efficacy and safety of the procedures. This article aims is to provide an overview of the available IO procedures based on clinical imaging guidance to develop a targeted and optimal approach to cancer patients.
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Affiliation(s)
- Chiara Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital “Umberto I—Lancisi—Salesi”, 60126 Ancona, Italy;
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126 Ancona, Italy;
- Correspondence:
| | - Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20122 Milan, Italy;
| | - Giovanni Irmici
- Post-Graduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (G.I.); (A.A.)
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
| | - Nicolo’ Rossini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
| | - Alessandra Borgheresi
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital “Umberto I—Lancisi—Salesi”, 60126 Ancona, Italy;
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
| | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.B.); (A.B.)
| | - Francesco Arrigoni
- Emergency and Interventional Radiology, San Salvatore Hospital, 67100 L’Aquila, Italy;
| | - Antonio Arrichiello
- Post-Graduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (G.I.); (A.A.)
| | - Roberto Candelari
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126 Ancona, Italy;
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.B.); (A.B.)
| | - Gianpaolo Carrafiello
- Operative Unit of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy;
- Department of Health Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital “Umberto I—Lancisi—Salesi”, 60126 Ancona, Italy;
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Saito N, Tanaka T, Minamiguchi K, Taiji R, Nishiofuku H, Matsumoto T, Hirai T, Kichikawa K, Kawahara N, Matsuda D, Akiyama I. Ultrasonic Heating Detects Lipiodol Deposition within Liver Tumors after Transarterial Embolization: An In Vivo Approach. BIOLOGY 2021; 10:biology10090901. [PMID: 34571777 PMCID: PMC8466351 DOI: 10.3390/biology10090901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022]
Abstract
Simple Summary The accumulation of Lipiodol (ethiodized oil) after transarterial embolization is known to reflect tumor necrosis. In general, the treatment effect is evaluated by computed tomography; there has been no development in imaging modalities for several decades. A new technique, ultrasonic heating, can differentiate biological tissues based on the fact that tissues’ characteristic sound velocity varies depending on the temperature. This technique could have the potential to evaluate treatment effect after transarterial embolization as an alternative to computed tomography. Abstract Computed tomography (CT) is the standard method to evaluate Lipiodol deposition after transarterial embolization (TAE) for a long period. However, iodine but not Lipiodol can be observed on CT. A minimally invasive other method to detect Lipiodol has been needed to evaluate accurate evaluation after procedure. The purpose of this study was to evaluate the efficacy of using the rate of change in sound velocity caused by ultrasonic heating to reflect Lipiodol accumulation after TAE in a rat liver tumor model. We analyzed the association of this developed technique with CT images and histological findings. Eight rats bearing N1S1 cells were prepared. After confirmation of tumor development in a rat liver, Lipiodol was injected via the hepatic artery. Seven days after TAE, CT scan and sound velocity changes caused by ultrasonic heating were measured, and then the rats were sacrificed. An ultrasonic pulse-echo method was used to measure the sound velocity. The temperature coefficient of the sound velocity in each treated tumor was evaluated and compared with the mean CT value and the histological Lipiodol accumulation ratio. Pearson’s correlation coefficients were calculated to assess the correlation between the measured values. The correlation coefficient (r) of the mean CT value and histological Lipiodol accumulation ratio was 0.835 (p = 0.010), which was considered statistically significant. Also, those of the temperature coefficient of the sound velocity and the histological Lipiodol accumulation ratio were statistically significant (r = 0.804; p = 0.016). To our knowledge, this is the first study that reported the efficacy of ultrasonic heating to detect Lipiodol accumulation in rat liver tumors after TAE. Our results suggest that the rate of change in sound velocity caused by ultrasonic heating can be used to evaluate Lipiodol accumulation in liver tumors after TAE, and thus could represent an alternative to CT in this application. This new innovative technique is easy to treat and less invasive in terms of avoiding radiation compared with CT.
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Affiliation(s)
- Natsuhiko Saito
- Department of Radiology and Nuclear Medicine, Nara Medical University, Kashihara Nara 634-8521, Japan; (T.T.); (K.M.); (R.T.); (H.N.); (T.M.); (T.H.); (K.K.)
- Correspondence:
| | - Toshihiro Tanaka
- Department of Radiology and Nuclear Medicine, Nara Medical University, Kashihara Nara 634-8521, Japan; (T.T.); (K.M.); (R.T.); (H.N.); (T.M.); (T.H.); (K.K.)
| | - Kiyoyuki Minamiguchi
- Department of Radiology and Nuclear Medicine, Nara Medical University, Kashihara Nara 634-8521, Japan; (T.T.); (K.M.); (R.T.); (H.N.); (T.M.); (T.H.); (K.K.)
| | - Ryosuke Taiji
- Department of Radiology and Nuclear Medicine, Nara Medical University, Kashihara Nara 634-8521, Japan; (T.T.); (K.M.); (R.T.); (H.N.); (T.M.); (T.H.); (K.K.)
| | - Hideyuki Nishiofuku
- Department of Radiology and Nuclear Medicine, Nara Medical University, Kashihara Nara 634-8521, Japan; (T.T.); (K.M.); (R.T.); (H.N.); (T.M.); (T.H.); (K.K.)
