Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Detection of Recurrent Hepatocellular Carcinoma in Cirrhotic Liver after Transcatheter Arterial Chemoembolization: Value of Quantitative Color Mapping of the Arterial Enhancement Fraction of the Liver

  • Lee, Dong Ho (Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine) ;
  • Lee, Jeong Min (Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine) ;
  • Klotz, Ernst (Siemens Medical Solutions) ;
  • Kim, Soo Jin (Department of Radiology, National Cancer Center) ;
  • Kim, Kyung Won (Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine) ;
  • Han, Joon Koo (Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine) ;
  • Choi, Byung Ihn (Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine)
  • Published : 2013.02.01
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Abstract

Objective: To investigate the additional diagnostic value of color mapping of the hepatic arterial enhancement fraction (AEF) for detecting recurrent or residual hepatocellular carcinoma (HCC) in patients treated with transcatheter arterial chemoembolization (TACE). Materials and Methods: Seventy-six patients with 126 HCCs, all of whom had undergone previous TACE, and subsequently, underwent follow-up multiphasic liver CT scans, were included in this study. Quantitative color maps of the AEF of the whole liver were created, by using prototype software with non-rigid registration. The AEF was defined as the ratio of the attenuation increment during the arterial phase to the attenuation increment during the portal phase. Two radiologists independently analyzed the two image sets at a two-week interval, i.e., the multiphasic CT image set and the second image set of the AEF color maps and the CT images. The additional diagnostic value of the AEF color mapping was determined, by the use of the jackknife-alternative free-response receiver-operating-characteristic analysis. The sensitivity and positive predictive values for detecting HCCs of each image set were also evaluated and compared. Results: The reader-averaged figures of merit were 0.699 on the initial interpretation of the MDCT image set, and 0.831 on the second interpretation of the combined image set; the difference between the two interpretations was significant (p value < 0.001). The mean sensitivity for residual or recurrent HCC detection increased from 62.7% on the initial analysis to 82.1% on the second analysis using the AEF color maps (p value < 0.001). The mean positive predictive value for HCC detection was 74.5% on the initial analysis using MDCT, and 71.6% on the second analysis using AEF color mapping. Conclusion: Quantitative color mapping of the hepatic AEF may have the possibility to increase the diagnostic performance of MDCT for the detection of recurrent or residual HCC without the potential risk of radiation-related hazards.

