European Radiology Experimental (Jan 2023)

A novel method for predicting hepatocellular carcinoma response to chemoembolization using an intraprocedural CT hepatic arteriography-based enhancement mapping: a proof-of-concept analysis

  • Ryosuke Taiji,
  • Yuan-Mao Lin,
  • Gouthami Chintalapani,
  • Ethan Y. Lin,
  • Steven Y. Huang,
  • Armeen Mahvash,
  • Rony Avritscher,
  • Chien-An Liu,
  • Rheun-Chuan Lee,
  • Vivian Resende,
  • Hideyuki Nishiofuku,
  • Toshihiro Tanaka,
  • Kimihiko Kichikawa,
  • Ernst Klotz,
  • Sanjay Gupta,
  • Bruno C. Odisio

DOI
https://doi.org/10.1186/s41747-022-00315-8
Journal volume & issue
Vol. 7, no. 1
pp. 1 – 11

Abstract

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Abstract Background To evaluate the feasibility of a novel approach for predicting hepatocellular carcinoma (HCC) response to drug-eluting beads transarterial chemoembolization (DEB-TACE) using computed tomography hepatic arteriography enhancement mapping (CTHA-EM) method. Methods This three-institution retrospective study included 29 patients with 46 HCCs treated with DEB-TACE between 2017 and 2020. Pre- and posttreatment CTHA-EM images were generated using a prototype deformable registration and subtraction software. Relative tumor enhancement (T Post/pre-RE) defined as the ratio of tumor enhancement to normal liver tissue was calculated to categorize tumor response as residual (T Post-RE > 1) versus non-residual (T Post-RE ≤ 1) enhancement, which was blinded compared to the response assessment on first follow-up imaging using modified RECIST criteria. Additionally, for tumors with residual enhancement, CTHA-EM was evaluated to identify its potential feeding arteries. Results CTHA-EM showed residual enhancement in 18/46 (39.1%) and non-residual enhancement in 28/46 (60.9%) HCCs, with significant differences on T Post-RE (3.05 ± 2.4 versus 0.48 ± 0.23, respectively; p < 0.001). The first follow-up imaging showed non-complete response (partial response or stable disease) in 19/46 (41.3%) and complete response in 27/46 (58.7%) HCCs. CTHA-EM had a response prediction sensitivity of 94.7% (95% CI, 74.0–99.9) and specificity of 100% (95% CI, 87.2–100). Feeding arteries to the residual enhancement areas were demonstrated in all 18 HCCs (20 arteries where DEB-TACE was delivered, 2 newly developed collaterals following DEB-TACE). Conclusion CTHA-EM method was highly accurate in predicting initial HCC response to DEB-TACE and identifying feeding arteries to the areas of residual arterial enhancement.

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