| | - Takeshi Matsumoto
- Department of Radiology and Nuclear Medicine, Nara Medical University, Kashihara Nara 634-8521, Japan; (T.T.); (K.M.); (R.T.); (H.N.); (T.M.); (T.H.); (K.K.)
| | - Toshiko Hirai
- Department of Radiology and Nuclear Medicine, Nara Medical University, Kashihara Nara 634-8521, Japan; (T.T.); (K.M.); (R.T.); (H.N.); (T.M.); (T.H.); (K.K.)
| | - Kimihiko Kichikawa
- Department of Radiology and Nuclear Medicine, Nara Medical University, Kashihara Nara 634-8521, Japan; (T.T.); (K.M.); (R.T.); (H.N.); (T.M.); (T.H.); (K.K.)
| | - Naoki Kawahara
- Department of Medical Ultrasound Research Center, Doshisha University, Kyotanabe Kyoto 610-0321, Japan; (N.K.); (D.M.); (I.A.)
| | - Daiki Matsuda
- Department of Medical Ultrasound Research Center, Doshisha University, Kyotanabe Kyoto 610-0321, Japan; (N.K.); (D.M.); (I.A.)
| | - Iwaki Akiyama
- Department of Medical Ultrasound Research Center, Doshisha University, Kyotanabe Kyoto 610-0321, Japan; (N.K.); (D.M.); (I.A.)
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Role of Cone-Beam CT in the Intraprocedural Evaluation of Chemoembolization of Hepatocellular Carcinoma. JOURNAL OF ONCOLOGY 2021; 2021:8856998. [PMID: 33790970 PMCID: PMC7997764 DOI: 10.1155/2021/8856998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/21/2021] [Accepted: 03/12/2021] [Indexed: 01/27/2023]
Abstract
Purpose To assess the ability of Cone-Beam CT (CBCT), performed during the Transcatheter Arterial Chemoembolization (TACE), in predicting the response to treatment of hepatocellular carcinoma (HCC). Materials and Methods We evaluated fifty patients (M/F = 40/10, mean age: 66.7 years ± 8.22) with hepatocellular carcinoma (HCC), for a total of 82 nodules evaluated (mean diameter: 21.4 ± 11 mm). All patients performed a CT scan one month before and one month after TACE. After TACE is completed, a CBCT was performed to assess the degree of drug retention in the lesions. For each lesion, the major diameter, volume, and density of the vital portion were evaluated. The response to TACE was assessed using the mRECIST criteria on the CT scan carried out one month after the procedure. The receiver operating characteristic (ROC) curves were performed to assess the accuracy of the CBCT in predicting the response to treatment and to identify the cut-off points for each parameter under examination. Results A complete response (CR) was observed in 24/50 patients (48%), a partial response (PR) in 16/50 (32%), stable disease (SD) in 8/50 (16%), and progressive disease (PD) in 2/50 (4%). Evaluation of the area under the ROC curve showed that the diameter, volume, and density of the lesion, measured with CBTC, had an accuracy of 94%, 96%, and 98%, respectively, in discriminating a complete response from a not complete response. Conclusion CBCT is effective in predicting short-term response at 1-month follow-up of HCC treated by chemoembolization.
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Effectiveness of intraprocedural dual-phase cone-beam computed tomography in detecting hepatocellular carcinoma and improving treatment outcomes following conventional transarterial chemoembolization. PLoS One 2021; 16:e0245911. [PMID: 33513172 PMCID: PMC7845953 DOI: 10.1371/journal.pone.0245911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/09/2021] [Indexed: 11/19/2022] Open
Abstract
To investigate the effectiveness of intraprocedural dual-phase cone-beam computed tomography (CBCT) in detecting hepatocellular carcinoma (HCC) during conventional transcatheter arterial chemoembolization (TACE) and its effect on improving treatment outcomes. Between November 2018 and November 2019, data from 111 patients with unresectable HCCs (N = 263 lesions) were reviewed retrospectively. All patients had undergone baseline magnetic resonance imaging (MRI) scans within one month prior to the procedure. Both arterial-phase (AP) and delayed-phase CBCT images were acquired during all conventional TACEs. Each HCC detection rate when read by AP-CBCT and when read by dual-phase (DP) CBCT including both AP and delayed phase was compared with that of MRI, and the diagnosis of HCC was based on MRI. Additionally, the follow-up results concerning lipiodol uptake status and tumor response of the lesions detected only by AP-/DP-CBCT were analyzed and compared with MRI-only detected lesions. The overall sensitivity of DP-CBCT (94.7%) was significantly higher than that of AP-CBCT (89.0%) (p = 0.003). In particular, the rate of subcentimeter HCC detection by DP-CBCT was pronounced (91.5% vs. 80.3%) (p = 0.01). Lesions found only by DP-CBCT exhibited positive lipiodol uptake (n = 31/31; 100%) and showed complete or partial responses (n = 24/31; 77.4%) on follow-up CT imaging, while MRI-only detected lesions had less lipiodol uptake (n = 6/14, 42.9%) and complete or partial responses (n = 4/14; 28.6%) (p ≤ 0.001). DP-CBCT imaging during TACE enabled better detection of HCCs than when using AP-CBCT alone, and AP- and DP-CBCT is superior to MRI in detecting chemoembolization-sensitive lesions. This resulted in increased detectability of HCCs and the achievement of better treatment outcomes.
