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Delayed-Phase Cone-Beam CT Improves Detectability of Intrahepatic Cholangiocarcinoma During Conventional Transarterial Chemoembolization

  • Clinical Investigation
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Abstract

Purpose

To evaluate the detectability of intrahepatic cholangiocarcinoma (ICC) on dual-phase cone-beam CT (DPCBCT) during conventional transarterial chemoembolization (cTACE) compared to that of digital subtraction angiography (DSA) with respect to pre-procedure contrast-enhanced magnetic resonance imaging (CE-MRI) of the liver.

Methods

This retrospective study included 17 consecutive patients (10 male, mean age 64) with ICC who underwent pre-procedure CE-MRI of the liver, and DSA and DPCBCT (early-arterial phase (EAP) and delayed-arterial phase (DAP)) just before cTACE. The visibility of each ICC lesion was graded by two radiologists on a three-rank scale (complete, partial, and none) on DPCBCT and DSA images, and then compared to pre-procedure CE-MRI.

Results

Of 61 ICC lesions, only 45.9 % were depicted by DSA, whereas EAP- and DAP-CBCT yielded a significantly higher detectability rate of 73.8 % and 93.4 %, respectively (p < 0.01). Out of the 33 lesions missed on DSA, 18 (54.5 %) and 30 (90.9 %) were revealed on EAP- and DAP-CBCT images, respectively. DSA depicted only one lesion that was missed by DPCBCT due to streak artifacts caused by a prosthetic mitral valve. DAP-CBCT identified significantly more lesions than EAP-CBCT (p < 0.01). Conversely, EAP-CBCT did not detect lesions missed by DAP-CBCT. For complete lesion visibility, DAP-CBCT yielded significantly higher detectability (78.7 %) compared to EAP (31.1 %) and DSA (21.3 %) (p < 0.01).

Conclusion

DPCBCT, and especially the DAP-CBCT, significantly improved the detectability of ICC lesions during cTACE compared to DSA. We recommend the routine use of DAP-CBCT in patients with ICC for per-procedure detectability and treatment planning in the setting of TACE.

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Acknowledgments

Support for this work was provided by the Max Kade Foundation, Inc., NY, USA, NIH/NCI R01 CA160771, P30 CA006973, Philips Research North America, Briarcliff Manor, NY, USA.

Conflict of interest

Ruediger E. Schernthaner: Grant Support: Max Kade Foundation, Inc., NY, USA. MingDe Lin: Grant Support: NIH; employee: Philips Research North America, Briarcliff Manor, NY, USA. Jean-François Geschwind: Consultant: Nordion, Biocompatibles/BTG, Bayer HealthCare; Grant Support: NIH, Philips Medical, DOB, Biocompatibles/BTG, Bayer HealthCare, Nordion, Context Vision, SIR, RSNA, Guerbet; Founder and CEO PreScience Labs, LLC. Rafael Duran, Julius Chapiro, and Zhijun Wang have nothing to disclose.

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Authors and Affiliations

  1. Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, 21287, USA

    Ruediger Egbert Schernthaner, Rafael Duran, Julius Chapiro, Zhijun Wang & Jean-François Geschwind

  2. Ultrasound and Interventions, Philips Research North America, 345 Scarborough Road, Briarcliff Manor, NY, 10510, USA

    MingDe Lin

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  1. Ruediger Egbert Schernthaner
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Correspondence to Jean-François Geschwind.

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Schernthaner, R.E., Lin, M., Duran, R. et al. Delayed-Phase Cone-Beam CT Improves Detectability of Intrahepatic Cholangiocarcinoma During Conventional Transarterial Chemoembolization. Cardiovasc Intervent Radiol 38, 929–936 (2015). https://doi.org/10.1007/s00270-014-1026-7

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