Korean J Radiol.  2005 Sep;6(3):153-160. 10.3348/kjr.2005.6.3.153.

Depiction of Viable Tumor in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization: Multiphasic Helical CT with Review of the Previous Serial CT Images

• Jang KM
• Choi D
• Lim HK
• Lim JH
• Lee JY
• Lee WJ
• Kim SH
• Lee SJ
• Jeon YH
• Lee J
• Kim MJ
• Shin SW
• Park CK

• KMID: 1102711
• DOI: http://doi.org/10.3348/kjr.2005.6.3.153

Abstract

OBJECTIVE
The purpose of our study was to assess whether a review of multiphasic helical CT combined with the previous serial CT images could be helpful to depict a viable tumor in hepatocellular carcinoma treated with transarterial chemoembolization. MATERIALS AND METHODS: Twenty-four consecutive patients with 35 hepatocellular carcinomas underwent transarterial chemoembolization followed by hepatic resection. First, three radiologists independently analyzed the last CT images taken before resection for the presence of viable tumor. A second analysis was then performed using the last CT combined with the previous serial CT images. The CT analyses were then compared with the pathologic results. The added value of the review of the previous serial CT images was evaluated by performing a receiver operating characteristic analysis. The sensitivity, specificity and diagnostic accuracy for the depiction of viable tumor were also assessed, and the characteristics of the false-negative lesions were pathologically evaluated. RESULTS: The mean diagnostic accuracies (Az values) for the depiction of viable tumor with using the last CT alone and with the review of the previous serial CT images for all observers were 0.885 and 0.901, respectively, which were not significantly difference (p> 0.05). However, the additional review of the previous serial CT images allowed the observers to render a correct diagnosis for three lesions that had been incorrectly diagnosed with the review of last CT alone. The sensitivity, specificity and diagnostic accuracy of the last CT along with the review of the previous serial CT images were 78%, 97% and 84%, respectively. All of the 16 false-negative lesions diagnosed by each observer showed 90% or greater necrosis on the pathologic examination. CONCLUSION: For the depiction of viable tumor in hepatocellular carcinoma treated with transarterial chemoembolization, although the difference in the diagnostic accuracies was not statistically significant, a review of the multiphasic helical CT combined with the previous serial CT images could help reach a correct diagnosis for those lesions incorrectly diagnosed with the review of the last CT alone.

Keyword

Liver, CT; Liver neoplasm, CT

MeSH Terms

Tomography, X-Ray Computed
*Tomography, Spiral Computed
Tissue Survival
Sensitivity and Specificity
Neoplasm, Residual/*radiography
Middle Aged
Male
Liver Neoplasms/*radiography/*therapy
Humans
Hepatectomy
Female
False Negative Reactions
*Chemoembolization, Therapeutic
Carcinoma, Hepatocellular/*radiography/*therapy
Aged
Adult

Figure

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  Fig. 1 A 56-year-old man who had undergone one time preoperative treatment with transarterial chemoembolization and right lobectomy. The pathologic examination revealed totally necrotic tumor. A, B. On the last contrast-enhanced CT, the lesion that is a focal slightly hyperattenuating area (arrow) adjacent to the iodized oil-containing nodule on the hepatic arterial phase CT image (A) appears as an isoattenuating area (arrow) at the corresponding region on the unenhanced CT image (B). This lesion was interpreted as a viable tumor by all the observers after reviewing the last CT alone. C, D. On the second to the last CT taken three weeks after the transarterial chemoembolization, the hepatic arterial phase (C) and unenhanced CT images (D) show that the hyperattenuating lesion seen in Figure A appears to be iodized oil-containing hepatic parenchyma (arrow). After reviewing the previous serial CT images, the two observers interpreted this hyperattenuating lesion on the last hepatic arterial phase CT as an arteriovenous shunt, and they changed the confidence level to probably not viable tumor.

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  Fig. 2 A 52-year-old man who had undergone three transarterial chemoembolization treatments and right hepatic lobectomy. A, B. The unenhanced CT images show two compact iodized oil-containing nodules at S8 (arrow) and S6 (arrowhead) of the liver. C-F. These contrast-enhanced CT scans obtained during the arterial phase (C, D) and the delayed phase (E, F) show neither enhancing portions nor defects within the iodized oil-containing nodules at S8 (arrow) and S6 (arrowhead). The two tumors were interpreted as non-viable tumors by all the observers. The pathologic examination revealed that the S6 tumor was 90% necrotic and that the S8 tumor was totally necrotic.

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