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Guo Z, Lauritsch G, Maier A, Kugler P, Islam M, Vogt F, Noo F. C-arm CT imaging with the extended line-ellipse-line trajectory: first implementation on a state-of-the-art robotic angiography system. Phys Med Biol 2020; 65:185016. [PMID: 32512552 DOI: 10.1088/1361-6560/ab9a82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Three-dimensional cone-beam imaging has become valuable in interventional radiology. Currently, this tool, referred to as C-arm CT, employs a circular short-scan for data acquisition, which limits the axial volume coverage and yields unavoidable cone-beam artifacts. To improve flexibility in axial coverage and image quality, there is a critical need for novel data acquisition geometries and related image reconstruction algorithms. For this purpose, we previously introduced the extended line-ellipse-line trajectory, which allows complete scanning of arbitrary volume lengths in the axial direction together with adjustable axial beam collimation, from narrow to wide depending on the targeted application. A first implementation of this trajectory on a state-of-the-art robotic angiography system is reported here. More specifically, an assessment of the quality of this first implementation is presented. The assessment is in terms of geometric fidelity and repeatability, complemented with a first visual inspection of how well the implementation enables imaging an anthropomorphic head phantom. The geometric fidelity analysis shows that the ideal trajectory is closely emulated, with only minor deviations that have no impact on data completeness and clinical practicality. Also, mean backprojection errors over short-term repetitions are shown to be below the detector pixel size at field-of-view center for most views, which indicates repeatability is satisfactory for clinical utilization. These repeatability observations are further supported by values of the Structural Similarity Index Metric above 94% for reconstructions of the FORBILD head phantom from computer-simulated data based on repeated data acquisition geometries. Last, the real data experiment with the anthropomorphic head phantom shows that the high contrast features of the phantom are well reconstructed without distortions as well as without breaks or other disturbing transition zones, which was not obvious given the complexity of the data acquisition geometry and the major variations in axial coverage that occur over the scan.
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Affiliation(s)
- Zijia Guo
- UCAIR, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States of America. Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
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Server S, Sabet S, Bilgin R, Inan N, Yuzer Y, Tokat Y. Intravoxel Incoherent Motion Parameters for Assessing the Efficiency of Locoregional Bridging Treatments before Liver Transplantation. Transplant Proc 2019; 51:2391-2396. [PMID: 31474296 DOI: 10.1016/j.transproceed.2019.01.161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/28/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of Intravoxel Incoherent Motion (IVIM) parameters for assessment of tumor response after locoregional treatment (LRT) of hepatocellular carcinoma (HCC). METHODS Fifteen patients with HCC who had undergone LRTs (11 transarterial radioembolization, 4 transarterial chemoembolization) were included. In addition to routine upper abdominal magnetic resonance imaging sequences, IVIM with 16 different b values and conventional diffusion weighted imaging with 3 different b factors were obtained immediately before and 8 weeks after LRTs. Magnetic resonance imaging response was evaluated according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) and HCCs were categorized into 2 subgroups, responders and nonresponders. Quantitatively, the number of diffusion-changes were calculated with apparent diffusion coefficient (ADC) and IVIM parameters, including mean D (true diffusion coefficient), pseudo-diffusion coefficient associated with blood flow, and f (perfusion fraction) values. Subsequently, the pre- and post-treatment parameters were compared using the Mann-Whitney U test. RESULTS Considering all HCCs, a significant decrease was observed according to mRECIST criteria (-38.43 ± 16.49). The ADC and D values after LRTs were significantly higher than those of the preceding ones. The f values after LRTs were significantly lower than those of pre-treatment. In the responders group, ADC and D values were significantly increased and f values were significantly decreased after LRTs. No difference of statistical significance was achieved in the nonresponders group. CONCLUSIONS ADC values and IVIM parameters appear to reflect the response of LRTs as effectively as those of mRECIST. This promises new horizons in the management of pretransplant patients, especially in renal insufficiency clinical settings, owing to the elimination of contrast media administration.
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Affiliation(s)
- Sadık Server
- Department of Radiology, Istanbul Bilim University, Sisli Florence Nightingale Hospital, Istanbul, Turkey.
