European Radiology

, Volume 26, Issue 3, pp 755–763 | Cite as

Intraprocedural blood volume measurement using C-arm CT as a predictor for treatment response of malignant liver tumours undergoing repetitive transarterial chemoembolization (TACE)

  • Thomas J. Vogl
  • Patrik Schaefer
  • Thomas Lehnert
  • Nour-Eldin A. Nour-Eldin
  • Hanns Ackermann
  • Emmanuel Mbalisike
  • Renate Hammerstingl
  • Katrin Eichler
  • Stephan Zangos
  • Nagy N. N. Naguib
Interventional

Abstract

Purpose

To evaluate feasibility of measuring parenchymal blood volume (PBV) of malignant hepatic tumours using C-arm CT, test the changes in PBV following repeated transarterial chemoembolization (TACE) and correlate these changes with the change in tumour size in MRI.

Methods

111 patients with liver malignancy were included. Patients underwent MRI and TACE in a 4- to 6-week interval. During intervention C-arm CT was performed. Images were post-processed to generate PBV maps. Blood volume data in C-arm CT and change in size in MRI were evaluated. The correlation between PBV and size was tested using Spearman rank test.

Results

Pre-interventional PBV maps showed a mean blood volume of 84.5 ml/1000 ml ± 62.0, follow-up PBV maps after multiple TACE demonstrated 61.1 ml/1000 ml ± 57.5. The change in PBV was statistically significant (p = 0.02). Patients with initial tumour blood volume >100 ml/1000 ml dropped 7.1 % in size and 47.2 % in blood volume; 50–100 ml/1000 ml dropped 4.6 % in size and 25.7 % in blood volume; and <50 ml/1000 ml decreased 2.8 % in size and increased 82.2 % in blood volume.

Conclusion

PBV measurement of malignant liver tumours using C-arm CT is feasible. Following TACE PBV decreased significantly. Patients with low initial PBV show low local response rates and further increase in blood volume, whereas high initial tumour PBV showed better response to TACE.

Key Points

Parenchymal blood volume assessment of malignant hepatic lesions using C-arm CT is feasible.

The parenchymal blood volume is reduced significantly following transarterial chemoembolization.

Parenchymal blood volume can monitor the response of tumours after transarterial chemoembolization.

Although not significant, high initial parenchymal blood volume yields better response to TACE.

Keywords

Liver Neoplastic processes Therapeutic chemoembolization Perfusion Computed tomography 

Notes

Acknowledgements

The scientific guarantor of this publication is Prof. Dr. Thomas Vogl. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Dr. Hanns Ackermann kindly provided statistical advice for this manuscript. Ethical committee approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: retrospective, performed at one institution. The Authors would like to thank Eng. Dr. Yu Deuerling-Zheng for her efforts in the current work and for her contribution in the software used for evaluation of the perfusion maps.

