How I do it: Cone-beam CT during transarterial chemoembolization for liver cancer.
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ABSTRACT:
SUBMITTER: Tacher V
PROVIDER: S-EPMC4314294 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposeTo assess the ability of Cone-Beam CT (CBCT), performed during the Transcatheter Arterial Chemoembolization (TACE), in predicting the response to treatment of hepatocellular carcinoma (HCC).Materials and methodsWe evaluated fifty patients (M/F = 40/10, mean age: 66.7 years ± 8.22) with hepatocellular carcinoma (HCC), for a total of 82 nodules evaluated (mean diameter: 21.4 ± 11 mm). All patients performed a CT scan one month before and one month after TACE. After TACE is completed, a CBCT was performed to assess the degree of drug retention in the lesions. For each lesion, the major diameter, volume, and density of the vital portion were evaluated. The response to TACE was assessed using the mRECIST criteria on the CT scan carried out one month after the procedure. The receiver operating characteristic (ROC) curves were performed to assess the accuracy of the CBCT in predicting the response to treatment and to identify the cut-off points for each parameter under examination.ResultsA complete response (CR) was observed in 24/50 patients (48%), a partial response (PR) in 16/50 (32%), stable disease (SD) in 8/50 (16%), and progressive disease (PD) in 2/50 (4%). Evaluation of the area under the ROC curve showed that the diameter, volume, and density of the lesion, measured with CBTC, had an accuracy of 94%, 96%, and 98%, respectively, in discriminating a complete response from a not complete response.ConclusionCBCT is effective in predicting short-term response at 1-month follow-up of HCC treated by chemoembolization.
| S-EPMC7997764 | biostudies-literature
Project description:To investigate the effectiveness of intraprocedural dual-phase cone-beam computed tomography (CBCT) in detecting hepatocellular carcinoma (HCC) during conventional transcatheter arterial chemoembolization (TACE) and its effect on improving treatment outcomes. Between November 2018 and November 2019, data from 111 patients with unresectable HCCs (N = 263 lesions) were reviewed retrospectively. All patients had undergone baseline magnetic resonance imaging (MRI) scans within one month prior to the procedure. Both arterial-phase (AP) and delayed-phase CBCT images were acquired during all conventional TACEs. Each HCC detection rate when read by AP-CBCT and when read by dual-phase (DP) CBCT including both AP and delayed phase was compared with that of MRI, and the diagnosis of HCC was based on MRI. Additionally, the follow-up results concerning lipiodol uptake status and tumor response of the lesions detected only by AP-/DP-CBCT were analyzed and compared with MRI-only detected lesions. The overall sensitivity of DP-CBCT (94.7%) was significantly higher than that of AP-CBCT (89.0%) (p = 0.003). In particular, the rate of subcentimeter HCC detection by DP-CBCT was pronounced (91.5% vs. 80.3%) (p = 0.01). Lesions found only by DP-CBCT exhibited positive lipiodol uptake (n = 31/31; 100%) and showed complete or partial responses (n = 24/31; 77.4%) on follow-up CT imaging, while MRI-only detected lesions had less lipiodol uptake (n = 6/14, 42.9%) and complete or partial responses (n = 4/14; 28.6%) (p ≤ 0.001). DP-CBCT imaging during TACE enabled better detection of HCCs than when using AP-CBCT alone, and AP- and DP-CBCT is superior to MRI in detecting chemoembolization-sensitive lesions. This resulted in increased detectability of HCCs and the achievement of better treatment outcomes.
| S-EPMC7845953 | biostudies-literature
Project description:We aimed to investigate the role of the quantitative parameters of dual-energy computed tomography (DECT) in evaluating patients with hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE). We retrospectively identified 80 HCC patients (mean age, 56 years; 61 men) treated by TACE who received contrast-enhanced DECT and were retreated by TACE within 7 days between November 2018 and December 2019. Taking digital subtraction angiography (DSA) and CT images as reference standard, two readers measured and calculated the values of normalized iodine concentration at arterial phase (NICAP), normalized iodine concentration at portal venous phase (NICPP), iodine concentration difference (ICD), arterial iodine fraction (AIF) and slope of the spectral Hounsfield unit curve (λHu) by placing matched regions of interests (ROIs) within the tumor active area (TAA), adjacent normal hepatic parenchyma (ANHP) and tumor necrotic area (TNA). Differences between the parameters were analyzed by the Kruskal-Wallis H test. Receiver operating characteristic analysis of the parameters performance in differentiating the three tissues types was performed. AIF exhibited a good performance in distinguishing TAA (0.93 ± 0.31) and ANHP (0.18 ± 0.14), the areas under the receiver operating characteristic curve (AUC) was 0.989, while the λHu exhibited an excellent performance in distinguishing TAA (3.32 ± 1.24) and TNA (0.29 ± 0.27), with an AUC of 1.000. In conclusion, quantitative DECT can be effectively used to evaluate the tumor viability in HCC patients treated by TACE.
