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Quantitative assessment of angiographic perfusion reduction using color-coded digital subtraction angiography during transarterial chemoembolization

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Abstract

Purpose

The aim of this study was to develop a quantitative measurement of perfusion reduction using color-coded digital subtraction angiography (ccDSA) to monitor intra-procedural arterial stasis during TACE.

Materials and methods

A total number of 35 patients with hepatocellular carcinoma who had undergone TACE were enrolled into the study. Pre- and post-two-dimensional digital subtraction angiography scans were conducted with same protocol and post-processed with ccDSA prototype software. Time-contrast-intensity (CI[t]) curve was obtained by region-of-interest (ROI) measurement on the generated ccDSA image. Quantitative 2D perfusion parameters time to peak, area under the curve (AUC), maximum upslope, and contrast intensity peak (CI-Peak) derived from the ROI-based CI[t] curve for pre- and post-TACE were evaluated to assess the reduction of antegrade blood flow and tumor blush. Relationships between 2D perfusion parameters, subjective angiographic chemoembolization endpoint (SACE) scale, and clinical outcomes were analyzed.

Results

Area normalized AUC and CI-Peak revealed significant reduction after the TACE (P < 0.0001). AUCnorm decreased from pre-procedure of 0.867 ± 0.242 to 0.421 ± 0.171 (P < 0.001) after completion of TACE. CI-Peaknorm was 0.739 ± 0.221 before TACE and 0.421 ± 0.174 (P < 0.001) after TACE. Tumor blood supply time slowed down obviously after embolization. A perfusion reduction either from AUCnorm or CI-Peaknorm ranging from 30% to 40% was associated with SACE level III and a reduction ranging from 60% to 70% was equivalent to SACE level IV. For intermediate reduction (SACE level III), better tumor response was found after TACE rather than a higher reduction (SACE level IV).

Conclusion

ccDSA application provides an objective approach to quantify the perfusion reduction and subjectively evaluate the arterial stasis of antegrade blood flow and tumor blush caused by TACE.

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Acknowledgment

The authors acknowledge that the present research was supported by National Natural Science Foundation of China (Grant No. 81201172). Prototype software DSA-Analyzer (Siemens Healthcare, Forchheim, Germany) is not commercially available.

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Authors and Affiliations

  1. Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd. 160, Shanghai, 200127, China

    Ji Wang, Jie-Jun Cheng, Zhi-Guo Zhuang, Xue-Bin Zhang, Jia-Chang Chi, Xiao-Lan Hua & Jian-Rong Xu

  2. Siemens Limited China, Shanghai Branch, Zhouzhu Rd. 278, Shanghai, 201318, China

    Kai-Yi Huang

Authors
  1. Ji Wang
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  2. Jie-Jun Cheng
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  3. Kai-Yi Huang
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  4. Zhi-Guo Zhuang
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Correspondence to Jian-Rong Xu.

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Wang, J., Cheng, JJ., Huang, KY. et al. Quantitative assessment of angiographic perfusion reduction using color-coded digital subtraction angiography during transarterial chemoembolization. Abdom Radiol 41, 545–552 (2016). https://doi.org/10.1007/s00261-015-0622-6

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  • DOI: https://doi.org/10.1007/s00261-015-0622-6

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