Cone-Beam Computed Tomography Correlates with Conventional Helical Computed Tomography in Evaluation of Lipiodol Accumulation in HCC after Chemoembolization

Background & Aims The amount of drug-loaded lipiodol in an HCC tumor post-transarterial chemoembolization (TACE) correlates with the risk of local tumor recurrence. Lipiodol enhancement of a tumor on conventional CT, measured in Hounsfield units (HU), can predict tumor response. Here we investigate whether cone-beam CT (CBCT) can also be used to predict tumor response, providing the benefit of being able to optimize the patient's treatment plan intra-procedurally. Methods A total of 82 HCC nodules (82 patients), <= 5 cm in diameter, were treated with balloon-occluded TACE using miriplatin between December 2013 and November 2014. For each patient, both CBCT and conventional CT images were obtained post-TACE. The degree of correlation between CBCT and conventional CT was determined by comparing identical regions of interest for each imaging modality using pixel values. Results The pixel values from conventional CT and CBCT were highly correlated, with a Pearson correlation coefficient of 0.912 (p< 0.001). The location of the nodules within the liver did not affect the results; the correlation coefficient was 0.891 (p< 0.001) for the left lobe and 0.926 (p< 0.001) for the right lobe. The mean pixel value for conventional CT was 439 +/- 279 HU, and the mean pixel value for CBCT was 416 +/- 311 HU. Conclusions CBCT may be used as a substitute for conventional CT to quantitatively evaluate the amount of drug-loaded lipiodol within an HCC nodule and, hence, the efficacy of TACE treatment. The major benefit of using CBCT is the ability to predict the likelihood of local recurrence intra-procedurally, enabling subsequent treatment optimization.