Three-dimensional evaluation of lipiodol retention in HCC after chemoembolization: a quantitative comparison between CBCT and MDCT

Acad Radiol. 2014 Mar;21(3):393-9. doi: 10.1016/j.acra.2013.11.006.


Rationale and objectives: To evaluate the capability of cone-beam computed tomography (CBCT) acquired immediately after transcatheter arterial chemoembolization (TACE) in determining lipiodol retention quantitatively and volumetrically when compared to 1-day postprocedure unenhanced multidetector computed tomography (MDCT).

Materials and methods: From June to December 2012, 15 patients met the inclusion criteria of unresectable hepatocellular carcinoma (HCC) that was treated with conventional TACE (cTACE) and had intraprocedural CBCT and 1-day post-TACE MDCT. Four patients were excluded because the lipiodol was diffuse throughout the entire liver or lipiodol deposition was not clear on both CBCT and MDCT. Eleven patients with a total of 31 target lesions were included in the analysis. A quantitative three-dimensional software was used to assess complete, localized, and diffuse lipiodol deposition. Tumor volume, lipiodol volume in the tumor, percent lipiodol retention, and lipiodol enhancement in Hounsfield units (HU) were calculated and compared between CBCT and MDCT using two-tailed Student's t test and Bland-Altman plots.

Results: The mean value of tumor volume, lipiodol-deposited regions, calculated average percent lipiodol retention, and HU value of CBCT were not significantly different from those of MDCT (tumor volume: 9.37 ± 11.35 cm(3) vs 9.34 ± 11.44 cm(3), P = .991; lipiodol volume: 7.84 ± 9.34 cm(3) vs 7.84 ± 9.60 cm(3), P = .998; lipiodol retention: 89.3% ± 14.7% vs. 90.2% ± 14.9%, P = .811; HU value: 307.7 ± 160.1 HU vs. 257.2 ± 120.0 HU, P = .139). Bland-Altman plots showed only minimal difference and high agreement when comparing CBCT to MDCT.

Conclusions: CBCT has a similar capability, intraprocedurally, to assess lipiodol deposition in three dimensions for patients with HCC treated with cTACE when compared to MDCT.

Keywords: Hepatocellular carcinoma; cone-beam computed tomography; multidetector computed tomography; three-dimensional; transcatheter arterial chemoembolization; volumetric.

Publication types

  • Comparative Study
  • Controlled Clinical Trial

MeSH terms

  • Aged
  • Antineoplastic Agents / therapeutic use
  • Carcinoma, Hepatocellular / diagnostic imaging
  • Carcinoma, Hepatocellular / metabolism*
  • Carcinoma, Hepatocellular / therapy*
  • Chemoembolization, Therapeutic
  • Cone-Beam Computed Tomography / methods*
  • Ethiodized Oil / pharmacokinetics*
  • Ethiodized Oil / therapeutic use
  • Female
  • Hemostatics / therapeutic use
  • Humans
  • Imaging, Three-Dimensional / methods
  • Liver Neoplasms / diagnostic imaging
  • Liver Neoplasms / metabolism*
  • Liver Neoplasms / therapy*
  • Male
  • Metabolic Clearance Rate
  • Middle Aged
  • Multidetector Computed Tomography / methods*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Tissue Distribution
  • Treatment Outcome


  • Antineoplastic Agents
  • Hemostatics
  • Ethiodized Oil