| | - Soheil Sabet
- Department of Radiology, Istanbul Bilim University, Sisli Florence Nightingale Hospital, Istanbul, Turkey
| | - Refik Bilgin
- Department of Nuclear Medicine, Istanbul Bilim University, Sisli Florence Nightingale Hospital, Istanbul, Turkey
| | - Nagihan Inan
- Department of Radiology, Istanbul Bilim University, Sisli Florence Nightingale Hospital, Istanbul, Turkey
| | - Yıldıray Yuzer
- Department of Liver Transplantation, Istanbul Bilim University, Sisli Florence Nightingale Hospital, Istanbul, Turkey
| | - Yaman Tokat
- Department of Liver Transplantation, Istanbul Bilim University, Sisli Florence Nightingale Hospital, Istanbul, Turkey
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Wattanasatesiri T, Kim HC, Choi JW, Lee JH, Joo I, Hur S, Lee M, Jae HJ, Chung JW. Cone-Beam CT-Guided Chemoembolization in Patients with Complete Response after Previous Chemoembolization but Subsequent Elevated α-Fetoprotein without Overt Hepatocellular Carcinoma. J Vasc Interv Radiol 2019; 30:1273-1280. [PMID: 31235410 DOI: 10.1016/j.jvir.2019.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 03/10/2019] [Accepted: 03/17/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the performance of C-arm computed tomography (CT)-guided chemoembolization in patients with hepatocellular carcinoma (HCC) with serum α-fetoprotein (AFP) level > 20 ng/mL but with no overt tumor on CT and/or magnetic resonance imaging. MATERIALS AND METHODS From May 2010 to May 2017, 34 patients with HCC (25 men and 9 women; mean age, 59.7 y) who had elevated serum AFP levels (> 20 ng/mL) but no overt tumor on 6-mo imaging studies and had shown complete response (CR) after previous chemoembolization underwent C-arm CT-guided conventional chemoembolization. Three radiologists retrospectively reviewed the imaging studies (preprocedural images, C-arm CT scans, and follow-up images) in consensus, and clinical data including AFP levels were retrospectively obtained. Tumor detection by C-arm CT and treatment response after chemoembolization were assessed. RESULTS HCC was imaged at the time of chemoembolization in 24 of 34 patients (70.6%). C-arm CT detected tumors in 25 patients (73.5%); 23 detections were true positives, 2 were false positives, and 1 was a false negative (diaphragm metastasis). Among the 23 patients with true-positive results, the first follow-up enhanced imaging studies showed CR (n = 17), partial response (n = 1), progressive disease (n = 4), and indeterminate status (n = 1; treated by percutaneous ethanol injection). CONCLUSIONS C-arm CT-guided chemoembolization may help to detect and treat recurrent tumors in patients who have shown CR after previous chemoembolization but subsequently, during follow-up surveillance, had serum AFP levels > 20 ng/mL without an overt tumor evident on imaging studies.
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Affiliation(s)
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea.
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
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Kim KA, Choi SY, Kim MU, Baek SY, Park SH, Yoo K, Kim TH, Kim HY. The Efficacy of Cone-Beam CT–Based Liver Perfusion Mapping to Predict Initial Response of Hepatocellular Carcinoma to Transarterial Chemoembolization. J Vasc Interv Radiol 2019; 30:358-369. [DOI: 10.1016/j.jvir.2018.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/16/2018] [Accepted: 10/06/2018] [Indexed: 02/08/2023] Open
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10
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Liu FY, Li X, Yuan HJ, Guan Y, Wang MQ. Angio-Computed Tomograph-Guided Immediate Lipiodol Computed Tomograph for Diagnosis of Small Hepatocellular Carcinoma Lesions during Transarterial Chemoembolization. Chin Med J (Engl) 2018; 131:2410-2416. [PMID: 30334525 PMCID: PMC6202594 DOI: 10.4103/0366-6999.243554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The diagnosis and treatment of small hepatocellular carcinoma (HCC) play a vital role in the prognosis of patients with HCC. The purpose of our study was to evaluate angio-computed tomography (angio-CT)-guided immediate lipiodol CT (a CT scan performed immediately after transarterial chemoembolization [TACE]) in the diagnosis of potential HCCs ≤1 cm in diameter. METHODS This study retrospectively analyzed 31 patients diagnosed with HCCs after routine imaging (contrast-enhanced CT or magnetic resonance imaging) or pathologic examinations with undefined or undetermined tumor lesions (diameter ≤1 cm) from February 2016 to September 2016. After TACE guided by digital subtraction angiography of the angio-CT system, potential HCC lesions with a diameter ≤1 cm were diagnosed by immediate lipiodol CT. The number of well-demarcated lesions was recorded to calculate the true positive rate. The correlation between the number of small HCCs detected by immediate lipiodol CT and the size of HCC lesions (diameter >1 cm) diagnosed preoperatively was analyzed 1 month after TACE. A paired t-test was used to analyze differences in liver function. Pearson analysis was used to analyze correlation. Chi-square test was used to compare the rates. RESULTS Fifty-eight lesions were detected on preoperative routine imaging examinations in 31 patients including 15 lesions with a diameter ≤1 cm. Ninety-one lesions were detected on immediate lipiodol CT, of which 48 had a diameter ≤1 cm. After 1 month, CT showed that 45 lesions had lipiodol deposition and three lesions had lipiodol clearance. Correlation analysis showed that the number of small HCCs detected by lipiodol CT was positively correlated with the size of HCC lesions diagnosed by conventional imaging examination (R2 = 0.54, P < 0.05). CONCLUSION Immediate lipiodol CT may be a useful tool in the diagnosis of potential HCC lesions with a diameter of ≤1 cm.
