Measuring the density of iodine depositions: Detecting an invisible residual tumor after conventional transarterial chemoembolization - Fig 6

A: ROC curve of enhancement scores of patients with and without a residual tumor; B: ROC curve of relative enhancement scores (enhancement score / non-contrast density) of patients with and without a residual tumor. The differentiation between patients with and without a residual tumor was slightly better using enhancement scores (area under the curve = 0.80; p p < 0.05).</p

A: Volume measurement of iodine deposition in patients with a (residual tumor) and without a residual tumor (no residual tumor) in the arterial (art) and venous (ven) phases represented as the mean + standard error of the mean (SEM).

The volume of iodine depositions did not differ significantly (ns = not significant) between the arterial and venous phases of patients with a residual tumor (arterial volume: 12.28 ml ± 3.06; venous volume: 12.25 ml ± 2.99) and those without a residual tumor (arterial volume: 8.44 ml ± 1.85; venous volume: 8.13 ml ± 1.79).</p

Enhancement scores (mean + SEM) of patients with and without a residual tumor.

The enhancement score of patients without a residual tumor (-13.97 ± 2.88) was significantly lower (p < 0.01) compared to patients with a residual tumor (1.41 ± 3.59).</p

Baseline characteristics of all patients.

Baseline characteristics of all patients.</p

Comparison of enhancement scores relative to non-contrast densities (mean+SEM).

Relative enhancement scores (enhancement score / non-contrast density) in patients with three-phasic computed tomographies (n = 25) did not lead to a better differentiation between patients with and without a residual tumor (-0.09 ± 0.02, n = 14 and -0.01 ± 0.02, n = 11; p < 0.05).</p

Measuring the density of iodine depositions: Detecting an invisible residual tumor after conventional transarterial chemoembolization - Fig 5

A: Computed tomography in the arterial phase of a patient with a hidden residual tumor; B: DSA of the same patient unveiling the hidden residual tumor. Measuring the density of iodine depositions in this patient, an enhancement score of 17.50 clearly revealed a hidden residual tumor beyond the iodine depositions that was diagnosed afterward in the DSA.</p

Example measurement.

Measurement of the density and area of iodine depositions using a polygon ROI in Syngo.via. The polygon ROI was plotted around the iodine depositions of HCC, previously treated with cTACE in a superselective manner.</p

47 year old male patient.

<p>During the initial DSA the gastroduodenal artery and right gastric artery were occluded. However, a small branch to the small bowel arising from the right hepatic artery was missed (Fig 3a) resulting in an extrahepatic 99mTc-HSA deposition in the small bowel wall (Fig 3b). During repeated angiography the microcatheter was positioned in a more distal part of the right hepatic artery (Fig 3c). Subsequent SPECT/CT did not reveal any extrahepatic tracer accumulation (Fig 3d).</p

41 year-old female patient.

<p>Initial DSA did not reveal any shunt vessels (Fig 2a). However, 99mTc-HSA scan revealed extrahepatic tracer uptake at the gastroduodenal junction (Fig 2b). A shunt vessel was identified during repeated DSA and occluded (Fig 2c) and no extrahepatic 99mTc-HSA deposition was seen anymore (Fig 2d).</p

65 year-old male patient.

<p>The right gastric artery (Fig 1a; arrow) was identified and coilembolized (Fig 1b). SPECT/CT (Fig 1c) did not reveal extrahepatic tracer deposition.</p