Characterization of Liver Metastases During Catheter-Directed Liver Interventions: A Comparison between Dual Phase Cone-Beam Computed Tomography and Conventional Contrast-Enhanced Computed Tomography

Geert Maleux; Maria-Louisa Izamis; Cedric Werbrouck; Alessandro Radaelli; Hans Prenen; Eric Van Cutsem; Vincent Vandecaveye

doi:10.5334/jbsr.2052

Characterization of Liver Metastases During Catheter-Directed Liver Interventions: A Comparison between Dual Phase Cone-Beam Computed Tomography and Conventional Contrast-Enhanced Computed Tomography

J Belg Soc Radiol. 2020 Jul 8;104(1):41. doi: 10.5334/jbsr.2052.

Authors

Geert Maleux^{1

2}, Maria-Louisa Izamis³, Cedric Werbrouck^{1

2}, Alessandro Radaelli³, Hans Prenen⁴, Eric Van Cutsem⁴, Vincent Vandecaveye^{1

2}

Affiliations

¹ Department of Radiology, University Hospitals Leuven, BE.
² Department of Imaging and Pathology, KU Leuven, Leuven, BE.
³ Philips Healthcare, NL.
⁴ Department of Digestive Oncology, University Hospitals Leuven, Leuven, BE.

Abstract

Objectives: To compare the diagnostic performance of intra-arterial dual phase cone-beam computed tomography (DP-CBCT) with contrast-enhanced computed tomography (CE-CT) when characterizing tumor burden in patients with metastatic liver cancer.

Materials and methods: This retrospective study included 29 patients with colorectal (n =10), breast (n = 9) and neuroendocrine (n = 10) liver metastases, referred for catheter-directed treatment. Tumor type, number, maximum size, and appearance were assessed. Paired-sample t-tests compared image quality, tumor numbers, and diameters between imaging modalities.

Results: Image quality was not different between DP-CBCT and CE-CT (p = 0.9). In 18 patients (62%) DP-CBCT and CE-CT showed diffuse, uncountable metastases in the liver. Of the remaining 11 patients, DP-CBCT identified two patients with diffuse tumors that appeared as a sum of 17 distinct metastases on CE-CT. In the remaining nine patients a total of 102 metastases were found using both DP-CBCT and CE-CT. Tumor detection accuracy was 98% in DP-CBCT and 67% in CE-CT (p = 0.025). Metastases were larger in diameter on DP-CBCT: colorectal: 57 +/- 9.5 mm versus 43 +/- 8.3 mm (p = 0.02); breast: 57 +/- 10 mm versus 43 +/- 8.5 mm (p = 0.03) and neuroendocrine: 56 +/- 6.3 mm versus 51 +/- 5.8 mm (p = 0.01). Rim enhancement appeared in 100% of patients with colorectal and 89% of patients with breast metastases on DP-CBCT, but was variable on CE-CT. Neuroendocrine tumors had variable rim enhancement within the same patient and across imaging modalities.

Conclusions: DP-CBCT of the liver may demonstrate larger metastatic tumor burden and lesion size with a variable contrast enhancement compared to CE-CT.

Keywords: cone beam computed tomography; diagnostic efficacy; liver; metastases; radioembolization.