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Affiliation(s)
- Feng-Yong Liu
- Department of Interventional Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Xin Li
- Department of Interventional Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Hong-Jun Yuan
- Department of Interventional Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yang Guan
- Department of Interventional Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Mao-Qiang Wang
- Department of Interventional Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Kim EH, Oh JS, Chun HJ, Choi BG, Lee HG. Usefulness of fusion images of unenhanced and contrast-enhanced arterial phase cone-beam CT in the detection of viable hepatocellular carcinoma during transarterial chemoembolization. ACTA ACUST UNITED AC 2018; 24:262-267. [PMID: 30211679 DOI: 10.5152/dir.2018.17503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate the diagnostic efficacy of fusion imaging of unenhanced and arterial phase contrast-enhanced cone-beam computed tomography (CBCT) by comparing with multidetector computed tomography (MDCT) in detection of viable hepatocellular carcinoma (HCC) in patients who have been previously treated with transarterial chemoembolization (TACE). METHODS In this retrospective study, a total of 173 tumors in 33 known HCC patients (21 men, 12 women; mean age, 64±7.6 years; mean tumor size, 2.15±1.70 cm) who had been previously treated with TACE and underwent additional session of TACE were included. The sensitivity and positive predictive values of preprocedural MDCT and fusion CBCT for detection of viable tumor were analyzed with follow-up MDCT images performed 3-4 weeks after TACE, as reference standard. RESULTS A total of 141 remote and 32 marginal viable tumors were included. The sensitivities for detection of remote, marginal, and total viable tumors were 80.9%, 68.8%, and 78.6% for MDCT and 96.5%, 96.9%, and 96.5% for fusion CBCT, respectively. The positive predictive values for detection of remote, marginal, and total viable tumors were 95.0%, 78.6%, and 95.8% for MDCT, and 97.1%, 88.6%, and 97.7% for fusion CBCT, respectively. Fusion CBCT showed statistically higher sensitivity and positive predictive value for detection of viable tumors (P < 0.001). CONCLUSION The diagnostic performance of fusion imaging of unenhanced and contrast-enhanced arterial phase CBCT was superior to MDCT for detection of viable HCCs.
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Affiliation(s)
- Eu Hyun Kim
- Department of Radiology Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Jung Suk Oh
- Department of Radiology Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Ho Jong Chun
- Department of Radiology Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Byung Gil Choi
- Department of Radiology Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Hae Giu Lee
- Department of Radiology Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
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Yao X, Yan D, Jiang X, Li X, Zeng H, Liu D, Li H. Dual-phase Cone-beam CT-based Navigation Imaging Significantly Enhances Tumor Detectability and Aids Superselective Transarterial Chemoembolization of Liver Cancer. Acad Radiol 2018; 25:1031-1037. [PMID: 29398432 DOI: 10.1016/j.acra.2017.12.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/23/2017] [Accepted: 12/24/2017] [Indexed: 01/16/2023]
Abstract
RATIONALE AND OBJECTIVES The objective of this study was to investigate the impact of a dual-phase cone-beam computed tomography (DP-CBCT)-based navigation imaging during transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) in a perspective randomized study. MATERIALS AND METHODS Forty-two patients with HCC (39 men, 57 ± 9 years, 13 first-time TACE) underwent TACE using three-dimensional image guidance with automatic detection of tumor-feeding vessels computed from DP-CBCT (early and delayed arterial phases). Forty-nine other patients with HCC (44 men, 55 ± 12 years, 14 first-time TACE) were treated conventionally using digital subtraction angiography (DSA). Tumor detectability in DP-CBCT was compared to DSA and preoperative CT or magnetic resonance (MR) imaging. Tumor-feeding vessel visibility was rated (good, fair, and poor) intraoperatively by the operators. The superselective embolization success rate, the number of DSA acquisitions, fluoroscopy time, and patient radiation dose were collected and compared using paired t test and the Mann-Whitney U test. RESULTS Tumor detection of DP-CBCT was superior to DSA (100% vs 83%, P = .001) and comparable to CT-MR (96%, P = .456). Tumor and feeder visibilities were significantly enhanced by DP-CBCT (P < .001). Compared to using DSA, more superselective embolization was achieved (60% vs 49%) with less DSA acquisitions (n = 2.6 ± 0.8 vs n = 3.4 ± 0.7, P < .001) and shorter fluoroscopy time (4.1 ± 2.6 vs 7.1 ± 4.2 minutes, P < .001) with a slight increase in patient radiation exposure, that is, air kerma (median: 0.33, first to third quartiles: 0.24-0.48 vs 0.30, 0.24-0.44 Gy; P = .519) and dose-area product (134, 92-181 vs 97, 75-140 Gy⋅cm2, P = .048). CONCLUSIONS DP-CBCT and navigation imaging improve tumor detectability and superselective embolization in TACE.
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Affiliation(s)
- Xuesong Yao
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing 10021, China
| | - Dong Yan
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing 10021, China
| | | | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing 10021, China
| | - Huiying Zeng
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing 10021, China
| | - Dezhong Liu
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing 10021, China
| | - Huai Li
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing 10021, China.
