Hepatic arterial and portal venous phase helical CT in patients treated with transcatheter arterial chemoembolization for hepatocellular carcinoma: added value of unenhanced images.
OBJECTIVE
To evaluate the additional diagnostic value of unenhanced computed tomographic (CT) images in the depiction of viable tumor in patients who were treated with transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) and followed up with biphasic helical CT that included the acquisition of unenhanced images.


METHODS
We performed helical CT (with unenhanced, arterial, and portal phases) in 54 patients who had been treated with TACE for HCC. Image analysis was first performed with only those images obtained in the arterial and portal venous phases of helical CT. A second analysis was then performed with unenhanced images, arterial images, and portal venous images that focused on the additional value of unenhanced images. The value of additional unenhanced images was evaluated by means of interobserver agreement (kappa statistic) and receiver operating characteristic (ROC) analysis.


RESULTS
The two readers detected 128 and 129 lesions. Unenhanced images were valuable for 32 of 129 lesions (23 patients) for reader 1 and for 29 of 128 lesions (21 patients) for reader 2. Although there was no significant difference between biphasic CT alone and biphasic CT with unenhanced images, results of ROC analysis showed higher diagnostic performance with biphasic CT with unenhanced images than with biphasic CT alone for detecting viable tumor.


CONCLUSIONS
The study data demonstrate the diagnostic value of unenhanced images interpreted in conjunction with biphasic CT images for follow-up of patients who have previously been treated with TACE for HCC.
Kim
Hyo-Cheol
HC
Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
Kim
Ah Young
AY
Han
Joon Koo
JK
Chung
Jin Wook
JW
Lee
Jae Young
JY
Park
Jae Hyung
JH
Choi
Byung Ihn
BI
D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging*; D012372:ROC Curve; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed