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Comparing HCC arterial tumour vascularisation on baseline imaging and after lipiodol cTACE: how do estimations of enhancing tumour volumes differ on contrast-enhanced MR and CT?

  • Interventional
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Abstract

Objectives

In this study, pre-treatment target lesion vascularisation in either contrast-enhanced (CE) CT or MRI and post-treatment lipiodol deposition in native CT scans were compared in HCC patients who underwent their first cTACE treatment. We analysed the impact of stratification according to cTACE selectivity on these correlations.

Methods

Seventy-eight HCC patients who underwent their first cTACE procedure were retrospectively included. Pre-treatment tumour vascularisation in arterial contrast phase and post-treatment lipiodol deposition in native CT scans were evaluated using the qEASL (quantitative tumour enhancement) method. Correlations were analysed using scatter plots, the Pearson correlation coefficient (PCC) and linear regression analysis. Subgroup analysis was performed according to lobar, segmental and subsegmental execution of cTACE.

Results

Arterial tumour volumes in both baseline CE CT (R2 = 0.83) and CE MR (R2 = 0.82) highly correlated with lipiodol deposition after cTACE. The regression coefficient between lipiodol deposition and enhancing tumour volume was 1.39 for CT and 0.33 for MR respectively, resulting in a ratio of 4.24. After stratification according to selectivity of cTACE, the regression coefficient was 0.94 (R2 = 1) for lobar execution, 1.38 (R2 = 0.96) for segmental execution and 1.88 (R2 = 0.89) for subsegmental execution in the CE CT group.

Conclusions

Volumetric lipiodol deposition can be used as a reference to compare different imaging modalities in detecting vital tumour volumes. That approach proved CE MRI to be more sensitive than CE CT. Selectivity of cTACE significantly impacts the respective regression coefficients which allows for an innovative approach to the assessment of technical success after cTACE with a multitude of possible applications.

Key Points

• Lipiodol deposition after cTACE highly correlates with pre-treatment tumour vascularisation and can be used as a reference to compare different imaging modalities in detecting vital tumour volumes.

• Lipiodol deposition also correlates with the selectivity of cTACE and can therefore be used to quantify the technical success of the intervention.

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Abbreviations

ASIR:

Adaptive statistical iterative reconstruction

BCLC:

Barcelona Clinic Liver Cancer staging system

CE:

Contrast-enhanced

cTACE:

Conventional transarterial chemoembolisation

ECOG:

Eastern Cooperative Oncology Group

ETV:

Enhancing tumour volume

HCC:

Hepatocellular carcinoma

HKLC:

Hong Kong Liver Cancer staging system

PCC:

Pearson correlation coefficient

(q)EASL:

(quantitative) European Association for the Study of the Liver (quantitative tumour enhancement)

RECIST:

Response Evaluation Criteria in Solid Tumors

ROI:

Region of interest

SEER:

Surveillance, Epidemiology, and End Results

TTV:

Total tumour volume

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Charité, Augustenburger Platz 1, 13353, Berlin, Germany

    Willie Magnus Luedemann, Dominik Geisel, Bernhard Gebauer, Dirk Schnapauff, Gero Wieners, Ingo Steffen & Johannes Kahn

  2. Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA

    Julius Chapiro

Authors
  1. Willie Magnus Luedemann
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  2. Dominik Geisel
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  3. Bernhard Gebauer
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  4. Dirk Schnapauff
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  5. Julius Chapiro
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  6. Gero Wieners
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  7. Ingo Steffen
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  8. Johannes Kahn
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Correspondence to Johannes Kahn.

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The scientific guarantor of this publication is Willie-Magnus Lüdemann.

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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.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was not required for this specific study because data were evaluated retrospectively. Written informed consent was obtained to use data for general scientific evaluation.

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• retrospective

• case-control study/observational

• performed at one institution

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Luedemann, W., Geisel, D., Gebauer, B. et al. Comparing HCC arterial tumour vascularisation on baseline imaging and after lipiodol cTACE: how do estimations of enhancing tumour volumes differ on contrast-enhanced MR and CT?. Eur Radiol 30, 1601–1608 (2020). https://doi.org/10.1007/s00330-019-06430-2

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  • DOI: https://doi.org/10.1007/s00330-019-06430-2

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