Feasibility of MDCT angiography for determination of tumor-feeding vessels in chemoembolization of hepatocellular carcinoma.
OBJECTIVE
To investigate the feasibility and accuracy of multidetector computed tomography (MDCT) angiography for assessment of subsegmental tumor-feeding vessels in transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC).


METHODS
A total of 23 patients with 36 HCCs who underwent TACE during a 14-month period were enrolled. All patients underwent 3-phase dynamic MDCT within a month before TACE. Arterial phase MDCT images were retrospectively reformatted and analyzed for determination of single subsegmental tumor-feeding vessel using maximum intensity projection (MIP) and volume-rendering technique (VRT). Two radiologists independently assessed and scored the MIP and VRT images using 4-grade visual scores (grade 1, no depiction of tumor-feeding vessel; grade 2, indeterminate tumor-feeding vessel; grade 3, probable tumor-feeding vessel; and grade 4, good depiction of tumor-feeding vessel). The weighted kappa test was used to determine interobserver variability, and Wilcoxon signed rank test was used to differentiate visual scores of each technique. Results of digital subtraction angiography were defined as the criterion standard; therefore, assessment of subsegmental tumor-feeding vessel using MIP or VRT was compared with digital subtraction angiography, and the accuracy of each technique was calculated.


RESULTS
Interobserver agreement (weighted kappa, 0.746 on VRT and 0.806 on MIP) was substantial to almost perfect. The visual scores for MIP (mean, 3.64 for reviewer 1 and 3.5 for reviewer 2) were higher than those for VRT (mean, 2.11 for reviewer 1 and 2.22 for reviewer 2; P = 0.000). The accuracy for assessing subsegmental tumor-feeding vessel was 22.2% for VRT and 77.8% for MIP.


CONCLUSIONS
Multidetector CT angiography using MIP showed good imaging quality and high accuracy for determination of subsegmental tumor-feeding vessels.
From the Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
Inwha
I
Kim
Dae Jung
DJ
Kim
Kyoung Ah
KA
Kim
Sang Wook
SW
Yoon
Jong Tae
JT
Lee
D000368:Aged; D000792:Angiography / Q000379:methods; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome