Value of spectral detector computed tomography for the early assessment of technique efficacy after microwave ablation of hepatocellular carcinoma.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Carcinoma, Hepatocellular/*diagnostic imaging ; Liver Neoplasms/*diagnostic imaging ; Microwaves/*therapeutic use ; Radiofrequency Ablation/*methods ; Tomography, X-Ray Computed/*methods; Aged ; Algorithms ; Carcinoma, Hepatocellular/complications ; Carcinoma, Hepatocellular/surgery ; Female ; Humans ; Liver/diagnostic imaging ; Liver/pathology ; Liver/surgery ; Liver Cirrhosis/complications ; Liver Neoplasms/complications ; Liver Neoplasms/surgery ; Male ; Middle Aged ; Radiographic Image Interpretation, Computer-Assisted/methods ; Retrospective Studies ; Signal-To-Noise Ratio

Objectives: To investigate whether virtual monoenergetic images (VMI) and iodine maps derived from spectral detector computed tomography (SDCT) improve early assessment of technique efficacy in patients who underwent microwave ablation (MWA) for hepatocellular carcinoma (HCC) in liver cirrhosis.
Methods: This retrospective study comprised 39 patients with 49 HCC lesions treated with MWA. Biphasic SDCT was performed 7.7±4.0 days after ablation. Conventional images (CI), VMI and IM were reconstructed. Signal- and contrast-to-noise ratio (SNR, CNR) in the ablation zone (AZ), hyperemic rim (HR) and liver parenchyma were calculated using regions-of-interest analysis and compared between CI and VMI between 40-100 keV. Iodine concentration and perfusion ratio of HR and residual tumor (RT) were measured. Two readers evaluated subjective contrast of AZ and HR, technique efficacy (complete vs. incomplete ablation) and diagnostic confidence at determining technique efficacy.
Results: Attenuation of liver parenchyma, HR and RT, SNR of liver parenchyma and HR, CNR of AZ and HR were significantly higher in low-keV VMI compared to CI (all p<0.05). Iodine concentration and perfusion ratio differed significantly between HR and RT (all p<0.05; e.g. iodine concentration, 1.6±0.5 vs. 2.7±1.3 mg/ml). VMI50keV improved subjective AZ-to-liver contrast, HR-to-liver contrast, visualization of AZ margin and vessels adjacent to AZ compared to CI (all p<0.05). Diagnostic accuracy for detection of incomplete ablation was slightly higher in VMI50keV compared to CI (0.92 vs. 0.89), while diagnostic confidence was significantly higher in VMI50keV (p<0.05).
Conclusions: Spectral detector computed tomography derived low-keV virtual monoenergetic images and iodine maps provide superior early assessment of technique efficacy of MWA in HCC compared to CI.
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: David Maintz and Nils Große Hokamp received speaker’s honor from Philips Healthcare. Nils Große Hokamp, David Zopfs and Simon Lennartz received research support unrelated to this project. This does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors have declared that no competing interest exist.

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Date Created: 20210615 Date Completed: 20211115 Latest Revision: 20211115

20240104

PMC8205161

10.1371/journal.pone.0252678

34129650