1. Transarterial Chemoembolization of HCC with Radiopaque Microspheres: Evaluation with Computed Tomography and the Complementary Role of Contrast-Enhanced Ultrasonography
- Author
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Anastasia Anagnostopoulou, Andreas Dimakis, Hippocrates Moschouris, Theodoros Kiakidis, and Katerina Malagari
- Subjects
Male ,Carcinoma, Hepatocellular ,Contrast Media ,Computed tomography ,Tumor response ,Multimodal Imaging ,Sensitivity and Specificity ,030218 nuclear medicine & medical imaging ,Microsphere ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Chemoembolization, Therapeutic ,Aged ,Ultrasonography ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Liver Neoplasms ,Ultrasound ,Reproducibility of Results ,Magnetic resonance imaging ,Middle Aged ,Image Enhancement ,medicine.disease ,Microspheres ,Treatment Outcome ,Liver ,Response Evaluation Criteria in Solid Tumors ,Hepatocellular carcinoma ,Female ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Abstract
To assess the diagnostic performance of computed tomography (CT), and of the combination of CT with contrast-enhanced ultrasonography (CT + CEUS), for the early evaluation of local response of hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) with radiopaque drug-eluting microspheres (RO-DEMs). 30 HCC patients (55 target tumors) were treated with TACE with RO-DEMs (diameter: 70–150 μm) preloaded with 75 mg doxorubicin/2 ml of microspheres. Unenhanced and contrast-enhanced CT, followed by CEUS, were performed 1–3 days post-RO-DEMs-TACE. Contrast-enhanced magnetic resonance (MR) performed 1 month later served as the reference standard. Local tumor response was evaluated with modified Response Evaluation Criteria in Solid Tumors (mRECIST). MR diagnosed 9 tumors with complete response and 46 with residual disease. Compared to MR, CT had 9 false negative and 1 false positive diagnosis for residual tumor. Potential causes for these misdiagnoses were the hyperdensities and associated artifacts (caused by the accumulation of RO-DEMs in the target tumors) and the small size of residual tumor. CT + CEUS had 3 false negative and no false positive diagnosis for residual tumor. The sensitivity, specificity and diagnostic accuracy of CT for detection of residual tumor were, respectively: 80.4%, 88.9% and 81.8%, and for CT + CEUS: 93.5%, 100% and 94.5%, respectively. Agreement (kappa coefficient) in application of mRECIST between MR and CT was lower than between MR and CT + CEUS (0.508 vs. 0.757). CT evaluation of TACE with RO-DEMs is associated with limitations which can be partially overcome by combining CT with CEUS.
- Published
- 2020