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Sequential dual-phase cone-beam CT is able to intra-procedurally predict the one-month treatment outcome of multi-focal HCC, in course of degradable starch microsphere TACE

  • ABDOMINAL RADIOLOGY
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Abstract

Objective

To evaluate the prognostic value of sequential dual-phase CBCT (DP-CBCT) imaging performed during degradable starch microsphere TACE (DSM-TACE) session in predicting the HCC’s response to treatment, evaluate with modify response evaluation criteria in solid tumours (mRECIST) at 1-month multi-detector CT (MDCT) follow-up.

Materials and methods

Between January and May 2018, 24 patients (68.5 ± 8.5 year [45–85]) with HCC lesions (n = 96 [average 4/patient]) were prospectively enrolled. Imaging assessment included: pre-procedural MDCT, intra-procedural DP-CBCT performed before first and second DSM-TACEs and 1-month follow-up MDCT. Lesions’ attenuation/pseudo-attenuation was defined as average value measured on ROIs (HU for MDCT; arbitrary unit called HU* for CBCT). Lesions’ attenuation modification was correlated with the post-procedural mRECIST criteria at 1-month MDCT.

Results

Eighty-two DSM-TACEs were performed. Lesion’s attenuation values were: pre-procedural MDCT arterial phase (AP) 107.00 HU (CI 95% 100.00–115.49), venous phase (VP) 85.00 HU (CI 95% 81.13–91.74); and lesion’s pseudo-attenuation were: first CBCT-AP 305.00 HU* (CI 95% 259.77–354.04), CBCT-VP 155.00 HU* (CI 95% 135.00–163.34). For second CBCT were: -AP 210.00 HU* (CI 95% 179.47–228.58), -VP 141.00 HU* (CI 95% 125.47–158.11); and for post-procedural MDCT were: -AP 95.00 HU (CI 95% 81.35–102.00), -VP 83.00 HU (CI 95% 78.00–88.00). ROC curve analysis showed that a higher difference pseudo-attenuation between first and second DP-CBCTs is related to treatment response. The optimal cut-off value of the difference between first and second CBCT-APs to predict complete response, objective response (complete + partial response) and overall disease control (objective response + stable disease) were > 206 HU* (sensitivity 80.0%, specificity 81.7%), > 72 HU* (sensitivity 79.5%, specificity 83.0%) and > − 7 HU* (sensitivity 91.6%, specificity 65.4%), respectively.

Conclusions

DP-CBCT can predict intra-procedurally, by assessing lesion pseudo-attenuation modification, the DSM-TACE 1-month treatment outcome.

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Abbreviations

HCC:

Hepato-cellular carcinoma

DSM-TACE:

Degradable starch microsphere trans-arterial chemo-embolization

MDCT:

Multi-detector computed tomography

CBCT:

Cone-beam computer tomography

DSA:

Digital subtraction angiography

HU:

Hounsfield units

ROIs:

Region of interest

mRECIST:

Modify response evaluation criteria in solid tumours

ROC:

Receiver operating characteristics

AUC:

Area under the curve

CR:

Complete response

PR:

Partial response

OR:

Objective response

SD:

Stable disease

DC:

Disease control

PD:

Progressive disease

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Author notes

  1. Pierleone Lucatelli and Gianluca De Rubeis equally contributed to the study.

Authors and Affiliations

  1. Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy

    Pierleone Lucatelli, Gianluca De Rubeis, Fabrizio Basilico, Luca Ginanni Corradini, Mario Corona, Mario Bezzi & Carlo Catalano

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  1. Pierleone Lucatelli
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  2. Gianluca De Rubeis
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  3. Fabrizio Basilico
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  4. Luca Ginanni Corradini
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  5. Mario Corona
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  6. Mario Bezzi
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  7. Carlo Catalano
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Correspondence to Pierleone Lucatelli.

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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.

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Lucatelli, P., De Rubeis, G., Basilico, F. et al. Sequential dual-phase cone-beam CT is able to intra-procedurally predict the one-month treatment outcome of multi-focal HCC, in course of degradable starch microsphere TACE. Radiol med 124, 1212–1219 (2019). https://doi.org/10.1007/s11547-019-01076-y

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  • DOI: https://doi.org/10.1007/s11547-019-01076-y

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