title: Semiquantitative prediction of early response of conventional transcatheter arterial chemoembolization for hepatocellular carcinoma using postprocedural plain cone-beam computed tomography.
abstract: OBJECTIVE
  To investigate whether plain cone-beam computed tomography (CT) immediately after conventional transcatheter arterial chemoembolization (c-TACE) can help to predict tumor response semiquantitatively in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  Analysis was carried out retrospectively on 262 targeted HCCs in 169 patients treated with c-TACE. Dynamic CT was performed at baseline and 1-4 months after c-TACE. Receiver-operating characteristic curve analysis was undertaken to evaluate whether voxel values of cone-beam CT could predict a complete response and to identify the cut-off value. Final tumor response assessment and early prediction using the retention pattern of iodized oil, the cut-off value of the density, and the combination of the cut-off density value and retention pattern of iodized oil in HCCs on postprocedural cone-beam CT were compared.
  
  
  RESULTS
  Complete response was obtained in 72.9% of lesions. According to the pattern of iodized oil uptake, the sensitivity, specificity, and accuracy for predicting complete response were 85.9%, 70.4%, and 81.7%, respectively by excellent uptake on cone-beam CT. The area under the curve was 0.86 with the optimal cut-off at a voxel value of 200.13. According to not only the density but also the homogeneity of iodized oil retention, the sensitivity, specificity, and accuracy values for predicting complete response were 86.4%, 95.8%, and 88.9%, respectively. The predictive accuracy was significantly better than that of the pattern of iodized oil retention only (P = 0.019).
  
  
  CONCLUSIONS
  The combination of density and visual estimate of homogeneity is superior to either alone in predicting tumor response of c-TACE in HCC patients.
authors.affiliation: Department of Gastroenterology and Hepatology.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Minami
authors.affiliation: Department of Gastroenterology and Hepatology.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Takita
authors.affiliation: Department of Radiology, Kinki University Faculty of Medicine, Osaka, Japan.
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Tsurusaki
authors.affiliation: Department of Radiology, Kinki University Faculty of Medicine, Osaka, Japan.
authors.forename: Yukinobu
authors.initials: Y
authors.lastname: Yagyu
authors.affiliation: Department of Gastroenterology and Hepatology.
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Ueshima
authors.affiliation: Department of Radiology, Kinki University Faculty of Medicine, Osaka, Japan.
authors.forename: Takamichi
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Gastroenterology and Hepatology.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
keywords: conventional transcatheter arterial chemoembolization; hepatocellular carcinoma; iodized oil; postprocedural plain cone-beam CT; voxel gray value