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Bae JS, Kim JH, Yu MH, Lee DH, Kim HC, Chung JW, Han JK. Diagnostic accuracy of gadoxetic acid-enhanced MR for small hypervascular hepatocellular carcinoma and the concordance rate of Liver Imaging Reporting and Data System (LI-RADS). PLoS One 2017; 12:e0178495. [PMID: 28558068 PMCID: PMC5448778 DOI: 10.1371/journal.pone.0178495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/14/2017] [Indexed: 01/08/2023] Open
Abstract
Background & aims To assess diagnostic accuracy of gadoxetic acid–enhanced MR for small hypervascular hepatocellular carcinoma (HCC) detected by C-arm CT and concordance rate of Liver Imaging Reporting and Data System (LI-RADS). Methods In this retrospective study, we recruited 4,544 patients suspected of having HCC underwent C-arm CT from November 2008 to May 2013. Among these patients, gadoxetic acid–enhanced MR was performed in 167 patients with HCC (n = 379; 257 > 1 cm, 122 ≤ 1 cm). HCC was confirmed by MR, CT, or follow-up images. Two radiologists graded likelihood of HCC and assessed MR features. Jackknife alternative free-response receiver operating characteristic (JAFROC) analysis was performed. All HCCs were evaluated concordance rate of LI-RADS. Results Mean JAFROC figure of merit for large (>1-cm) HCC was 0.948, while that for small HCC was 0.787 with fair agreement (κ = 0.409). Mean sensitivity and positive predictive value (PPV) were 91% and 90% for large HCC versus 63.0% and 79% for small HCC, respectively. Seventeen of 122 small HCCs (13.9%) were not visible on MR. Among 379 HCCs, 99 met LR-5, and 259 met LR-4. Common features for small HCC included arterial enhancement (81.9%), hepatobiliary phase hypointensity (80.3%), and delayed washout (72.9%). Conclusion Diagnostic accuracy of gadoxetic acid–enhanced MR imaging for small, hypervascular HCCs (Mean figure of merit = 0.787) was still low compared with large HCC (Mean figure of merit = 0.948). LR-5 and LR-4 covered 94% (358/379) of the HCCs.
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Affiliation(s)
- Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
| | - Mi Hye Yu
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Yang W, Yan K, Chen MH, Wu JY, Zhang ZY, Lee JC, Wang S, Wu W. Preliminary experience with direct percutaneous arterial embolisation combined with radiofrequency ablation for hypervascular HCC. Int J Hyperthermia 2017; 33:836-845. [DOI: 10.1080/02656736.2017.1305126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Minami Y, Takita M, Tsurusaki M, Yagyu Y, Ueshima K, Murakami T, Kudo M. Semiquantitative prediction of early response of conventional transcatheter arterial chemoembolization for hepatocellular carcinoma using postprocedural plain cone-beam computed tomography. Hepatol Res 2017; 47:E113-E119. [PMID: 27138382 DOI: 10.1111/hepr.12735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 02/06/2023]
Abstract
AIM To investigate whether plain cone-beam computed tomography (CT) immediately after conventional transcatheter arterial chemoembolization (c-TACE) can help to predict tumor response semiquantitatively in patients with hepatocellular carcinoma (HCC). METHODS Analysis was carried out retrospectively on 262 targeted HCCs in 169 patients treated with c-TACE. Dynamic CT was performed at baseline and 1-4 months after c-TACE. Receiver-operating characteristic curve analysis was undertaken to evaluate whether voxel values of cone-beam CT could predict a complete response and to identify the cut-off value. Final tumor response assessment and early prediction using the retention pattern of iodized oil, the cut-off value of the density, and the combination of the cut-off density value and retention pattern of iodized oil in HCCs on postprocedural cone-beam CT were compared. RESULTS Complete response was obtained in 72.9% of lesions. According to the pattern of iodized oil uptake, the sensitivity, specificity, and accuracy for predicting complete response were 85.9%, 70.4%, and 81.7%, respectively by excellent uptake on cone-beam CT. The area under the curve was 0.86 with the optimal cut-off at a voxel value of 200.13. According to not only the density but also the homogeneity of iodized oil retention, the sensitivity, specificity, and accuracy values for predicting complete response were 86.4%, 95.8%, and 88.9%, respectively. The predictive accuracy was significantly better than that of the pattern of iodized oil retention only (P = 0.019). CONCLUSION The combination of density and visual estimate of homogeneity is superior to either alone in predicting tumor response of c-TACE in HCC patients.
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Affiliation(s)
| | | | | | - Yukinobu Yagyu
- Department of Radiology, Kinki University Faculty of Medicine, Osaka, Japan
| | | | - Takamichi Murakami
- Department of Radiology, Kinki University Faculty of Medicine, Osaka, Japan
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The Role of Cone-Beam CT in Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: A Systematic Review and Meta-analysis. J Vasc Interv Radiol 2017; 28:334-341. [PMID: 28109724 DOI: 10.1016/j.jvir.2016.11.037] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/04/2016] [Accepted: 11/16/2016] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To review available evidence for use of cone-beam CT during transcatheter arterial chemoembolization in hepatocellular carcinoma (HCC) for detection of tumor and feeding arteries. MATERIALS AND METHODS Literature searches were conducted from inception to May 15, 2016, in PubMed (MEDLINE), Scopus, and Cochrane Central Register of Controlled Trials. Searches included "cone beam," "CBCT," "C-arm," "CACT," "cone-beam CT," "volumetric CT," "volume computed tomography," "volume CT," AND "liver," "hepatic*," "hepatoc*." Studies that involved adults with HCC specifically and treated with transcatheter arterial chemoembolization that used cone-beam CT were included. RESULTS Inclusion criteria were met by 18 studies. Pooled sensitivity of cone-beam CT for detecting tumor was 90% (95% confidence interval [CI], 82%-95%), whereas pooled sensitivity of digital subtraction angiography (DSA) for tumor detection was 67% (95% CI, 51%-80%). Pooled sensitivity of cone-beam CT for detecting tumor feeding arteries was 93% (95% CI, 91%-95%), whereas pooled sensitivity of DSA was 55% (95% CI, 36%-74%). CONCLUSIONS Cone-beam CT can significantly increase detection of tumors and tumor feeding arteries during transcatheter arterial chemoembolization. Cone-beam CT should be considered as an adjunct tool to DSA during transcatheter arterial chemoembolization treatments of HCC.
