title: Quantitative assessment of angiographic perfusion reduction using color-coded digital subtraction angiography during transarterial chemoembolization.
abstract: OBJECTIVE
  The aim of this study was to develop a quantitative measurement of perfusion reduction using color-coded digital subtraction angiography (ccDSA) to monitor intra-procedural arterial stasis during TACE.
  
  
  METHODS
  A total number of 35 patients with hepatocellular carcinoma who had undergone TACE were enrolled into the study. Pre- and post-two-dimensional digital subtraction angiography scans were conducted with same protocol and post-processed with ccDSA prototype software. Time-contrast-intensity (CI[t]) curve was obtained by region-of-interest (ROI) measurement on the generated ccDSA image. Quantitative 2D perfusion parameters time to peak, area under the curve (AUC), maximum upslope, and contrast intensity peak (CI-Peak) derived from the ROI-based CI[t] curve for pre- and post-TACE were evaluated to assess the reduction of antegrade blood flow and tumor blush. Relationships between 2D perfusion parameters, subjective angiographic chemoembolization endpoint (SACE) scale, and clinical outcomes were analyzed.
  
  
  RESULTS
  Area normalized AUC and CI-Peak revealed significant reduction after the TACE (P < 0.0001). AUCnorm decreased from pre-procedure of 0.867 ± 0.242 to 0.421 ± 0.171 (P < 0.001) after completion of TACE. CI-Peaknorm was 0.739 ± 0.221 before TACE and 0.421 ± 0.174 (P < 0.001) after TACE. Tumor blood supply time slowed down obviously after embolization. A perfusion reduction either from AUCnorm or CI-Peaknorm ranging from 30% to 40% was associated with SACE level III and a reduction ranging from 60% to 70% was equivalent to SACE level IV. For intermediate reduction (SACE level III), better tumor response was found after TACE rather than a higher reduction (SACE level IV).
  
  
  CONCLUSIONS
  ccDSA application provides an objective approach to quantify the perfusion reduction and subjectively evaluate the arterial stasis of antegrade blood flow and tumor blush caused by TACE.
authors.affiliation: Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd. 160, Shanghai, 200127, China.
authors.forename: Ji
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd. 160, Shanghai, 200127, China.
authors.forename: Jie-Jun
authors.initials: JJ
authors.lastname: Cheng
authors.affiliation: Siemens Limited China, Shanghai Branch, Zhouzhu Rd. 278, Shanghai, 201318, China.
authors.forename: Kai-Yi
authors.initials: KY
authors.lastname: Huang
authors.affiliation: Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd. 160, Shanghai, 200127, China.
authors.forename: Zhi-Guo
authors.initials: ZG
authors.lastname: Zhuang
authors.affiliation: Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd. 160, Shanghai, 200127, China.
authors.forename: Xue-Bin
authors.initials: XB
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd. 160, Shanghai, 200127, China.
authors.forename: Jia-Chang
authors.initials: JC
authors.lastname: Chi
authors.affiliation: Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd. 160, Shanghai, 200127, China.
authors.forename: Xiao-Lan
authors.initials: XL
authors.lastname: Hua
authors.affiliation: Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd. 160, Shanghai, 200127, China. jianr_xu@163.com.
authors.forename: Jian-Rong
authors.initials: JR
authors.lastname: Xu
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Arterial stasis; Color-coded DSA; Hepatic artery; Perfusion reduction; TACE