Ruediger Egbert Schernthaner MD, Presenter: Nothing to Disclose

MingDe Lin PhD, Abstract Co-Author: Employee, Koninklijke Philips NV

Rafael Duran MD, Abstract Co-Author: Nothing to Disclose

Julius Chapiro MD, Abstract Co-Author: Nothing to Disclose

Zhijun Wang MD, Abstract Co-Author: Nothing to Disclose

Jean-Francois H. Geschwind MD, Abstract Co-Author: Consultant, BTG International Ltd Consultant, Bayer AG Consultant, Guerbet SA Consultant, Nordion, Inc Grant, BTG International Ltd Grant, F. Hoffmann-La Roche Ltd Grant, Bayer AG Grant, Koninklijke Philips NV Grant, Nordion, Inc Grant, ContextVision AB Grant, CeloNova BioSciences, Inc Founder, PreScience Labs, LLC CEO, PreScience Labs, LLC

To evaluate the impact of dual-phase cone-beam CT (CBCT) on the identification of cholangiocarcinoma (CCC) lesions during transarterial chemoembolization (TACE) compared to conventional DSA, in relation to pre-interventional contrast-enhanced magnetic resonance imaging (CE-MRI) of the liver.

This retrospective study included 17 consecutive patients (10 men, 7 women; mean age 64) with CCC who underwent pre-interventional CE-MRI of the liver and intra-procedural dual-phase (early and delayed arterial) CBCT just before the chemotherapeutic drug delivery. The degree of visibility of each CCC lesion was graded on a three rank scale (complete, partial and none) on dual-phase CBCT and DSA images and compared to CE-MRI. Lesions < 5 mm diameter or outside the CBCT’s field of view were excluded from evaluation. Statistical analysis was performed with Wilcoxon signed-rank test and Friedman test.

At total of 61 CCC lesions was included. The sensitivity of DSA for the complete or partial depiction of CCC lesions was only 45.9%, whereas early and delayed arterial phase CBCT had significantly higher sensitivity of 73.8% and 93.4%, respectively (p<0.01). There was only one lesion (1.6%) that was depicted by DSA, but not by dual-phase CBCT due to severe streak artifacts caused by a mitral valve replacement. Conversely, out of the 33 lesions not visible on DSA, 18 (54.5%) and 30 (90.9%) were revealed on early and delayed arterial phase CBCT images, respectively. Early arterial phase CBCT showed no additional lesions compared to delayed arterial phase CBCT. Delayed arterial phase CBCT identified significantly more lesions (n=12, 19.7%, p<0.01) than early arterial phase CBCT. Especially with regard to the complete delineation of lesions, delayed arterial phase CBCT yielded significantly higher sensitivity (78.7%) compared to early-phase CBCT (31.1%) and DSA (21.3%)(p<0.01).  

Dual-phase CBCT significantly improved the identification of CCC lesions during TACE. Delayed arterial phase CBCT yielded the highest sensitivity for the complete delineation of CCC lesions. Dual-phase CBCT should be used as standard imaging technique during TACE in CCC patients.

Dual-phase CBCT can help to identify CCC lesions during TACE thus preventing some lesions to be overlooked for optimal treatment.

Schernthaner, R, Lin, M, Duran, R, Chapiro, J, Wang, Z, Geschwind, J, Dual-phase Cone Beam CT Improves Identification of Cholangiocarcinoma Lesions during Trans-arterial Chemoembolization.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045526.html