Volume perfusion computed tomography (VPCT)—based evaluation of response to TACE using two different sized drug eluting beads in patients with nonresectable hepatocellular carcinoma: Impact on tumor and liver parenchymal vascularisation

• VPCT accurately measures the impact of TACE on liver tumor and hepatic parenchymal perfusion.
• The former proved not to be significantly dependent on particle size and epirubicin dose.
• Very early post-TACE monitoring has a good specificity and PPV with respect to mid-term prediction of tumor outcome.
• In the non-involved liver parenchyma, TACE is only temporarily causing a disbalance in the dual liver blood supply.

ObjectiveResponse monitoring of transarterial chemoembolization (TACE) with the help of volume perfusion computed tomography (VPCT) at day one post-TACE and analysis of TACE-impact on tumor and uninvolved liver parenchymal perfusion by using different particles sizes and epirubicin dose.Materials and methodsInstitutional review board approved this prospective study. VPCT was performed in the baseline, post-interventional (FU1; 24 h post-TACE) and at follow-up (FU2; median, 81 days) in 45 consecutive patients. 100–300 μm (n = 17) and 300–500 μm (n = 28) drug eluting beads (DEB) using an epirubicin dose of (< = 25 vs. >25) were administered. VPCT was performed for 40-s using 80 kV, 100/120 mAs, 64 × 0.6 mm collimation, 26 consecutive measurements, IV injection (50 ml iodinated contrast), flow rate (5 ml/s). Blood flow (BF), blood volume (BV) and k-trans were registered as average and max values in the tumor. Arterial liver perfusion (ALP), portal-venous perfusion (PVP) and the hepatic perfusion index (HPI) were registered both in tumor and non-involved liver parenchyma. Response to TACE was classified by VPCT as complete (CR), partial (PR) or no response (NR).ResultsA significant reduction of viable tumor tissue was found in all patients between baseline and FU1 (p < 0.001) being independent on particle size and epirubicin dose (p > 0.05). PPV/NPV/sensitivity/specificity of post-interventional VPCT (FU1) results for prediction of the mid-term tumor course (FU2) were 100%/70%/76%/100%. There was generally a significant increase of the ALP between baseline and FU1 in the liver parenchyma coupled by a significant subsequent decrease (normalization) of ALP and HPI between FU1 and FU2.ConclusionVPCT accurately measures impact of TACE on liver tumor and hepatic parenchymal perfusion. The former proved not to be significantly dependent on particle size and epirubicin dose. There was no persistent perfusion deficit in the liver after TACE.