title: The Role of Cone-Beam CT in Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  To review available evidence for use of cone-beam CT during transcatheter arterial chemoembolization in hepatocellular carcinoma (HCC) for detection of tumor and feeding arteries.
  
  
  METHODS
  Literature searches were conducted from inception to May 15, 2016, in PubMed (MEDLINE), Scopus, and Cochrane Central Register of Controlled Trials. Searches included "cone beam," "CBCT," "C-arm," "CACT," "cone-beam CT," "volumetric CT," "volume computed tomography," "volume CT," AND "liver," "hepatic*," "hepatoc*." Studies that involved adults with HCC specifically and treated with transcatheter arterial chemoembolization that used cone-beam CT were included.
  
  
  RESULTS
  Inclusion criteria were met by 18 studies. Pooled sensitivity of cone-beam CT for detecting tumor was 90% (95% confidence interval [CI], 82%-95%), whereas pooled sensitivity of digital subtraction angiography (DSA) for tumor detection was 67% (95% CI, 51%-80%). Pooled sensitivity of cone-beam CT for detecting tumor feeding arteries was 93% (95% CI, 91%-95%), whereas pooled sensitivity of DSA was 55% (95% CI, 36%-74%).
  
  
  CONCLUSIONS
  Cone-beam CT can significantly increase detection of tumors and tumor feeding arteries during transcatheter arterial chemoembolization. Cone-beam CT should be considered as an adjunct tool to DSA during transcatheter arterial chemoembolization treatments of HCC.
authors.affiliation: Siemens Medical Solutions USA, Inc, Malvern, Pennsylvania.
authors.forename: Leland
authors.initials: L
authors.lastname: Pung
authors.affiliation: Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H3630, Stanford, CA94305-5642.
authors.forename: Moiz
authors.initials: M
authors.lastname: Ahmad
authors.affiliation: Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H3630, Stanford, CA94305-5642.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Mueller
authors.affiliation: Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H3630, Stanford, CA94305-5642.
authors.forename: Jarrett
authors.initials: J
authors.lastname: Rosenberg
authors.affiliation: Lane Medical Library, Stanford University, Stanford, California.
authors.forename: Christopher
authors.initials: C
authors.lastname: Stave
authors.affiliation: Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H3630, Stanford, CA94305-5642; Stanford Health Care, Stanford, California.
authors.forename: Gloria L
authors.initials: GL
authors.lastname: Hwang
authors.affiliation: Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H3630, Stanford, CA94305-5642; Stanford Health Care, Stanford, California.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Shah
authors.affiliation: Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H3630, Stanford, CA94305-5642; Stanford Health Care, Stanford, California. Electronic address: kothary@stanford.edu.
authors.forename: Nishita
authors.initials: N
authors.lastname: Kothary
mesh_terms: D015901:Angiography, Digital Subtraction; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000379:methods*; D054893:Cone-Beam Computed Tomography; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D011237:Predictive Value of Tests; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D016896:Treatment Outcome