Skip to main content
SpringerLink
Log in

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

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  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. Maillard E (2011) Epidemiology, natural history and pathogenesis of hepatocellular carcinoma. Cancer Radiother 15:3–6

    Article  CAS  PubMed  Google Scholar 

  3. Golling M, Bechstein W (2006) Surgical resection of colorectal liver metastases–the current standard therapy (review). Rozhl Chir 85:381–389

    CAS  PubMed  Google Scholar 

  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 229:457–464

    Article  PubMed  Google Scholar 

  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 19:388–396

    Article  CAS  PubMed  Google Scholar 

  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 24:835–842

    Article  CAS  PubMed  Google Scholar 

  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 45:427–436

    Google Scholar 

  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 47:11–17

    Article  Google Scholar 

  9. Kalender WA, Kyriakou Y (2007) Flat-detector computed tomography (FD-CT). Eur Radiol 17:2767–2779

    Article  PubMed  Google Scholar 

  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 17:1267–1275

    Article  PubMed Central  PubMed  Google Scholar 

  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–W72

    Article  PubMed  Google Scholar 

  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 38:352–360

    Article  PubMed Central  PubMed  Google Scholar 

  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 21:113–120

    Article  PubMed Central  PubMed  Google Scholar 

  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 32:423–427

    Article  Google Scholar 

  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. 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 45:228–247

    Article  CAS  PubMed  Google Scholar 

  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 25:1993–2003

    Article  PubMed  Google Scholar 

  18. Bengtsson G, Carlsson G, Hafström L, Jönsson PE (1981) Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg 141:586–589

    Article  CAS  PubMed  Google Scholar 

  19. Baden H, Andersen B (1975) Survival of patients with untreated liver metastases from colorectal cancer. Scand J Gastroenterol 10:221–223

    CAS  PubMed  Google Scholar 

  20. Korobkin M, Kressel HY, Moss AA, Koehler RE (1978) Computed tomographic angiography of the body. Radiology 126:807–811

    Article  CAS  PubMed  Google Scholar 

  21. Yao J, Yang Z, Chen T, Li Y, Yang L (2010) Perfusion changes in gastric adenocarcinoma: evaluation with 64-section MDCT. Abdom Imaging 35:195–202

    Article  PubMed  Google Scholar 

  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 18:347–352

    Article  PubMed  Google Scholar 

  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 31:536–540

    Article  CAS  PubMed  Google Scholar 

  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 30:917–922

    Article  CAS  PubMed  Google Scholar 

  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 260:762–770

    Article  Google Scholar 

  26. Sahani DV, Holalkere N-S, Mueller PR, Zhu AX (2007) Advanced hepatocellular carcinoma: CT perfusion of liver and tumor tissue–initial experience. Radiology 243:736–743

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Thomas J. Vogl, Patrik Schaefer, Thomas Lehnert, Nour-Eldin A. Nour-Eldin, Emmanuel Mbalisike, Renate Hammerstingl, Katrin Eichler, Stephan Zangos & Nagy N. N. Naguib

  2. Department of Radiology, Faculty of Medicine (Kasr Al-Ainy), Cairo University, Cairo, Egypt

    Nour-Eldin A. Nour-Eldin

  3. Department of Biomedical Statistics, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Hanns Ackermann

  4. Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Nagy N. N. Naguib

Authors
  1. Thomas J. Vogl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrik Schaefer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Lehnert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nour-Eldin A. Nour-Eldin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hanns Ackermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emmanuel Mbalisike
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Renate Hammerstingl
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Katrin Eichler
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Stephan Zangos
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Nagy N. N. Naguib
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas J. Vogl.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vogl, T.J., Schaefer, P., Lehnert, T. et al. Intraprocedural blood volume measurement using C-arm CT as a predictor for treatment response of malignant liver tumours undergoing repetitive transarterial chemoembolization (TACE). Eur Radiol 26, 755–763 (2016). https://doi.org/10.1007/s00330-015-3869-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-015-3869-y

Keywords

Search

Navigation