The Clinical Application And Values Of Using Cone-beam Computed Tomography In Identification Of The Lesions And Feeding-arteries For Hepatocellular Carcinoma

PurposeThe study is aiming at to detect the sensitivity of identification hepatocellular carcinoma(HCC) and its feeding arteries on the images of cone-beam computed tomographic hepatoangiography(CBCT-HA) and lipiodol cone-beam tomography(Lip-CBCT) and evaluate the effectiveness of improving the procedures of transcatheter chemoembolization(TACE) in the first session. Materials and methods54 consecutive patients were diagnosed as HCC and underwent first-session TACE and CBCT scan in the department of interventional radiology at the first affiliated hospital of Zhengzhou University from Sep. 2015 to Jan. 2016. The clinical data and images were collected and retrospectively analyzed. All the patients underwent contrast-enhanced multi-detector computed tomography pre-procedurally. The patients underwent intra-procedural digital subtraction angiography(DSA), CBCT-HA and post-procedural Lip-CBCT. The patients involved were followed up by MDCT in post-procedural 1-3 months. The images of each patient were restored and reconstructed at the work station and as well as pre-procedural and post-procedural MDCT images in the first session TACE analyzed by 2 experienced interventional radiologists respectively. All the statistic data was calculated by Statistic Package for Social Science 21.0 edition. The differences of sensitivity of MDCT and DSA in identification of tumor lesions with CBCT were analyzed by the Wilcoxon sign rank test. The difference of sensitivity in identification of tumor feeding arteries between DSA and CBCT was analyzed by Chi-square test. The difference was considered significant if two-side ? less than 0.05. The additional information of CBCT was graded as whether TACE procedure of a patient was altered as the result. If no additional information or the procedure was not altered, the case was scored 0 point. If several additional information help to alter the procedure, the case was scored 1 point. Results43 patients were included in analysis and 11 patients were excluded.(1)52 tumors were identified on pre-procedural MDCT images and 60 tumors were on intra-procedural DSA. A total of 84 tumors were identified on images of CBCTHA and LipCBCT. The differences of sensitivity between MDCT and CBCT were statistical significant(Z=-16.146, p<0.001). The differences of sensitivity between MDCT and CBCT were also statistical significant(Z=-16.127, p<0.001).(2)The feeding arteries of 49 tumor lesions out of total 84 were identified on DSA and 71 out of 84 were identified on CBCT. The sensitivities in identification of feeding arteries on DSA and CBCT were 44.0%(37/84) and 84.5%(71/84) respectively. The difference of sensitivities between DSA and CBCT was of statistical significance(?2 =4.449, p=0.035<0.05).(3)In view of the accumulated scores in 43 cases. 16 cases were scored 0 point. 24 were scored 1 point and 3 were scored 2 points. The procedures of 27 out of 43 cases(62.8%) were altered by additional information brought up by CBCT. Conclusions1. CBCT is superior to both of MDCT and DSA in identification of tumor lesions2. CBCT is superior to DSA in identification of feeding arteries.3. CBCT alters the interventional oncological procedure effectively.