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.

Pierleone Lucatelli Gianluca De Rubeis Luca Ginnani Corradini Fabrizio Basilico Michele Di Martino Quirino Lai Stefano Ginanni Corradini Alessandro Cannavale Pier Giorgio Nardis Mario Corona Luca Saba Carlo Catalano Mario Bezzi

Eur J Radiol

Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy. Electronic address:

Published: March 2020

The study compared the diagnostic accuracy of dual-phase cone beam computed tomography (DP-CBCT) to pre-procedural second line imaging modalities (SLIM) for detecting hepatocellular carcinoma (HCC) in cirrhotic patients needing treatment.
In a retrospective analysis of 72 eligible patients, three radiologists reviewed imaging results, finding that DP-CBCT significantly outperformed SLIM in sensitivity, specificity, and overall accuracy.
DP-CBCT identified 63 occult hyper-vascular foci (HVF) that SLIM missed, confirming its superiority in diagnosing HCC effectively among cirrhotic patients.

Purpose: 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).

Methods: 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.

Results: 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).

Conclusions: DP-CBCT has a better diagnostic accuracy and NPV than pre-procedural SLIM in cirrhotic patients with indication for TACE.

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http://dx.doi.org/10.1016/j.ejrad.2019.108806	DOI Listing

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