title: Delayed-Phase Cone-Beam CT Improves Detectability of Intrahepatic Cholangiocarcinoma During Conventional Transarterial Chemoembolization.
abstract: OBJECTIVE
  To evaluate the detectability of intrahepatic cholangiocarcinoma (ICC) on dual-phase cone-beam CT (DPCBCT) during conventional transarterial chemoembolization (cTACE) compared to that of digital subtraction angiography (DSA) with respect to pre-procedure contrast-enhanced magnetic resonance imaging (CE-MRI) of the liver.
  
  
  METHODS
  This retrospective study included 17 consecutive patients (10 male, mean age 64) with ICC who underwent pre-procedure CE-MRI of the liver, and DSA and DPCBCT (early-arterial phase (EAP) and delayed-arterial phase (DAP)) just before cTACE. The visibility of each ICC lesion was graded by two radiologists on a three-rank scale (complete, partial, and none) on DPCBCT and DSA images, and then compared to pre-procedure CE-MRI.
  
  
  RESULTS
  Of 61 ICC lesions, only 45.9% were depicted by DSA, whereas EAP- and DAP-CBCT yielded a significantly higher detectability rate of 73.8% and 93.4%, respectively (p < 0.01). Out of the 33 lesions missed on DSA, 18 (54.5%) and 30 (90.9%) were revealed on EAP- and DAP-CBCT images, respectively. DSA depicted only one lesion that was missed by DPCBCT due to streak artifacts caused by a prosthetic mitral valve. DAP-CBCT identified significantly more lesions than EAP-CBCT (p < 0.01). Conversely, EAP-CBCT did not detect lesions missed by DAP-CBCT. For complete lesion visibility, DAP-CBCT yielded significantly higher detectability (78.7%) compared to EAP (31.1%) and DSA (21.3%) (p < 0.01).
  
  
  CONCLUSIONS
  DPCBCT, and especially the DAP-CBCT, significantly improved the detectability of ICC lesions during cTACE compared to DSA. We recommend the routine use of DAP-CBCT in patients with ICC for per-procedure detectability and treatment planning in the setting of TACE.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, 21287, USA.
authors.forename: Ruediger Egbert
authors.initials: RE
authors.lastname: Schernthaner
authors.forename: MingDe
authors.initials: M
authors.lastname: Lin
authors.forename: Rafael
authors.initials: R
authors.lastname: Duran
authors.forename: Julius
authors.initials: J
authors.lastname: Chapiro
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Wang
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Geschwind
mesh_terms: D015901:Angiography, Digital Subtraction; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging* / Q000628:therapy*; D015331:Cohort Studies; D054893:Cone-Beam Computed Tomography; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015641:Radiography, Interventional; D015203:Reproducibility of Results; D012189:Retrospective Studies