| S-EPMC8160271 | biostudies-literature
Project description:PurposeTo provide initial assessment of image quality and dose for a cone-beam computed tomographic (CT) scanner dedicated to extremity imaging.Materials and methodsA prototype cone-beam CT scanner has been developed for imaging the extremities, including the weight-bearing lower extremities. Initial technical assessment included evaluation of radiation dose measured as a function of kilovolt peak and tube output (in milliampere seconds), contrast resolution assessed in terms of the signal difference-to-noise ratio (SDNR), spatial resolution semiquantitatively assessed by using a line-pair module from a phantom, and qualitative evaluation of cadaver images for potential diagnostic value and image artifacts by an expert CT observer (musculoskeletal radiologist).ResultsThe dose for a nominal scan protocol (80 kVp, 108 mAs) was 9 mGy (absolute dose measured at the center of a CT dose index phantom). SDNR was maximized with the 80-kVp scan technique, and contrast resolution was sufficient for visualization of muscle, fat, ligaments and/or tendons, cartilage joint space, and bone. Spatial resolution in the axial plane exceeded 15 line pairs per centimeter. Streaks associated with x-ray scatter (in thicker regions of the patient--eg, the knee), beam hardening (about cortical bone--eg, the femoral shaft), and cone-beam artifacts (at joint space surfaces oriented along the scanning plane--eg, the interphalangeal joints) presented a slight impediment to visualization. Cadaver images (elbow, hand, knee, and foot) demonstrated excellent visibility of bone detail and good soft-tissue visibility suitable to a broad spectrum of musculoskeletal indications.ConclusionA dedicated extremity cone-beam CT scanner capable of imaging upper and lower extremities (including weight-bearing examinations) provides sufficient image quality and favorable dose characteristics to warrant further evaluation for clinical use.
| S-EPMC4263642 | biostudies-literature
Project description:Background & purposeFour dimensional Cone beam CT (CBCT) has many potential benefits for radiotherapy but suffers from poor image quality, long acquisition times, and/or long reconstruction times. In this work we present a fast iterative reconstruction algorithm for 4D reconstruction of fast acquisition cone beam CT, as well as a new method for temporal regularization and compare to state of the art methods for 4D CBCT.Materials & methodsRegularization parameters for the iterative algorithms were found automatically via computer optimization on 60 s acquisitions using the XCAT phantom. Nineteen lung cancer patients were scanned with 60 s arcs using the onboard image on a Varian trilogy linear accelerator. Images were reconstructed using an accelerated ordered subset algorithm. A frequency based temporal regularization algorithm was developed and compared to the McKinnon-Bates algorithm, 4D total variation and prior images compressed sensing (PICCS).ResultsAll reconstructions were completed in 60 s or less. The proposed method provided a structural similarity of 0.915, compared with 0.786 for the classic McKinnon-bates method. For the patient study, it provided fewer image artefacts than PICCS, and better spatial resolution than 4D TV.ConclusionFour dimensional iterative CBCT reconstruction was done in less than 60 s, demonstrating the clinical feasibility. The frequency based method outperformed 4D total variation and PICCS on the simulated data, and for patients allowed for tumor location based on 60 s acquisitions, even for slowly breathing patients. It should thus be suitable for routine clinical use.
| S-EPMC7807579 | biostudies-literature
Project description:A 73-year-old woman with chief complaint of macroscopic hematuria was diagnosed as having left renal tumor with pancreatic invasion. Nephrectomy was performed. Pathological diagnosis was clear cell carcinoma, pT3a. Three months after the operation, liver metastasis appeared and sunitinib was started. Most of the liver metastases disappeared; however, a new lesion appeared, and sunitinib was switched to axitinib, which was effective on the residual lesion, but the new lesion had poor response. Transarterial chemoembolization was performed to treat the liver metastases, and all metastatic lesions disappeared. There was no recurrence at 2 years, and axitinib was discontinued.
| S-EPMC5849875 | biostudies-other
Project description:We describe a dataset from patients who received ablative radiation therapy for locally advanced pancreatic cancer (LAPC), consisting of computed tomography (CT) and cone-beam CT (CBCT) images with physician-drawn organ-at-risk (OAR) contours. The image datasets (one CT for treatment planning and two CBCT scans at the time of treatment per patient) were collected from 40 patients. All scans were acquired with the patient in the treatment position and in a deep inspiration breath-hold state. Six radiation oncologists delineated the gastrointestinal OARs consisting of small bowel, stomach and duodenum, such that the same physician delineated all image sets belonging to the same patient. Two trained medical physicists further edited the contours to ensure adherence to delineation guidelines. The image and contour files are available in DICOM format and are publicly available from The Cancer Imaging Archive ( https://doi.org/10.7937/TCIA.ESHQ-4D90 , Version 2). The dataset can serve as a criterion standard for evaluating the accuracy and reliability of deformable image registration and auto-segmentation algorithms, as well as a training set for deep-learning-based methods.
| S-EPMC9587208 | biostudies-literature
Project description:Background and purposeThe limited image quality in Cone Beam CT (CBCT) stemming primarily from scattered radiation hinders accurate CBCT based dose calculation in radiotherapy. We investigated the use of a stoichiometric calibration for dose calculation on CBCT images of lung cancer patients.Materials and methodsCBCT calibrations were performed with thorax scan protocols, using a phantom with approximately the diameter of an average human thorax and a central cavity simulating the thoracic cavity. Thus scatter conditions resembling those in clinical thorax CBCT scans were simulated. A published stoichiometric parametrization was used. A treatment plan was simulated on CBCT and CT scans of an anthropomorphic phantom, the dose distributions were calculated, and clinically relevant DVH parameters were compared. Twelve lung cancer patients had surveillance CT scans (s-CT) taken twice during their treatment course in addition to daily setup CBCTs. Dose calculations were performed on the s-CTs and the corresponding CBCTs taken on the same day, and DVH parameters were compared.ResultsEighty percent of CBCT DVH parameters found for the phantom were within ±1% of CT doses, and 98% were within ±3%. For patients, the median CT/CBCT dose difference was within ±2%, and 98% of DVH parameters were within ±4%. Minimum dose to the tumor was underestimated (median 1.9%) on CBCT, while maximum doses to most organs at risk were slightly overestimated.ConclusionDirect dose calculations on CBCTs of lung cancer patients were feasible within ∼4% accuracy using a simple calibration method, which is easily implemented in a clinical setting.
| S-EPMC7807659 | biostudies-literature
Project description:ObjectivesInvestigate long-term effects of repeated transarterial chemoembolization (TACE) on portal venous pressure (PVP) using non-invasive surrogate markers of portal hypertension.MethodsRetrospective, Institutional Review Board-approved study. 99 patients [hepatocellular carcinoma (HCC) group (n=57); liver metastasis group (n=42)] who underwent 279TACEs and had longitudinal pre-/post-therapy contrast-enhanced-MRI (n=388) and complete blood work were included. Outcomes of interest were platelet count (PC), spleen volume, ascites and portosystemic collaterals. Variables included TACE type/number, tumor type, microcatheter location, Child-Pugh, baseline tumor burden (tumor number/total/largest size), vessel invasion, alpha-fetoprotein, Eastern Cooperative Oncology Group (ECOG) performance status, and Model for End-Stage Liver Disease (MELD) score. Generalized Estimating Equations assessed the associations between TACE and outcomes. Power analysis determined the sample size was sufficient.ResultsNo significant change in PC over time was observed in either groups, regardless of liver function (P>0.05). Baseline spleen volume was 226 cm3 for metastatic group, and was larger by 204 cm3 for HCC group (P<0.001). Spleen volume increased by 20 cm3 (95%CI: 8-32; P=0.001) for both groups after 1stTACE and by 16cm3/TACE (P=0.099) over the full follow-up (up to 9TACEs). Spleen volume also tended to increase by 23cm3 (95%CI: -1-48; P=0.064) with higher tumor burden. Odds of developing moderate/severe ascites for metastatic patients was decreased by 0.5 (95%CI: 0.3-0.9; P=0.014), regardless of the Child-Pugh, and increased by 1.5 (95%CI: 1.2-1.9; P<0.001) among HCC patients with unstable Child-Pugh, whereas no change was noted with stable Child-Pugh. HCC patients with unstable Child-Pugh demonstrated a significant increase in portosystemic collaterals number over time (P=0.008). PVP-related complications such as variceal bleeding post-TACE were low (0.4%).ConclusionRepeated TACEs did seem to have an impact on PVP. However, the increase in PVP had marginal effects with low portal hypertension-related complications.
| S-EPMC8602787 | biostudies-literature
Project description:The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 dimensional (3D) diagnostic imaging in the interventional suite and can enhance minimally-invasive therapy beyond the limitations of 2D angiography alone. The role of CBCT has been recognized in transarterial chemo-embolization (TACE) treatment of hepatocellular carcinoma (HCC). The recent introduction of a CBCT technique: dual-phase CBCT (DP-CBCT) improves intra-arterial HCC treatment with drug-eluting beads (DEB-TACE). DP-CBCT can be used to localize liver tumors with the diagnostic accuracy of multi-phasic multidetector computed tomography (M-MDCT) and contrast enhanced magnetic resonance imaging (CE-MRI) (See the tumor), to guide intra-arterially guidewire and microcatheter to the desired location for selective therapy (Reach the tumor), and to evaluate treatment success during the procedure (Treat the tumor). The purpose of this manuscript is to illustrate how DP-CBCT is used in DEB-TACE to see, reach, and treat HCC.
| S-EPMC3910428 | biostudies-literature