Is dual-phase C-arm CBCT sufficiently accurate for the diagnosis of colorectal cancer liver metastasis during liver intra-arterial treatment?

  • Olivier PellerinEmail author
  • Helena Pereira
  • Claire Van Ngoc Ty
  • Nadia Moussa
  • Costantino Del Giudice
  • Simon Pernot
  • Carole Déan
  • Gilles Chatellier
  • Marc Sapoval
Computed Tomography



This study aimed to estimate the accuracy of dual-phase C-arm cone beam computed tomography (CBCT) for the detection of colorectal cancer liver metastases, as compared with multidetector computed tomography (MDCT).

Materials and methods

Between March 2014 and December 2016, 49 consecutive patients referred for intra-arterial treatment for colorectal cancer liver metastases were enrolled in a single-center observational study. All patients were examined with MDCT and with dual-phase C-arm cone beam computed tomography performed after iodine injection in the proper hepatic artery before intra-arterial treatment. Two blinded observers independently reviewed all examinations. Diagnostic accuracy was determined using both a six-cell matrix method and a “worst-case scenario.”


Readers identified at MDCT 264 colorectal liver metastases and 43 other liver lesions. The early and late arterial phase showed 240 and 277 liver lesions respectively. A certainty of the diagnosis was obtained in 63% and 85% at the early (EAP) and late arterial phase (LAP), respectively. Streak artifacts or liver segment truncation, or inadequate enhancement was responsible for the inability to see or to correctly adjudicate a lesion to a diagnosis in 27% and 15% of the cases at the EAP and LAP. The “worst-case scenario” yielded a Se and Sp of 58% and 51%, respectively, at EAP and 84% and 70%, respectively, at LAP.


On CBCT, EAP showed limited accuracy. LAP provided the best tumor detectability.

Key Points

• The early arterial phase (EAP) yielded poor accuracy: Se = 58% and Sp = 51% (p < 0.0001).

• The late arterial phase (LAP) phase yielded good accuracy: Se = 84% and Se = 70% (p = 0.02).

• The probability of a correct diagnosis at the EAP was 60%.


Chemoembolization, therapeutic Liver neoplasms Cone beam computed tomography Multidetector computed tomography Data accuracy 



C-arm cone beam computed tomography


Confidence interval


Colorectal cancer liver metastases


Early arterial phase


Intra-class correlation coefficient


Late arterial phase


Likelihood ratio


Multidetector computed tomography







The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Olivier Pellerin, Deputy Head of the interventional radiology department at Hôpital Européen Georges Pompidou.

Conflict of interest

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.

Statistics and biometry

Hélena Pereira, PhD, one of the authors, has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• observational

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Olivier Pellerin
    • 1
    • 2
    • 3
    Email author
  • Helena Pereira
    • 4
    • 5
  • Claire Van Ngoc Ty
    • 2
  • Nadia Moussa
    • 2
    • 3
  • Costantino Del Giudice
    • 1
    • 2
    • 3
  • Simon Pernot
    • 2
    • 6
  • Carole Déan
    • 3
  • Gilles Chatellier
    • 2
    • 4
    • 5
  • Marc Sapoval
    • 1
    • 2
    • 3
  1. 1.INSERM U970ParisFrance
  2. 2.Université Paris DescartesSorbonne Paris CitéParisFrance
  3. 3.Department of Interventional Radiology, Hôpital Européen Georges PompidouAssistance Publique - Hôpitaux de ParisParisFrance
  4. 4.Clinical Research Unit, Hôpital Européen Georges PompidouAssistance Publique - Hôpitaux de ParisParisFrance
  5. 5.INSERM U1418ParisFrance
  6. 6.Department of Digestive Oncology, Hôpital Européen Georges PompidouAssistance Publique - Hôpitaux de ParisParisFrance

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