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Yu Z, Lauritsch G, Dennerlein F, Mao Y, Hornegger J, Noo F. Extended ellipse-line-ellipse trajectory for long-object cone-beam imaging with a mounted C-arm system. Phys Med Biol 2016; 61:1829-51. [PMID: 26854687 DOI: 10.1088/0031-9155/61/4/1829] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Recent reports show that three-dimensional cone-beam (CB) imaging with a floor-mounted (or ceiling-mounted) C-arm system has become a valuable tool in interventional radiology. Currently, a circular short scan is used for data acquisition, which inevitably yields CB artifacts and a short coverage in the direction of the patient table. To overcome these two limitations, a more sophisticated data acquisition geometry is needed. This geometry should be complete in terms of Tuy's condition and should allow continuous scanning, while being compatible with the mechanical constraints of mounted C-arm systems. Additionally, the geometry should allow accurate image reconstruction from truncated data. One way to ensure such a feature is to adopt a trajectory that provides full R-line coverage within the field-of-view (FOV). An R-line is any segment of line that connects two points on a source trajectory, and the R-line coverage is the set of points that belong to an R-line. In this work, we propose a novel geometry called the extended ellipse-line-ellipse (ELE) for long-object imaging with a mounted C-arm system. This trajectory is built from modules consisting of two elliptical arcs connected by a line. We demonstrate that the extended ELE can be configured in many ways so that full R-line coverage is guaranteed. Both tight and relaxed parametric settings are presented. All results are supported by extensive mathematical proofs provided in appendices. Our findings make the extended ELE trajectory attractive for axially-extended FOV imaging in interventional radiology.
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Affiliation(s)
- Zhicong Yu
- Department of Radiology, University of Utah, Salt Lake City, USA. Department of Radiology, Mayo Clinic, Rochester, USA
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Chen BB, Murakami T, Shih TTF, Sakamoto M, Matsui O, Choi BI, Kim MJ, Lee JM, Yang RJ, Zeng MS, Chen RC, Liang JD. Novel Imaging Diagnosis for Hepatocellular Carcinoma: Consensus from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014). Liver Cancer 2015; 4:215-27. [PMID: 26734577 PMCID: PMC4698631 DOI: 10.1159/000367742] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Current novel imaging techniques in the diagnosis of hepatocellular carcinoma (HCC), with the latest evidence in this field, was discussed at the Asia-Pacific Primary Liver Cancer Expert (APPLE) meeting held in Taipei, Taiwan, in July 2014. Based on their expertise in a specific area of research, the novel imaging group comprised 12 participants from Japan, South Korea, Taiwan, and China and it included 10 abdominal radiologists, one hepatologist, and one pathologist. The expert participants discussed topics related to HCC imaging that were divided into four categories: (i) detection method, (ii) diagnostic method, (iii) evaluation method, and (iv) functional method. Consensus was reached on 10 statements; specific comments on each statement were provided to explain the rationale for the voting results and to suggest future research directions.
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Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
| | - Takamichi Murakami
- Department of Radiology, Kinki University, Faculty of Medicine, Osaka, Japan,*Takamichi Murakami, MD, PhD, Department of Radiology, Kinki University, Faculty of Medicine, 377-2, Ohno-Higashi, Osakasayama-City, Osaka 589-8511 (Japan), TEL. +81 72 366 0221, E-Mail
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo
| | - Osamu Matsui
- Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | | | - Myeong-Jin Kim
- Department of Radiology, Yonsei University College of Medicine
| | - Jeong Min Lee
- Department of Radiology, Seoul National University, Seoul, Republic of Korea
| | - Ren-jie Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Interventional Therapy, Peking University Cancer Hospital & Institute, Beijing, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ran-Chou Chen
- Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Heping Fuyou Branch, Taipei City Hospital, Taiwan (ROC)
| | - Ja-Der Liang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
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Histogram Analysis of CT Perfusion of Hepatocellular Carcinoma for Predicting Response to Transarterial Radioembolization: Value of Tumor Heterogeneity Assessment. Cardiovasc Intervent Radiol 2015. [PMID: 26216725 DOI: 10.1007/s00270-015-1185-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate in patients with hepatocellular carcinoma (HCC), whether assessment of tumor heterogeneity by histogram analysis of computed tomography (CT) perfusion helps predicting response to transarterial radioembolization (TARE). MATERIALS AND METHODS Sixteen patients (15 male; mean age 65 years; age range 47-80 years) with HCC underwent CT liver perfusion for treatment planning prior to TARE with Yttrium-90 microspheres. Arterial perfusion (AP) derived from CT perfusion was measured in the entire tumor volume, and heterogeneity was analyzed voxel-wise by histogram analysis. Response to TARE was evaluated on follow-up imaging (median follow-up, 129 days) based on modified Response Evaluation Criteria in Solid Tumors (mRECIST). Results of histogram analysis and mean AP values of the tumor were compared between responders and non-responders. Receiver operating characteristics were calculated to determine the parameters' ability to discriminate responders from non-responders. RESULTS According to mRECIST, 8 patients (50%) were responders and 8 (50%) non-responders. Comparing responders and non-responders, the 50th and 75th percentile of AP derived from histogram analysis was significantly different [AP 43.8/54.3 vs. 27.6/34.3 mL min(-1) 100 mL(-1)); p < 0.05], while the mean AP of HCCs (43.5 vs. 27.9 mL min(-1) 100 mL(-1); p > 0.05) was not. Further heterogeneity parameters from histogram analysis (skewness, coefficient of variation, and 25th percentile) did not differ between responders and non-responders (p > 0.05). If the cut-off for the 75th percentile was set to an AP of 37.5 mL min(-1) 100 mL(-1), therapy response could be predicted with a sensitivity of 88% (7/8) and specificity of 75% (6/8). CONCLUSION Voxel-wise histogram analysis of pretreatment CT perfusion indicating tumor heterogeneity of HCC improves the pretreatment prediction of response to TARE.
