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Semiquantitative prediction of early response of conventional transcatheter arterial chemoembolization for hepatocellular carcinoma using postprocedural plain cone‐beam computed tomography
Author(s) -
Minami Yasunori,
Takita Masahiro,
Tsurusaki Masakatsu,
Yagyu Yukinobu,
Ueshima Kazuomi,
Murakami Takamichi,
Kudo Masatoshi
Publication year - 2017
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.12735
Subject(s) - medicine , hepatocellular carcinoma , cone beam computed tomography , transcatheter arterial chemoembolization , nuclear medicine , radiology , voxel , iodized oil , receiver operating characteristic , computed tomography
Aim To investigate whether plain cone‐beam computed tomography (CT) immediately after conventional transcatheter arterial chemoembolization (c‐TACE) can help to predict tumor response semiquantitatively in patients with hepatocellular carcinoma (HCC). Methods Analysis was carried out retrospectively on 262 targeted HCCs in 169 patients treated with c‐TACE. Dynamic CT was performed at baseline and 1–4 months after c‐TACE. Receiver–operating characteristic curve analysis was undertaken to evaluate whether voxel values of cone‐beam CT could predict a complete response and to identify the cut‐off value. Final tumor response assessment and early prediction using the retention pattern of iodized oil, the cut‐off value of the density, and the combination of the cut‐off density value and retention pattern of iodized oil in HCCs on postprocedural cone‐beam CT were compared. Results Complete response was obtained in 72.9% of lesions. According to the pattern of iodized oil uptake, the sensitivity, specificity, and accuracy for predicting complete response were 85.9%, 70.4%, and 81.7%, respectively by excellent uptake on cone‐beam CT. The area under the curve was 0.86 with the optimal cut‐off at a voxel value of 200.13. According to not only the density but also the homogeneity of iodized oil retention, the sensitivity, specificity, and accuracy values for predicting complete response were 86.4%, 95.8%, and 88.9%, respectively. The predictive accuracy was significantly better than that of the pattern of iodized oil retention only ( P = 0.019). Conclusion The combination of density and visual estimate of homogeneity is superior to either alone in predicting tumor response of c‐TACE in HCC patients.