Intra-procedural dual phase cone beam computed tomography has a better diagnostic accuracy over pre-procedural MRI and MDCT in detection and characterization of HCC in cirrhotic patients undergoing TACE procedure

Pierleone Lucatelli; Gianluca De Rubeis; Luca Ginnani Corradini; Fabrizio Basilico; Michele Di Martino; Quirino Lai; Stefano Ginanni Corradini; Alessandro Cannavale; Pier Giorgio Nardis; Mario Corona; Luca Saba; Carlo Catalano; Mario Bezzi

doi:10.1016/j.ejrad.2019.108806

Intra-procedural dual phase cone beam computed tomography has a better diagnostic accuracy over pre-procedural MRI and MDCT in detection and characterization of HCC in cirrhotic patients undergoing TACE procedure

Eur J Radiol. 2020 Mar:124:108806. doi: 10.1016/j.ejrad.2019.108806. Epub 2019 Dec 24.

Affiliations

¹ Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy. Electronic address: pierleone.lucatelli@gmail.com.
² Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy. Electronic address: derubeis.gianluca@gmail.com.
³ Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy. Electronic address: lucaginannicorradini@gmail.com.
⁴ Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy. Electronic address: fabribasi@gmail.com.
⁵ Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy. Electronic address: micdimartino@hotmail.it.
⁶ Department of General Surgery and Organ Transplantation, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy. Electronic address: Quirino.lai@uniroma1.it.
⁷ Department of Translational and Precision Medicine, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy. Electronic address: Stefano.corradini@uniroma1.it.
⁸ Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy. Electronic address: alessandro.cannavale@hotmail.com.
⁹ Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy. Electronic address: p.nardis@gmail.com.
¹⁰ Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy. Electronic address: mario.corona@uniroma1.it.
¹¹ Department of Medical Imaging, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo Di Monserrato, Via Ospedale, 54, 09124 Cagliari CA, Italy. Electronic address: lucasabamd@gmail.com.
¹² Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy. Electronic address: Carlo.catalano@uniroma1.it.
¹³ Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy. Electronic address: Mario.bezzi@uniroma1.it.

PMID: 31945673
DOI: 10.1016/j.ejrad.2019.108806

Abstract

Purpose: This study was directed to compare diagnostic accuracy of dual-phase cone beam computed tomography (DP-CBCT) vs pre-procedural second line imaging modality (SLIM [multidetector computed tomography and magnetic resonance imaging]) to detect and characterize hepatocellular carcinoma (HCC) in cirrhotic patients with indication for trans-arterial chemoembolization (TACE).

Methods: This is a single centre, retrospective, and observational study. Exclusion criteria were not-assisted DP-CBCT TACE, and unavailable follow-up SLIM. We evaluated 280 consecutive patients (January/2015-Febraury/2019). Seventy-two patients were eligible. Three radiologists in consensus reviewed: pre-procedural SLIM, DP-CBCT, and SLIM at follow-up, with 4 months of interval between each reading. Hyper-vascular foci (HVF) were detected and characterized. Diameter was recorded. Radiological behaviour, according to LI-RADS criteria, of HFV throughout follow-up time was the reference standard. Diagnostic accuracy was calculated for pre-procedural SLIM and DP-CBCT and evaluated through receiver operating characteristic curve. HVF only visible on DP-CBCT (defined as occult) were analysed. Tumour diameters were compared.

Results: Median time between pre-procedural SLIM and DP-CBCT and between DP-CBCT and definitive radiological diagnosis of HVF were 46.0 days (95%CI 36.5-55.0) and 30.5 days (95%CI 29.0-33.0), respectively. DP-CBCT had a better diagnostic performance than pre-examination SLIM (sensitivity 99%vs78%; specificity 89%vs85%; PPV 99%vs99%; NPV 92%vs30%; and accuracy 94%vs79%). DP-CBCT diagnosed 63 occult HVF. Occult HCC were 54/243 (22.2%). Six were occult angiomas. Three were false positive. Mean diameter was significantly higher in DP-CBCT vs pre-procedural SLIM (+7.5% [95%CI 3.7-11.3], p < 0.05).

Conclusions: DP-CBCT has a better diagnostic accuracy and NPV than pre-procedural SLIM in cirrhotic patients with indication for TACE.

Keywords: Computerized tomography, X ray; Cone-Beam computed tomography; Hepatocellular cancer; Magnetic resonance imaging; Therapeutic chemoembolization.

Publication types

Observational Study

MeSH terms

Adult
Aged
Aged, 80 and over
Algorithms
Carcinoma, Hepatocellular / complications
Carcinoma, Hepatocellular / diagnostic imaging*
Carcinoma, Hepatocellular / therapy
Chemoembolization, Therapeutic*
Cone-Beam Computed Tomography / methods*
Female
Humans
Liver Cirrhosis / diagnostic imaging
Liver Cirrhosis / etiology
Liver Cirrhosis / therapy
Liver Neoplasms / complications
Liver Neoplasms / diagnostic imaging*
Liver Neoplasms / therapy
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Multidetector Computed Tomography / methods*
ROC Curve
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity