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Transarterial Chemoembolization of HCC with Radiopaque Microspheres: Evaluation with Computed Tomography and the Complementary Role of Contrast-Enhanced Ultrasonography

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  • Imaging
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Abstract

Purpose

To assess the diagnostic performance of computed tomography (CT), and of the combination of CT with contrast-enhanced ultrasonography (CT + CEUS), for the early evaluation of local response of hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) with radiopaque drug-eluting microspheres (RO-DEMs).

Materials and Methods

30 HCC patients (55 target tumors) were treated with TACE with RO-DEMs (diameter: 70–150 μm) preloaded with 75 mg doxorubicin/2 ml of microspheres. Unenhanced and contrast-enhanced CT, followed by CEUS, were performed 1–3 days post-RO-DEMs-TACE. Contrast-enhanced magnetic resonance (MR) performed 1 month later served as the reference standard. Local tumor response was evaluated with modified Response Evaluation Criteria in Solid Tumors (mRECIST).

Results

MR diagnosed 9 tumors with complete response and 46 with residual disease. Compared to MR, CT had 9 false negative and 1 false positive diagnosis for residual tumor. Potential causes for these misdiagnoses were the hyperdensities and associated artifacts (caused by the accumulation of RO-DEMs in the target tumors) and the small size of residual tumor. CT + CEUS had 3 false negative and no false positive diagnosis for residual tumor. The sensitivity, specificity and diagnostic accuracy of CT for detection of residual tumor were, respectively: 80.4%, 88.9% and 81.8%, and for CT + CEUS: 93.5%, 100% and 94.5%, respectively. Agreement (kappa coefficient) in application of mRECIST between MR and CT was lower than between MR and CT + CEUS (0.508 vs. 0.757).

Conclusion

CT evaluation of TACE with RO-DEMs is associated with limitations which can be partially overcome by combining CT with CEUS.

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Acknowledgements

The authors wish to thank Franz Edward Boas, interventional radiologist, Memorial Sloan Kettering Cancer Center, New York, for his valuable advice and for sharing his experience on the potential application of metal artifact reduction software for the purposes of this study.

Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Radiology Department, General Hospital “Tzanio”, Zanni and Afentouli 1 Str., 18536, Piraeus, Greece

    Hippocrates Moschouris, Andreas Dimakis & Anastasia Anagnostopoulou

  2. 2nd Department of Radiology, University of Athens, “Attikon” Hospital, Rimini 1 Str., Chaidari, 12462, Athens, Greece

    Katerina Malagari

  3. Radiology Research Unit, Evgenidion Hospital, Papadiamantopoulou 20, 11528, Athens, Greece

    Theodoros Kiakidis

Authors
  1. Hippocrates Moschouris
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  2. Katerina Malagari
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  3. Andreas Dimakis
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  4. Theodoros Kiakidis
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  5. Anastasia Anagnostopoulou
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Correspondence to Hippocrates Moschouris.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Institutional review board (IRB) approval was obtained for this study.

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Moschouris, H., Malagari, K., Dimakis, A. et al. Transarterial Chemoembolization of HCC with Radiopaque Microspheres: Evaluation with Computed Tomography and the Complementary Role of Contrast-Enhanced Ultrasonography. Cardiovasc Intervent Radiol 43, 1075–1083 (2020). https://doi.org/10.1007/s00270-020-02487-5

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  • DOI: https://doi.org/10.1007/s00270-020-02487-5

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