title: Application of gemstone spectral imaging for efficacy evaluation in hepatocellular carcinoma after transarterial chemoembolization.
abstract: OBJECTIVE
  To assess the value of gemstone spectral imaging (GSI) in efficacy evaluation in hepatocellular cancer (HCC) after transcatheter arterial chemoembolization (TACE) treatment.
  
  
  METHODS
  Thirty patients with HCC underwent GSI, including nonenhanced, arterial, portalvenous and delayed phase scans, after TACE treatment. Arterial phase images were acquired with GSI for reconstruction of virtual nonenhanced images and color overlay images. Digital subtraction angiography (DSA) was performed in all these patients. Two blinded and independent readers evaluated the data in two reading sessions; standard nonenhanced, arterial, portalvenous, and delayed phase images were read in session A, and the optimal monochromatic images, iodine/water based images and spectrum features were read in session B. Sensitivity and specificity were calculated with the DSA data as the reference standard. The sensitivity and specificity were compared using the χ (2) test.
  
  
  RESULTS
  DSA revealed 154 lesions in 30 patients, and 100 of them had blood supply. Overall sensitivity and specificity were 72% (72/100) and 77.8% (42/54) for session A, and 97% (97/100) and 94.4% (51/54) for session B, respectively. The sensitivity and specificity of the two reading sessions were significantly different (χ (2) = 23.04, χ (2) = 7.11, P < 0.05).
  
  
  CONCLUSIONS
  Compared with conventional CT, GSI could significantly improve the detection of small and multiple lesions without increasing the radiation dose. Based on spectrum features, GSI could assess tumor homogeneity and more accurately identify residual tumors and recurrent or metastatic lesions during efficacy evaluation and follow-up in HCC after TACE treatment.
authors.affiliation: Qi-Yu Liu, Chuan-Dong He, Ying Zhou, Dan Huang, Hua Lin, Zhong Wang, Dong Wang, Jin-Qiu Wang, Li-Ping Liao, Department of Radiology, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China.
authors.forename: Qi-Yu
authors.initials: QY
authors.lastname: Liu
authors.affiliation: Qi-Yu Liu, Chuan-Dong He, Ying Zhou, Dan Huang, Hua Lin, Zhong Wang, Dong Wang, Jin-Qiu Wang, Li-Ping Liao, Department of Radiology, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China.
authors.forename: Chuan-Dong
authors.initials: CD
authors.lastname: He
authors.affiliation: Qi-Yu Liu, Chuan-Dong He, Ying Zhou, Dan Huang, Hua Lin, Zhong Wang, Dong Wang, Jin-Qiu Wang, Li-Ping Liao, Department of Radiology, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Qi-Yu Liu, Chuan-Dong He, Ying Zhou, Dan Huang, Hua Lin, Zhong Wang, Dong Wang, Jin-Qiu Wang, Li-Ping Liao, Department of Radiology, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Huang
authors.affiliation: Qi-Yu Liu, Chuan-Dong He, Ying Zhou, Dan Huang, Hua Lin, Zhong Wang, Dong Wang, Jin-Qiu Wang, Li-Ping Liao, Department of Radiology, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Lin
authors.affiliation: Qi-Yu Liu, Chuan-Dong He, Ying Zhou, Dan Huang, Hua Lin, Zhong Wang, Dong Wang, Jin-Qiu Wang, Li-Ping Liao, Department of Radiology, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China.
authors.forename: Zhong
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Qi-Yu Liu, Chuan-Dong He, Ying Zhou, Dan Huang, Hua Lin, Zhong Wang, Dong Wang, Jin-Qiu Wang, Li-Ping Liao, Department of Radiology, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Wang
authors.affiliation: Qi-Yu Liu, Chuan-Dong He, Ying Zhou, Dan Huang, Hua Lin, Zhong Wang, Dong Wang, Jin-Qiu Wang, Li-Ping Liao, Department of Radiology, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China.
authors.forename: Jin-Qiu
authors.initials: JQ
authors.lastname: Wang
authors.affiliation: Qi-Yu Liu, Chuan-Dong He, Ying Zhou, Dan Huang, Hua Lin, Zhong Wang, Dong Wang, Jin-Qiu Wang, Li-Ping Liao, Department of Radiology, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China.
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Liao
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D016009:Chi-Square Distribution; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D007472:Iohexol
keywords: Digital subtraction angiography; Efficacy evaluation; Gemstone spectral imaging; Hepatocellular carcinoma; Transcatheter arterial chemoembolization