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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 2/2019

01-02-2019 | Clinical Investigation

Visibility of Hypovascularized Liver Tumors during Intra-Arterial Therapy Using Split-Bolus Single-Phase Cone Beam CT

Authors: Martin Jonczyk, Federico Collettini, Dirk Schnapauff, Dominik Geisel, Georg Böning, Willie M. Lüdemann, Gero Wieners, Bernd Hamm, Bernhard Gebauer

Published in: CardioVascular and Interventional Radiology | Issue 2/2019

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Abstract

Purpose

To validate a split-bolus contrast injection protocol for single-phase CBCT in terms of detectability of hypovascular liver tumors compared to digital subtraction angiography (DSA).

Materials and Methods

In this retrospective, single-center study, 20 consecutive patients with in total 77 hypovascularized tumors referred for intra-arterial therapy received a split-bolus single-phase CBCT. Two readers rated the visibility of the target tumors scheduled for embolization in CBCT and DSA compared to the pre-interventional multiphasic CT or MRI used as reference on a 3-point scoring system (1 = optimal, 3 = not visible) and catheter-associated artifacts (1 = none, 3 = extended). SNR, CNR and contrast values were derived from 37 target tumors in CBCT and MRI. Statistical analysis included the kappa test to determine interrater reliability, the Friedman’s test for the inter-modality comparison evaluating tumor visibility in DSA and CBCT as well as for quantitative assessment. Post hoc analysis included the Wilcoxon signed-rank test. p values < 0.05 were considered significant.

Results

Ninety percentage of target tumors were rated as visible in CBCT and 37.5% in DSA (p < 0.001). 70.1% of pre-interventionally detected hypovascularized tumors were depicted with CBCT and 31.2% by DSA (p < 0.001). 7.8% of known tumors were outside the FOV. Quantitative assessment showed higher image contrasts in CBCT (1.91 ± 7.01) compared to hepatobiliary-phase MRI (0.29 ± 0.14, p = 0.003) and to portal-venous (p.v.) MRI (0.31 ± 0.13, p < 0.001), but higher CNR for MRI (1.18 ± 0.80; 13.92 ± 15.82; 13.79 ± 6.65).

Conclusion

In conclusion, the split-bolus single-phase CBCT detects significantly more hypovascularized liver tumors compared to DSA performed through the proper hepatic artery with high image contrasts.

Level of Evidence

Level III, diagnostic study.
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Metadata
Title
Visibility of Hypovascularized Liver Tumors during Intra-Arterial Therapy Using Split-Bolus Single-Phase Cone Beam CT
Authors
Martin Jonczyk
Federico Collettini
Dirk Schnapauff
Dominik Geisel
Georg Böning
Willie M. Lüdemann
Gero Wieners
Bernd Hamm
Bernhard Gebauer
Publication date
01-02-2019
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 2/2019
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-018-2101-2

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