title: Lipiodol retention pattern assessed by cone beam computed tomography during conventional transarterial chemoembolization of hepatocellular carcinoma: accuracy and correlation with response.
abstract: BACKGROUND
  To investigate accuracy of intraprocedural cone beam computed tomography (CBCT) compared to fluoroscopy for detection of lipiodol retention pattern during conventional transarterial chemoembolization (cTACE) of hepatocellular carcinoma (HCC) and its correlation with short-term response.
  
  
  METHODS
  Between September 2013 and July 2014, 29 patients with HCC underwent chemoembolization of 51 tumors (mean diameter 28.1 mm, range 10.0-136.3 mm). Lipiodol retention pattern was assessed by CBCT at the endpoint of cTACE compared by fluoroscopy. Depending on the pattern of tumor covered by lipiodol three classes were defined: complete (more than 90 %, no peripheral defects), moderate (50-90 %, some with or without peripheral defects), and poor (less than 50 %). Tumor response was assessed by modified Response Evaluation Criteria in Solid Tumors (mRECIST) based on follow-up contrast enhanced (CE) computed tomography (CT) or magnetic resonance imaging (MRI) obtained 4-6 weeks post-cTACE. Correlations between lipiodol retention patterns on CBCT and fluoroscopy as well as tumor response were assessed using multivariate logistic regression.
  
  
  RESULTS
  Of 51 hepatic tumors, 40 (78.4 %) had complete response (CR); 8 (15.7 %) had partial response (PR); 1 (2.0 %) had stable disease (SD); and 2 (3.9 %) had progressive disease (PD). The degree of lipiodol retention scored excellent, moderate, and poor, in fluoroscopic images vs CBCT images were 23 (45.1 %) vs 39 (76.5 %), 19 (37.3 %) vs 11 (21.6 %), and 9 (17.6 %) vs 1 (2.0 %), respectively. Lipiodol retention assessment with CBCT (Az= 0.75) is more accurate than fluoroscopy (Az= 0.54) in predicting target tumor response. Other than lipiodol retention pattern assessed with CBCT (p = 0.01), tumor size (p = 0.04) is an independent predictors of CR.
  
  
  CONCLUSIONS
  CBCT is more accurate than fluoroscopy in classification of lipiodol retention pattern in HCC tumors at the time of cTACE. CBCT could be used as a reliable intra precedural monitoring modality of cTACE.
authors.affiliation: Department of Interventional Radiology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, 100142, China.
authors.forename: Jungang
authors.initials: J
authors.lastname: Hu
authors.affiliation: Department of Radiology, Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, 10021, NY, USA.
authors.forename: Majid
authors.initials: M
authors.lastname: Maybody
authors.affiliation: Department of Interventional Radiology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, 100142, China.
authors.forename: Guang
authors.initials: G
authors.lastname: Cao
authors.affiliation: Department of Epidemiology and Biostatistics, Peking University Sixth Hospital, Beijing, 100191, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Interventional Radiology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, 100142, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Interventional Radiology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, 100142, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Department of Interventional Radiology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, 100142, China.
authors.forename: Renjie
authors.initials: R
authors.lastname: Yang
authors.affiliation: Department of Interventional Radiology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, 100142, China. xiaodongw75@yahoo.com.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D054893:Cone-Beam Computed Tomography; D004998:Ethiodized Oil / Q000493:pharmacokinetics* / Q000627:therapeutic use; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D008297:Male; D008875:Middle Aged
chemical_list: D000970:Antineoplastic Agents; D004998:Ethiodized Oil
keywords: Cone beam computed tomography; Fluoroscopy; Hepatocellular carcinoma; Liver; Transarterial chemoembolization