Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2015; 21(10): 3035-3040
Published online Mar 14, 2015. doi: 10.3748/wjg.v21.i10.3035
C-arm Lipiodol CT in transcatheter arterial chemoembolization for small hepatocellular carcinoma
Jian-Jun Li, Jia-Sheng Zheng, Shi-Chang Cui, Xiong-Wei Cui, Cai-Xia Hu, Da Fang, Lin-Chao Ye
Jian-Jun Li, Jia-Sheng Zheng, Shi-Chang Cui, Xiong-Wei Cui, Cai-Xia Hu, Da Fang, Oncology and Hepatobiliary Minimally Invasive Interventional Center, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
Lin-Chao Ye, AX Business Group, Healthcare Sector, Siemens Ltd. China, Shanghai 201318, China
Author contributions: Li JJ, Zheng JS, Cui SC, Cui XW and Hu CX performed the majority of experiments; Fang D collected the imaging material; Ye LC revised the manuscript; Zheng JS and Li JJ designed the study and wrote the manuscript.
Supported by Funding from the Chinese Ministry of Science and Technology, No. 2012BAI15B08; and International Cooperation Projects of the Ministry of Science and Technology, No. 2012DFA30850.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Jia-Sheng Zheng, Head of Department, Oncology and Hepatobiliary Minimally Invasive Interventional Center, Beijing Youan Hospital, Capital Medical University, 8 Xitoutiao, Beijing 100069, China. zhengjiasheng6@163.com
Telephone: +86-10-83997112 Fax: +86-10-83997628
Received: August 12, 2014
Peer-review started: August 13, 2014
First decision: September 15, 2014
Revised: October 14, 2014
Accepted: November 7, 2014
Article in press: November 11, 2014
Published online: March 14, 2015
Processing time: 215 Days and 22 Hours
Abstract

AIM: To investigate the value of C-arm Lipiodol computed tomography (CT) for intra-procedural hepatocellular carcinoma (HCC) lesion detection during transcatheter arterial chemoembolization (TACE).

METHODS: Forty patients (37 male, 3 female; mean age, 52.6 ± 12.5 years, age range: 25-82 years) diagnosed with HCC were enrolled in this study. All patients underwent 64-slice CT 1-2 wk before TACE. During the procedure, hepatic angiography was performed first. Following diagnostic embolization with Lipiodol injected into the hepatic artery, a C-arm CT scan was immediately conducted (C-arm Lipiodol CT). If new HCC lesions were confirmed, gelfoam particles were super-selectively injected into the tumor-nourishing blood vessel. A Lipiodol CT scan was performed 7-14 d after TACE. All images acquired from 64-slice CT, digital subtraction angiography (DSA), C-arm Lipiodol CT and Lipiodol CT were retrospectively reviewed by four radiologists and the number of detected lesions in each examination was counted, respectively. The results of Lipiodol CT were taken as the diagnostic reference. Alpha-fetoprotein values were examined both before and after TACE. This study only takes into account the lesions that were not found or were considered suspicious on 64-slice CT before TACE.

RESULTS: Preprocedural 64-slice CT detected a total of 13 suspicious lesions in the 40 patients. DSA detected ten definite and four suspicious lesions. C-arm Lipiodol CT detected 71 lesions in total and Lipiodol CT confirmed 67 lesions with a diameter range of 3-12 mm. Four false-positive lesions, which were detected by C-arm Lipiodol CT, were considered to be hepatic artery-portal vein fistulas. The average alpha-fetoprotein values before and after TACE were significantly different (452.3 ± 192.6 ng/mL vs 223.8 ± 93.2 ng/mL; P = 0.039).

CONCLUSION: C-arm Lipiodol CT has a higher diagnostic sensitivity for small HCC lesions. This technique may help physicians make intraprocedural decisions to provide patients with earlier treatment.

Keywords: Hepatocellular Carcinoma; C-arm computed tomography; Chemoembolization; Angiography; Digital subtraction; Lipiodol; Therapeutic

Core tip: This article describes a new imaging modality for detecting small hepatocellular carcinoma (HCC) lesions during transcatheter arterial chemoembolization (TACE). C-arm Lipiodol computed tomography (CT) is defined as a plain C-arm CT scan performed immediately after Lipiodol embolization during TACE, which allows an early diagnosis and reduces the use of contrast medium. Use of the method can reduce the radiation dose to patients and provide a higher diagnostic sensitivity for small HCC lesions at an early stage during TACE. This technique may help physicians make intraprocedural decisions to provide earlier treatment and reduce the recurrence rate of HCC.