References

  1. 1.
    World Health Organization (2013) "Cancer". World Health Organization, Geneva. http://www.who.int/mediacentre/factsheets/fs297/en/index.html. Accessed 1 Jan 2014
  2. 2.
    Maillard E (2011) Epidemiology, natural history and pathogenesis of hepatocellular carcinoma. Cancer Radiother 15:3–6CrossRefPubMedGoogle Scholar
  3. 3.
    Golling M, Bechstein W (2006) Surgical resection of colorectal liver metastases–the current standard therapy (review). Rozhl Chir 85:381–389PubMedGoogle Scholar
  4. 4.
    Vogl TJ, Mack MG, Balzer JO, Engelmann K, Straub R, Eichler K et al (2003) Liver metastases: neoadjuvant downsizing with transarterial chemoembolization before laser-induced thermotherapy. Radiology 229:457–464CrossRefPubMedGoogle Scholar
  5. 5.
    Jaeger HJ, Mehring UM, Castañeda F, Hasse F, Blumhardt G, Loehlein D et al (1996) Sequential transarterial chemoembolization for unresectable advanced hepatocellular carcinoma. Cardiovasc Intervent Radiol 19:388–396CrossRefPubMedGoogle Scholar
  6. 6.
    Jinzaki M, Tanimoto A, Mukai M, Ikeda E, Kobayashi S, Yuasa Y et al (2000) Double-phase helical CT of small renal parenchymal neoplasms: correlation with pathologic findings and tumor angiogenesis. J Comput Assist Tomogr 24:835–842CrossRefPubMedGoogle Scholar
  7. 7.
    Choi SH, Chung JW, Kim HC, Baek JH, Park CM, Jun S et al (2010) The role of perfusion CT as a follow-up modality after transcatheter arterial chemoembolization: an experimental study in a rabbit model. Investig Radiol 45:427–436Google Scholar
  8. 8.
    Jiang T, Kambadakone A, Kulkarni NM, Zhu AX, Sahani DV (2012) Monitoring response to antiangiogenic treatment and predicting outcomes in advanced hepatocellular carcinoma using image biomarkers, CT perfusion, tumor density, and tumor size (RECIST). Investig Radiol 47:11–17CrossRefGoogle Scholar
  9. 9.
    Kalender WA, Kyriakou Y (2007) Flat-detector computed tomography (FD-CT). Eur Radiol 17:2767–2779CrossRefPubMedGoogle Scholar
  10. 10.
    Vogl TJ, Nour-Eldin NE, Emad-Eldin S, Naguib NN, Trojan J, Ackermann H et al (2011) Portal vein thrombosis and arterioportal shunts: effects on tumor response after chemoembolization of hepatocellular carcinoma. World J Gastroenterol 17:1267–1275PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Vogl TJ, Naguib NN, Nour-Eldin NE, Mack MG, Zangos S, Abskharon JE et al (2011) Repeated chemoembolization followed by laser-induced thermotherapy for liver metastasis of breast cancer. AJR Am J Roentgenol 196:W66–W72CrossRefPubMedGoogle Scholar
  12. 12.
    Pitton MB, Kloeckner R, Ruckes C, Wirth GM, Eichhorn W, Wörns MA et al (2015) Randomized comparison of selective internal radiotherapy (SIRT) versus drug-eluting bead transarterial chemoembolization (DEB-TACE) for the treatment of hepatocellular carcinoma. Cardiovasc Intervent Radiol 38:352–360PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Paul SB, Gamanagatti S, Sreenivas V, Chandrashekhara SH, Mukund A, Gulati MS et al (2011) Trans-arterial chemoembolization (TACE) in patients with unresectable Hepatocellular carcinoma: experience from a tertiary care centre in India. Indian J Radiol Imaging 21:113–120PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Kim HK, Chung YH, Song BC, Yang SH, Yoon HK, Yu E et al (2011) Ischemic bile duct injury as a serious complication after transarterial chemoembolization in patients with hepatocellular carcinoma. J Clin Gastroenterol 32:423–427CrossRefGoogle Scholar
  15. 15.
    Zellerhoff M, Deuerling-Zheng Y, Strother CM, Ahmed A, Pulfer K, Redel T, Royalty K, Grinde J, Consigny D (2009) Measurement of cerebral blood volume using angiographic C-arm systems. Proc SPIE 7262, Medical Imaging 2009: Biomedical Applications in Molecular, Structural, and Functional Imaging, 72620H (February 27, 2009). doi:10.1117/12.812097
  16. 16.
    Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRefPubMedGoogle Scholar
  17. 17.
    Chapiro J, Duran R, Lin M, Schernthaner R, Lesage D, Wang Z et al (2015) Early survival prediction after intra-arterial therapies: a 3D quantitative MRI assessment of tumour response after TACE or radioembolization of colorectal cancer metastases to the liver. Eur Radiol 25:1993–2003CrossRefPubMedGoogle Scholar
  18. 18.
    Bengtsson G, Carlsson G, Hafström L, Jönsson PE (1981) Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg 141:586–589CrossRefPubMedGoogle Scholar
  19. 19.
    Baden H, Andersen B (1975) Survival of patients with untreated liver metastases from colorectal cancer. Scand J Gastroenterol 10:221–223PubMedGoogle Scholar
  20. 20.
    Korobkin M, Kressel HY, Moss AA, Koehler RE (1978) Computed tomographic angiography of the body. Radiology 126:807–811CrossRefPubMedGoogle Scholar
  21. 21.
    Yao J, Yang Z, Chen T, Li Y, Yang L (2010) Perfusion changes in gastric adenocarcinoma: evaluation with 64-section MDCT. Abdom Imaging 35:195–202CrossRefPubMedGoogle Scholar
  22. 22.
    Buerke B, Wittkamp G, Dziewas R, Seidensticker P, Heindel W, Kloska SP (2011) Perfusion-weighted map and perfused blood volume in comparison with CT angiography source imaging in acute ischemic stroke different sides of the same coin? Acad Radiol 18:347–352CrossRefPubMedGoogle Scholar
  23. 23.
    Bley T, Strother CM, Pulfer K, Royalty K, Zellerhoff M, Deuerling-Zheng Y et al (2010) C-arm CT measurement of cerebral blood volume in ischemic stroke: an experimental study in canines. AJNR Am J Neuroradiol 31:536–540CrossRefPubMedGoogle Scholar
  24. 24.
    Ahmed AS, Zellerhoff M, Strother CM, Pulfer KA, Redel T, Deuerling-Zheng Y et al (2009) C-arm CT measurement of cerebral blood volume: an experimental study in canines. AJNR Am J Neuroradiol 30:917–922CrossRefPubMedGoogle Scholar
  25. 25.
    Ng CS, Chandler AG, Wei W, Herron DH, Anderson EF, Kurzrock R et al (2010) Reproducibility of CT perfusion parameters in liver tumors and normal liver. Radiology 260:762–770CrossRefGoogle Scholar
  26. 26.
    Sahani DV, Holalkere N-S, Mueller PR, Zhu AX (2007) Advanced hepatocellular carcinoma: CT perfusion of liver and tumor tissue–initial experience. Radiology 243:736–743CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Thomas J. Vogl
    • 1
  • Patrik Schaefer
    • 1
  • Thomas Lehnert
    • 1
  • Nour-Eldin A. Nour-Eldin
    • 1
    • 2
  • Hanns Ackermann
    • 3
  • Emmanuel Mbalisike
    • 1
  • Renate Hammerstingl
    • 1
  • Katrin Eichler
    • 1
  • Stephan Zangos
    • 1
  • Nagy N. N. Naguib
    • 1
    • 4
  1. 1.Institute for Diagnostic and Interventional RadiologyJohann Wolfgang Goethe-University FrankfurtFrankfurt am MainGermany
  2. 2.Department of Radiology, Faculty of Medicine (Kasr Al-Ainy)Cairo UniversityCairoEgypt
  3. 3.Department of Biomedical StatisticsJohann Wolfgang Goethe-University FrankfurtFrankfurt am MainGermany
  4. 4.Department of Radiology, Faculty of MedicineAlexandria UniversityAlexandriaEgypt

Personalised recommendations