Dynamic CT angiography for therapy evaluation after transarterial chemoembolization of hepatocellular carcinoma

Background Liver dynamic computed tomography (CT) is an established method for pre- and post-interventional evaluation of hepatocellular carcinoma. To date only the liver parenchyma and perfusion information of dynamic CT has been evaluated widely. Purpose To evaluate the vascular information contained in dynamic CT datasets. Material and Methods Dynamic CT performed one day after transarterial chemoembolization (60 mL of contrast medium, 6 mL/s, 40 s scan duration) were retrospectively evaluated. Conventional slice and angiographic maximum-intensity-projection reconstructions were calculated on a multi-modality post-processing platform. Datasets were evaluated for viable tumor, anatomy of the vasculature, and potential tumor-feeding vessels. The results were compared to digital subtraction angiography images. Results In total, 94 treated hepatocellular carcinoma nodules were evaluated (62 dynamic CT scans, 46 patients [34 men; mean age = 69 years]). Forty-six partially viable tumors were diagnosed after transarterial chemoembolization. In all of these, tumor-feeding vessels were found in dynamic CT. Seventeen suspected extra-hepatic tumor feeders were reported, of which 14 had not been found during previous transarterial chemoembolization. Conclusion Dynamic CT is useful in post-interventional imaging of hepatocellular carcinoma after transarterial chemoembolization due to its ability to detect residual viable tumor parts and to show previously unknown intra- and extra-hepatic tumor-feeding vessels.