Cone-Beam CT–Guided Chemoembolization in Patients with Complete Response after Previous Chemoembolization but Subsequent Elevated α-Fetoprotein without Overt Hepatocellular Carcinoma

Tunyarat Wattanasatesiri, Hyo Cheol Kim, Jin Woo Choi, Jeong Hoon Lee, Ijin Joo, Saebeom Hur, Myungsu Lee, Hwan Jun Jae, Jin Wook Chung

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Abstract

Purpose: To evaluate the performance of C-arm computed tomography (CT)–guided chemoembolization in patients with hepatocellular carcinoma (HCC) with serum α-fetoprotein (AFP) level > 20 ng/mL but with no overt tumor on CT and/or magnetic resonance imaging. Materials and Methods: From May 2010 to May 2017, 34 patients with HCC (25 men and 9 women; mean age, 59.7 y) who had elevated serum AFP levels (> 20 ng/mL) but no overt tumor on 6-mo imaging studies and had shown complete response (CR) after previous chemoembolization underwent C-arm CT–guided conventional chemoembolization. Three radiologists retrospectively reviewed the imaging studies (preprocedural images, C-arm CT scans, and follow-up images) in consensus, and clinical data including AFP levels were retrospectively obtained. Tumor detection by C-arm CT and treatment response after chemoembolization were assessed. Results: HCC was imaged at the time of chemoembolization in 24 of 34 patients (70.6%). C-arm CT detected tumors in 25 patients (73.5%); 23 detections were true positives, 2 were false positives, and 1 was a false negative (diaphragm metastasis). Among the 23 patients with true-positive results, the first follow-up enhanced imaging studies showed CR (n = 17), partial response (n = 1), progressive disease (n = 4), and indeterminate status (n = 1; treated by percutaneous ethanol injection). Conclusions: C-arm CT–guided chemoembolization may help to detect and treat recurrent tumors in patients who have shown CR after previous chemoembolization but subsequently, during follow-up surveillance, had serum AFP levels > 20 ng/mL without an overt tumor evident on imaging studies.

Original languageEnglish
Pages (from-to)1273-1280
Number of pages8
JournalJournal of Vascular and Interventional Radiology
Volume30
Issue number8
DOIs
StatePublished - 1 Aug 2019

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Fetal Proteins
Hepatocellular Carcinoma
Tomography
Neoplasms
Serum
Diaphragm
Ethanol
Magnetic Resonance Imaging
Neoplasm Metastasis
Injections

Cite this

@article{eba66daf0586433d8f397c0d0b5264a5,
title = "Cone-Beam CT–Guided Chemoembolization in Patients with Complete Response after Previous Chemoembolization but Subsequent Elevated α-Fetoprotein without Overt Hepatocellular Carcinoma",
abstract = "Purpose: To evaluate the performance of C-arm computed tomography (CT)–guided chemoembolization in patients with hepatocellular carcinoma (HCC) with serum α-fetoprotein (AFP) level > 20 ng/mL but with no overt tumor on CT and/or magnetic resonance imaging. Materials and Methods: From May 2010 to May 2017, 34 patients with HCC (25 men and 9 women; mean age, 59.7 y) who had elevated serum AFP levels (> 20 ng/mL) but no overt tumor on 6-mo imaging studies and had shown complete response (CR) after previous chemoembolization underwent C-arm CT–guided conventional chemoembolization. Three radiologists retrospectively reviewed the imaging studies (preprocedural images, C-arm CT scans, and follow-up images) in consensus, and clinical data including AFP levels were retrospectively obtained. Tumor detection by C-arm CT and treatment response after chemoembolization were assessed. Results: HCC was imaged at the time of chemoembolization in 24 of 34 patients (70.6{\%}). C-arm CT detected tumors in 25 patients (73.5{\%}); 23 detections were true positives, 2 were false positives, and 1 was a false negative (diaphragm metastasis). Among the 23 patients with true-positive results, the first follow-up enhanced imaging studies showed CR (n = 17), partial response (n = 1), progressive disease (n = 4), and indeterminate status (n = 1; treated by percutaneous ethanol injection). Conclusions: C-arm CT–guided chemoembolization may help to detect and treat recurrent tumors in patients who have shown CR after previous chemoembolization but subsequently, during follow-up surveillance, had serum AFP levels > 20 ng/mL without an overt tumor evident on imaging studies.",
author = "Tunyarat Wattanasatesiri and Kim, {Hyo Cheol} and Choi, {Jin Woo} and Lee, {Jeong Hoon} and Ijin Joo and Saebeom Hur and Myungsu Lee and Jae, {Hwan Jun} and Chung, {Jin Wook}",
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journal = "Journal of Vascular and Interventional Radiology",
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Cone-Beam CT–Guided Chemoembolization in Patients with Complete Response after Previous Chemoembolization but Subsequent Elevated α-Fetoprotein without Overt Hepatocellular Carcinoma. / Wattanasatesiri, Tunyarat; Kim, Hyo Cheol; Choi, Jin Woo; Lee, Jeong Hoon; Joo, Ijin; Hur, Saebeom; Lee, Myungsu; Jae, Hwan Jun; Chung, Jin Wook.