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Boal Carvalho P, Pereira E. Imagiological Diagnosis of Gastrointestinal Diseases - Diagnostic Criteria of Hepatocellular Carcinoma. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:153-160. [PMID: 28868398 PMCID: PMC5580142 DOI: 10.1016/j.jpge.2015.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/12/2015] [Indexed: 12/21/2022]
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of neoplastic morbidity and mortality worldwide, and despite recent treatment advances, the prognosis remains dismal, with a 5-year mortality rate of 85%. The surveillance and timely diagnosis is therefore of crucial importance in order to improve survival rates and alleviate the health burden imposed by the HCC. Previously, HCC diagnosis warranted liver biopsy, an invasive process with limited diagnostic accuracy. In the past 15 years, HCC diagnosis based solely on imaging criteria was accepted by all the major national and international guidelines, and is now widely employed across the globe. Current European guidelines for the HCC diagnosis support the use of both dynamic contrasted computer tomography as well as magnetic resonance imaging for the non-invasive diagnosis of HCC for nodules >1 cm in a cirrhotic liver. The non-invasive diagnosis of HCC depends on radiological hallmarks, such as homogeneous contrast uptake during the arterial phase and wash-out during the venous and late phases, but while such tumoral behaviour is frequent in nodules >2 cm, high-end equipment and superior expertise is often needed for the correct diagnosis of early HCC. Nevertheless, the accuracy of imaging techniques for the diagnosis of HCC is permanently improving, and supports the progressively reduced need for liver biopsy during liver nodule workout in a cirrhotic liver.
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Affiliation(s)
- Pedro Boal Carvalho
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Eduardo Pereira
- Gastroenterology Department, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal
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Kim HC. Role of C-arm cone-beam CT in chemoembolization for hepatocellular carcinoma. Korean J Radiol 2015; 16:114-24. [PMID: 25598679 PMCID: PMC4296258 DOI: 10.3348/kjr.2015.16.1.114] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 10/09/2014] [Indexed: 11/22/2022] Open
Abstract
With the advent of C-arm cone-beam computed tomography (CBCT), minimally-invasive procedures in the angiography suite made a new leap beyond the limitations of 2-dimensional (D) angiography alone. C-arm CBCT can help interventional radiologists in several ways with the treatment of hepatocellular carcinoma (HCC); visualization of small tumors and tumor-feeding arteries, identification of occult lesion and 3D configuration of tortuous hepatic arteries, assurance of completeness of chemoembolization, suggestion of presence of extrahepatic collateral arteries supplying HCCs, and prevention of nontarget embolization. With more improvements in the technology, C-arm CBCT may be essential in all kinds of interventional procedures in the near future.
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Affiliation(s)
- Hyo-Cheol Kim
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
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Choi WS, Kim HC, Hur S, Choi JW, Lee JH, Yu SJ, Chung JW. Role of C-Arm CT in Identifying Caudate Arteries Supplying Hepatocellular Carcinoma. J Vasc Interv Radiol 2014; 25:1380-8. [DOI: 10.1016/j.jvir.2014.02.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/22/2014] [Accepted: 02/25/2014] [Indexed: 12/28/2022] Open
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Floridi C, Radaelli A, Abi-Jaoudeh N, Grass M, Lin M, Chiaradia M, Geschwind JF, Kobeiter H, Squillaci E, Maleux G, Giovagnoni A, Brunese L, Wood B, Carrafiello G, Rotondo A. C-arm cone-beam computed tomography in interventional oncology: technical aspects and clinical applications. Radiol Med 2014; 119:521-32. [PMID: 25012472 DOI: 10.1007/s11547-014-0429-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 06/16/2014] [Indexed: 12/12/2022]
Abstract
C-arm cone-beam computed tomography (CBCT) is a new imaging technology integrated in modern angiographic systems. Due to its ability to obtain cross-sectional imaging and the possibility to use dedicated planning and navigation software, it provides an informed platform for interventional oncology procedures. In this paper, we highlight the technical aspects and clinical applications of CBCT imaging and navigation in the most common loco-regional oncological treatments.
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Affiliation(s)
- Chiara Floridi
- Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy,
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Yu MH, Kim JH, Yoon JH, Kim HC, Chung JW, Han JK, Choi BI. Small (≤1-cm) Hepatocellular Carcinoma: Diagnostic Performance and Imaging Features at Gadoxetic Acid–enhanced MR Imaging. Radiology 2014; 271:748-60. [DOI: 10.1148/radiol.14131996] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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25
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Chung JW. Recent advance in international management of hepatocellular carcinoma. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2013. [DOI: 10.5124/jkma.2013.56.11.972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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