Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2016; 22(11): 3242-3251
Published online Mar 21, 2016. doi: 10.3748/wjg.v22.i11.3242
Application of gemstone spectral imaging for efficacy evaluation in hepatocellular carcinoma after transarterial chemoembolization
Qi-Yu Liu, Chuan-Dong He, Ying Zhou, Dan Huang, Hua Lin, Zhong Wang, Dong Wang, Jin-Qiu Wang, Li-Ping Liao
Qi-Yu Liu, Chuan-Dong He, Ying Zhou, Dan Huang, Hua Lin, Zhong Wang, Dong Wang, Jin-Qiu Wang, Li-Ping Liao, Department of Radiology, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
Author contributions: Liu QY designed the research and wrote the paper; He CD designed the research and supervised the report; Zhou Y and Huang D contributed to the analysis; Lin H and Wang D provided clinical advice; Wang Z, Wang JQ and Liao LP performed the research.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Mianyang Central Hospital, Sichuan Province, China.
Informed consent statement: All patients provided written informed consent prior to GSI scan and transcatheter arterial chemoembolization in this study, and we use the anonymous clinical data during the analysis.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
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: Chuan-Dong He, MD, Associate Professor, Department of Radiology, Mianyang Central Hospital, 12 Changjia Road, Fucheng District, Mianyang 621000, Sichuan Province, China. hecd735@163.com
Telephone: +86-816-2222821
Received: November 3, 2015
Peer-review started: November 3, 2015
First decision: November 27, 2015
Revised: December 31, 2015
Accepted: January 17, 2016
Article in press: January 17, 2016
Published online: March 21, 2016
Processing time: 131 Days and 20.9 Hours
Abstract

AIM: To assess the value of gemstone spectral imaging (GSI) in efficacy evaluation in hepatocellular cancer (HCC) after transcatheter arterial chemoembolization (TACE) treatment.

METHODS: Thirty patients with HCC underwent GSI, including nonenhanced, arterial, portalvenous and delayed phase scans, after TACE treatment. Arterial phase images were acquired with GSI for reconstruction of virtual nonenhanced images and color overlay images. Digital subtraction angiography (DSA) was performed in all these patients. Two blinded and independent readers evaluated the data in two reading sessions; standard nonenhanced, arterial, portalvenous, and delayed phase images were read in session A, and the optimal monochromatic images, iodine/water based images and spectrum features were read in session B. Sensitivity and specificity were calculated with the DSA data as the reference standard. The sensitivity and specificity were compared using the χ2 test.

RESULTS: DSA revealed 154 lesions in 30 patients, and 100 of them had blood supply. Overall sensitivity and specificity were 72% (72/100) and 77.8% (42/54) for session A, and 97% (97/100) and 94.4% (51/54) for session B, respectively. The sensitivity and specificity of the two reading sessions were significantly different (χ2 = 23.04, χ2 = 7.11, P < 0.05).

CONCLUSION: Compared with conventional CT, GSI could significantly improve the detection of small and multiple lesions without increasing the radiation dose. Based on spectrum features, GSI could assess tumor homogeneity and more accurately identify residual tumors and recurrent or metastatic lesions during efficacy evaluation and follow-up in HCC after TACE treatment.

Keywords: Gemstone spectral imaging, Hepatocellular carcinoma, Transcatheter arterial chemoembolization, Digital subtraction angiography, Efficacy evaluation

Core tip: This is a retrospective study to evaluate the efficacy of gemstone spectral imaging (GSI) in hepatocellular cancer (HCC) after transarterial chemoembolization (TACE) treatment. The overall sensitivity and specificity of GSI in detection of lesions were 97% (97/100) and 94.4% (51/54), and 72% (72/100) and 77.8% (42/54) for conventional computed tomography (CT), respectively. Compared with conventional CT, GSI could not only significantly improve the detection of small and multiple lesions without increasing the radiation dose, but also could assess tumor homogeneity and more accurately identify residual tumors and recurrent or metastatic lesions during the follow-up in HCC after TACE treatment.