title: Improved Visibility of Metastatic Disease in the Liver During Intra-Arterial Therapy Using Delayed Arterial Phase Cone-Beam CT.
abstract: OBJECTIVE
  To compare the visibility of liver metastases on dual-phase cone-beam CT (DP-CBCT) and digital subtraction angiography (DSA), with reference to preinterventional contrast-enhanced magnetic resonance imaging (CE-MRI) of the liver.
  
  
  METHODS
  This IRB-approved, retrospective study included 28 patients with neuroendocrine (NELM), colorectal (CRCLM), or sarcoma (SLM) liver metastases who underwent DP-CBCT during intra-arterial therapy (IAT) between 01/2010 and 10/2014. DP-CBCT was acquired after a single contrast agent injection in the tumor-feeding arteries at early and delayed arterial phases (EAP and DAP). The visibility of each lesion was graded by two radiologists in consensus on a three-rank scale (complete, partial, none) on DP-CBCT and DSA images using CE-MRI as reference.
  
  
  RESULTS
  47 NELM, 43 CRCLM, and 16 SLM were included. On DSA 85.1, 44.1, and 37.5 % of NELM, CRCLM, and SLM, were at least partially depicted, respectively. EAP-CBCT yielded significantly higher sensitivities of 88.3 and 87.5 % for CRCLM and SLM, respectively (p < 0.01), but not for NELM (89.4 %; p = 1.0). On DAP-CBCT all NELM, CRCLM, and SLM were visible (p < 0.001). Complete depiction was achieved on DSA for 59.6, 16.3, and 18.8 % of NELM, CRCLM, and SLM, respectively. The complete depiction rate on EAP-CBCT was significantly higher for CRCLM (46.5 %; p < 0.001), lower for NELM (40.4 %; p = 0.592), and similar for SLM (25 %, p = 0.399). On DAP-CBCT however, the highest rates of complete depiction were found-NELM (97.8 %; p = 0.008), CRCLM (95.3 %; p = 0.008), and SLM (100 %; p < 0.001).
  
  
  CONCLUSIONS
  DAP-CBCT substantially improved the visibility of liver metastases during IAT. Future studies need to evaluate the clinical impact.
authors.affiliation: Section of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.|Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Ruediger E
authors.initials: RE
authors.lastname: Schernthaner
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Reham R
authors.initials: RR
authors.lastname: Haroun
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Duran
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Sahu
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Sohn
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Julius
authors.initials: J
authors.lastname: Chapiro
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Boris
authors.initials: B
authors.lastname: Gorodetski
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Florian
authors.initials: F
authors.lastname: Fleckenstein
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Susanne
authors.initials: S
authors.lastname: Smolka
authors.affiliation: Image-Guided Therapy Systems, Philips Healthcare, Best, The Netherlands.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Radaelli
authors.affiliation: Image-Guided Therapy Systems, Philips Healthcare, Best, The Netherlands.
authors.forename: Imramsjah Martijn
authors.initials: IM
authors.lastname: van der Bom
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.|U/S Imaging and Interventions, Philips Research North America, Cambridge, MA, USA.
authors.forename: MingDe
authors.initials: M
authors.lastname: Lin
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA. jeff.geschwind@yale.edu.
authors.forename: Jean Francois
authors.initials: JF
authors.lastname: Geschwind
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction / Q000379:methods; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging* / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media
keywords: Cancer; Imaging; Interventional oncology; Liver/hepatic; Radio-embolization/radio-embolisation; Transarterial chemoembolization/embolisation (TACE)