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



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.


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.


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.


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.

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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.

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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).

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  • Liver
  • Neoplastic processes
  • Therapeutic chemoembolization
  • Perfusion
  • Computed tomography