Prognostic value of incidental hypervascular micronodules detected on cone-beam computed tomography angiography of patients with liver metastasis
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To determine the clinical relevance of incidentally-found hypervascular micronodules (IHM) on cone-beam computed tomography angiography (CBCTA) in patients with liver metastasis undergoing transarterial (chemo)embolization (TACE/TAE).
Material and methods
This was a HIPAA-compliant institutional review board-approved single-institution retrospective review of 95 non-cirrhotic patients (52 men; mean age, 60 years) who underwent CBCTA prior to (chemo)embolic delivery. IHM were defined by the presence of innumerable subcentimetre hepatic parenchymal hypevascular foci not detected on pre-TACE/TAE contrast-enhanced cross-sectional imaging. Multivariate analysis was performed to compare time to tumour progression (TTP) between patients with and without IHM.
IHM were present in 21 (22%) patients. Patients with IHM had a significantly shorter intrahepatic TTP determined by a higher frequency of developing new liver metastasis (hazard ratio [HR]: 1.99; 95% confidence interval [CI] 1.08–3.67, P= 0.02). Patients with IHM trended towards a shorter TTP of the tumour(s) treated with TACE/TAE (HR: 1.72; 95% CI: 0.98–3.01, P= 0.056). Extrahepatic TTP was not significantly different between the two cohorts (P= 0.27).
Patients with IHM on CBCTA have worse prognosis due to a significantly higher risk of developing new hepatic tumours. Further work is needed to elucidate its underlying mechanisms of pathogenesis.
• 21% of liver metastasis patients undergoing TACE/TAE have IHM on CBTA.
• IHM are associated with a high risk of developing new hepatic tumours.
• IHA are also associated with a trend toward poorer response to TACE/TAE.
KeywordsLiver metastasis Cone-beam computed tomography Incidental findings Disease progression Embolization
Cone-beam computed tomography angiography
Incidentally-found hypervascular micronodules
Modified Response Evaluation Criteria in Solid Tumours
Response Evaluation Criteria in Solid Tumours
Compliance with ethical standards
The scientific guarantor of this publication is Bruno C. Odisio.
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.
The authors state that this work has not received any funding.
Statistics and biometry
Joe Ensor kindly provided statistical advice for this manuscript.
Institutional Review Board approval was obtained.
Written informed consent was waived by the Institutional Review Board.
performed at one institution
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