In: Journal of Vascular and Interventional Radiology, Vol. 30, No. 8, 01.08.2019, p. 1273-1280.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Cone-Beam CT–Guided Chemoembolization in Patients with Complete Response after Previous Chemoembolization but Subsequent Elevated α-Fetoprotein without Overt Hepatocellular Carcinoma

AU - Wattanasatesiri, Tunyarat

AU - Kim, Hyo Cheol

AU - Choi, Jin Woo

AU - Lee, Jeong Hoon

AU - Joo, Ijin

AU - Hur, Saebeom

AU - Lee, Myungsu

AU - Jae, Hwan Jun

AU - Chung, Jin Wook

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Purpose: To evaluate the performance of C-arm computed tomography (CT)–guided chemoembolization in patients with hepatocellular carcinoma (HCC) with serum α-fetoprotein (AFP) level > 20 ng/mL but with no overt tumor on CT and/or magnetic resonance imaging. Materials and Methods: From May 2010 to May 2017, 34 patients with HCC (25 men and 9 women; mean age, 59.7 y) who had elevated serum AFP levels (> 20 ng/mL) but no overt tumor on 6-mo imaging studies and had shown complete response (CR) after previous chemoembolization underwent C-arm CT–guided conventional chemoembolization. Three radiologists retrospectively reviewed the imaging studies (preprocedural images, C-arm CT scans, and follow-up images) in consensus, and clinical data including AFP levels were retrospectively obtained. Tumor detection by C-arm CT and treatment response after chemoembolization were assessed. Results: HCC was imaged at the time of chemoembolization in 24 of 34 patients (70.6%). C-arm CT detected tumors in 25 patients (73.5%); 23 detections were true positives, 2 were false positives, and 1 was a false negative (diaphragm metastasis). Among the 23 patients with true-positive results, the first follow-up enhanced imaging studies showed CR (n = 17), partial response (n = 1), progressive disease (n = 4), and indeterminate status (n = 1; treated by percutaneous ethanol injection). Conclusions: C-arm CT–guided chemoembolization may help to detect and treat recurrent tumors in patients who have shown CR after previous chemoembolization but subsequently, during follow-up surveillance, had serum AFP levels > 20 ng/mL without an overt tumor evident on imaging studies.

AB - Purpose: To evaluate the performance of C-arm computed tomography (CT)–guided chemoembolization in patients with hepatocellular carcinoma (HCC) with serum α-fetoprotein (AFP) level > 20 ng/mL but with no overt tumor on CT and/or magnetic resonance imaging. Materials and Methods: From May 2010 to May 2017, 34 patients with HCC (25 men and 9 women; mean age, 59.7 y) who had elevated serum AFP levels (> 20 ng/mL) but no overt tumor on 6-mo imaging studies and had shown complete response (CR) after previous chemoembolization underwent C-arm CT–guided conventional chemoembolization. Three radiologists retrospectively reviewed the imaging studies (preprocedural images, C-arm CT scans, and follow-up images) in consensus, and clinical data including AFP levels were retrospectively obtained. Tumor detection by C-arm CT and treatment response after chemoembolization were assessed. Results: HCC was imaged at the time of chemoembolization in 24 of 34 patients (70.6%). C-arm CT detected tumors in 25 patients (73.5%); 23 detections were true positives, 2 were false positives, and 1 was a false negative (diaphragm metastasis). Among the 23 patients with true-positive results, the first follow-up enhanced imaging studies showed CR (n = 17), partial response (n = 1), progressive disease (n = 4), and indeterminate status (n = 1; treated by percutaneous ethanol injection). Conclusions: C-arm CT–guided chemoembolization may help to detect and treat recurrent tumors in patients who have shown CR after previous chemoembolization but subsequently, during follow-up surveillance, had serum AFP levels > 20 ng/mL without an overt tumor evident on imaging studies.

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U2 - 10.1016/j.jvir.2019.03.020

DO - 10.1016/j.jvir.2019.03.020

M3 - Article

VL - 30

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EP - 1280

JO - Journal of Vascular and Interventional Radiology

JF - Journal of Vascular and Interventional Radiology

SN - 1051-0443

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