title: Intraprocedural 3D Quantification of Lipiodol Deposition on Cone-Beam CT Predicts Tumor Response After Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma.
abstract: OBJECTIVE
  To evaluate whether intraprocedural 3D quantification of Lipiodol deposition on cone-beam computed tomography (CBCT) can predict tumor response on follow-up contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE).
  
  
  METHODS
  This IRB approved, retrospective analysis included 36 patients with 51 HCC target lesions, who underwent cTACE with CBCT. CE-MRI was acquired at baseline and 1 month after cTACE. Overall tumor volumes as well as intratumoral Lipiodol volumes on CBCT were measured and compared with the overall and necrotic (non-enhancing) tumor volumes on CE-MRI using the paired student's t test. Tumor response on CE-MRI was assessed using modified response evaluation criteria in solid tumors (mRECIST). A linear regression model was used to correlate tumor volumes, Lipiodol volumes, and the percentage of Lipiodol deposition on CBCT with the corresponding parameters on CE-MRI. Nonparametric spearman rank-order correlation and trend test were used to correlate the percentage of Lipiodol deposition in the tumor with tumor response.
  
  
  RESULTS
  A strong correlation between overall tumor volumes on CBCT and CE-MRI was observed (R(2) = 0.986). In addition, a strong correlation was obtained between the volume of Lipiodol deposition on CBCT and tumor necrosis (in cm(3)) on CE-MRI (R(2) = 0.960), and between the percentage of Lipiodol deposition and tumor necrosis (R(2) = 0.979). Importantly, the extent of Lipiodol deposition (in percentage of total tumor volume) correlated strongly with tumor response on CE-MRI (Spearman rho = 0.84, p < 0.001).
  
  
  CONCLUSIONS
  Intraprocedural 3D quantification of Lipiodol deposition on CBCT can be used to predict tumor response on follow-up CE-MRI.
authors.affiliation: Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, 21287, USA. wangzj301hospital@163.com.|Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China. wangzj301hospital@163.com.
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, 21287, USA. chenrongxin@zs-hospital.sh.cn.
authors.forename: Rongxin
authors.initials: R
authors.lastname: Chen
authors.affiliation: Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, 21287, USA. rafaelduran.md@gmail.com.
authors.forename: Rafael
authors.initials: R
authors.lastname: Duran
authors.affiliation: Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, 21287, USA. yanzhao211@163.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21287, USA. Gyenokya@jhsph.edu.
authors.forename: Gayane
authors.initials: G
authors.lastname: Yenokyan
authors.affiliation: Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, 21287, USA. j.chapiro@googlemail.com.
authors.forename: Julius
authors.initials: J
authors.lastname: Chapiro
authors.affiliation: Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, 21287, USA. rschern1@jhmi.edu.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Schernthaner
authors.affiliation: iXR, Philips Healthcare, Best, The Netherlands. alessandro.radaelli@philips.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Radaelli
authors.affiliation: Ultrasound Imaging and Interventions (UII), Philips Research North America, Briarcliff Manor, NY, USA. ming.lin@philips.com.
authors.forename: MingDe
authors.initials: M
authors.lastname: Lin
authors.affiliation: Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, 21287, USA. jfg@jhmi.edu.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Geschwind
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D054893:Cone-Beam Computed Tomography; D003287:Contrast Media; D004998:Ethiodized Oil / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D004998:Ethiodized Oil
keywords: Cone-beam computed tomography; Hepatocellular carcinoma; Quantitative; Three dimensional; Transcatheter arterial chemoembolization; Tumor response