Intra-procedural dual phase cone beam computed tomography has a better diagnostic accuracy over pre-procedural MRI and MDCT in detection and characterization of HCC in cirrhotic patients undergoing TACE procedure.
Adult
Aged
Aged, 80 and over
Algorithms
Carcinoma, Hepatocellular
/ complications
Chemoembolization, Therapeutic
Cone-Beam Computed Tomography
/ methods
Female
Humans
Liver Cirrhosis
/ diagnostic imaging
Liver Neoplasms
/ complications
Magnetic Resonance Imaging
/ methods
Male
Middle Aged
Multidetector Computed Tomography
/ methods
ROC Curve
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Computerized tomography, X ray
Cone-Beam computed tomography
Hepatocellular cancer
Magnetic resonance imaging
Therapeutic chemoembolization
Journal
European journal of radiology
ISSN: 1872-7727
Titre abrégé: Eur J Radiol
Pays: Ireland
ID NLM: 8106411
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
18
09
2019
revised:
28
11
2019
accepted:
19
12
2019
pubmed:
17
1
2020
medline:
15
9
2020
entrez:
17
1
2020
Statut:
ppublish
Résumé
This study was directed to compare diagnostic accuracy of dual-phase cone beam computed tomography (DP-CBCT) vs pre-procedural second line imaging modality (SLIM [multidetector computed tomography and magnetic resonance imaging]) to detect and characterize hepatocellular carcinoma (HCC) in cirrhotic patients with indication for trans-arterial chemoembolization (TACE). This is a single centre, retrospective, and observational study. Exclusion criteria were not-assisted DP-CBCT TACE, and unavailable follow-up SLIM. We evaluated 280 consecutive patients (January/2015-Febraury/2019). Seventy-two patients were eligible. Three radiologists in consensus reviewed: pre-procedural SLIM, DP-CBCT, and SLIM at follow-up, with 4 months of interval between each reading. Hyper-vascular foci (HVF) were detected and characterized. Diameter was recorded. Radiological behaviour, according to LI-RADS criteria, of HFV throughout follow-up time was the reference standard. Diagnostic accuracy was calculated for pre-procedural SLIM and DP-CBCT and evaluated through receiver operating characteristic curve. HVF only visible on DP-CBCT (defined as occult) were analysed. Tumour diameters were compared. Median time between pre-procedural SLIM and DP-CBCT and between DP-CBCT and definitive radiological diagnosis of HVF were 46.0 days (95%CI 36.5-55.0) and 30.5 days (95%CI 29.0-33.0), respectively. DP-CBCT had a better diagnostic performance than pre-examination SLIM (sensitivity 99%vs78%; specificity 89%vs85%; PPV 99%vs99%; NPV 92%vs30%; and accuracy 94%vs79%). DP-CBCT diagnosed 63 occult HVF. Occult HCC were 54/243 (22.2%). Six were occult angiomas. Three were false positive. Mean diameter was significantly higher in DP-CBCT vs pre-procedural SLIM (+7.5% [95%CI 3.7-11.3], p < 0.05). DP-CBCT has a better diagnostic accuracy and NPV than pre-procedural SLIM in cirrhotic patients with indication for TACE.
Identifiants
pubmed: 31945673
pii: S0720-048X(19)30456-5
doi: 10.1016/j.ejrad.2019.108806
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
108806Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest All authors have participated in (a) conception and design, or analysis and interpretation of the data; (b) drafting the article or revising it critically for important intellectual content; and (c) approval of the final version. This manuscript has not been submitted to, nor is under review at, another journal or other publishing venue. The authors have no affiliation with any organization with a direct or indirect financial interest in the subject matter discussed in the manuscript