Keywords

References

  1. Yamada, R, Sato, M, Kawabata, M, Nakatsuka, H, Nakamura, K, Takashima, S,Hepatic artery embolization in 120 patients with unresectable hepatoma, Radiology, 148, 1, 397-401(1983) https://doi.org/10.1148/radiology.148.2.6306721
  2. Choi, BI, Kim, HC, Han, JK, Park, JH, Kim, YI, Kim, ST,Therapeutic effect of transcatheter oily chemoembolization therapy for encapsulated nodular hepatocellular carcinoma: CT and pathologic findings, Radiology, 182, 2, 709-713(1992) https://doi.org/10.1148/radiology.182.3.1311116
  3. Matsui, O, Kadoya, M, Yoshikawa, J, Gabata, T, Arai, K, Demachi, H,Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization, Radiology, 188, 3, 79-83(1993) https://doi.org/10.1148/radiology.188.1.8390073
  4. Park, JH, Han, JK, Chung, JW, Han, MC, Kim, ST,Postoperative recurrence of hepatocellular carcinoma: results of transcatheter arterial chemoembolization, Cardiovasc Intervent Radiol, 16, 4, 21-24(1993) https://doi.org/10.1007/BF02603032
  5. Kim, SH, Lee, WJ, Lim, HK, Lim, JH,Prediction of viable tumor in hepatocellular carcinoma treated with transcatheter arterial chemoembolization: usefulness of attenuation value measurement at quadruple-phase helical computed tomography, J Comput Assist Tomogr, 31, 5, 198-203(2007) https://doi.org/10.1097/01.rct.0000236424.20514.2e
  6. Takayasu, K, Arii, S, Matsuo, N, Yoshikawa, M, Ryu, M, Takasaki, K,Comparison of CT findings with resected specimens after chemoembolization with iodized oil for hepatocellular carcinoma, AJR Am J Roentgenol, 175, 6, 699-704(2000) https://doi.org/10.2214/ajr.175.3.1750699
  7. Willatt, JM, Hussain, HK, Adusumilli, S, Marrero, JA,MR Imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies, Radiology, 247, 7, 311-330(2008) https://doi.org/10.1148/radiol.2472061331
  8. Kim, TK, Choi, BI, Han, JK, Chung, JW, Park, JH, Han, MC,Nontumorous arterioportal shunt mimicking hypervascular tumor in cirrhotic liver: two-phase spiral CT findings, Radiology, 208, 8, 597-603(1998) https://doi.org/10.1148/radiology.208.3.9722834
  9. Kim, HC, Kim, AY, Han, JK, Chung, JW, Lee, JY, Park, JH,Hepatic arterial and portal venous phase helical CT in patients treated with transcatheter arterial chemoembolization for hepatocellular carcinoma: added value of unenhanced images, Radiology, 225, 9, 773-780(2002) https://doi.org/10.1148/radiol.2253011346
  10. Jang, KM, Choi, D, Lim, HK, Lim, JH, Lee, JY, Lee, WJ,Depiction of viable tumor in hepatocellular carcinoma treated with transarterial chemoembolization: multiphasic helical CT with review of the previous serial CT images, Korean J Radiol, 6, 10, 153-160(2005) https://doi.org/10.3348/kjr.2005.6.3.153
  11. Kim, YS, Rhim, H, Lim, HK, Park, CK, Lee, WJ, Do, YS,Completeness of treatment in hepatocellular carcinomas treated with image-guided tumor therapies: Evaluation of positive predictive value of contrast-enhanced CT with histopathologic correlation in the explanted liver specimen, J Comput Assist Tomogr, 30, 11, 578-582(2006) https://doi.org/10.1097/00004728-200607000-00005
  12. Kim, KW, Lee, JM, Klotz, E, Park, HS, Lee, DH, Kim, JY,Quantitative CT color mapping of the arterial enhancement fraction of the liver to detect hepatocellular carcinoma, Radiology, 250, 12, 425-434(2009) https://doi.org/10.1148/radiol.2501072196
  13. Bruix, J, Sherman, M,Management of hepatocellular carcinoma, Hepatology, 42, 13, 1208-1236(2005) https://doi.org/10.1002/hep.20933
  14. Platt, JF, Francis, IR, Ellis, JH, Reige, KA,Difference in global hepatic enhancement assessed by dynamic CT in normal subjects and patients with hepatic metastases, J Comput Assist Tomogr, 21, 14, 348-354(1997) https://doi.org/10.1097/00004728-199705000-00003
  15. Platt, JF, Francis, IR, Ellis, JH, Reige, KA,Liver metastases: early detection based on abnormal contrast material enhancement at dual-phase helical CT, Radiology, 205, 15, 49-53(1997) https://doi.org/10.1148/radiology.205.1.9314961
  16. Quiroga, S, Sebastia, C, Pallisa, E, Castella, E, Perez-Lafuente, M, Alvarez-Castells, A,Improved diagnosis of hepatic perfusion disorders: value of hepatic arterial phase imaging during helical CT, Radiographics, 21, 16, 65-81(2001) https://doi.org/10.1148/radiographics.21.1.g01ja0165
  17. White, MJ, O'Gorman, RL, Charles-Edwards, EM, Kane, PA, Karani, JB, Leach, MO,Parametric mapping of the hepatic perfusion index with gadolinium-enhanced volumetric MRI, Br J Radiol, 80, 17, 113-120(2007) https://doi.org/10.1259/bjr/36793733
  18. Iannaccone, R, Laghi, A, Catalano, C, Rossi, P, Mangiapane, F, Murakami, T,Hepatocellular carcinoma: role of unenhanced and delayed phase multi-detector row helical CT in patients with cirrhosis, Radiology, 234, 18, 460-467(2005) https://doi.org/10.1148/radiol.2342031202
  19. Kim, YK, Kwak, HS, Kim, CS, Chung, GH, Han, YM, Lee, JM,Hepatocellular carcinoma in patients with chronic liver disease: comparison of SPIO-enhanced MR imaging and 16-detector row CT, Radiology, 238, 19, 531-541(2006) https://doi.org/10.1148/radiol.2381042193
  20. Chakraborty, DP,Analysis of location specific observer performance data: validated extensions of the jackknife free-response (JAFROC) method, Acad Radiol, 13, 20, 1187-1193(2006) https://doi.org/10.1016/j.acra.2006.06.016
  21. Kim, SH, Lee, JM, Kim, YJ, Choi, JY, Kim, GH, Lee, HY,Detection of hepatocellular carcinoma on CT in liver transplant candidates: comparison of PACS tile and multisynchronized stack modes, AJR Am J Roentgenol, 188, 21, 1337-1342(2007) https://doi.org/10.2214/AJR.06.0801
  22. Park, Y, Kim, SH, Kim, SH, Jeon, YH, Lee, J, Kim, MJ,Gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI versus gadobenate dimeglumine (Gd-BOPTA)-enhanced MRI for preoperatively detecting hepatocellular carcinoma: an initial experience, Korean J Radiol, 11, 22, 433-440(2010) https://doi.org/10.3348/kjr.2010.11.4.433
  23. Heo, SH, Jeong, YY, Shin, SS, Kim, JW, Lim, HS, Lee, JH,Apparent diffusion coefficient value of diffusion-weighted imaging for hepatocellular carcinoma: correlation with the histologic differentiation and the expression of vascular endothelial growth factor, Korean J Radiol, 11, 23, 295-303(2010) https://doi.org/10.3348/kjr.2010.11.3.295

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