Guiding role of cone beam CT with DynaCT in transcatheter arterial chemoembolization for patients with primary liver cancer and its value in assessing treatment outcome / 临床肝胆病杂志

ABSTRACT

Objective To investigate the effect of cone beam CT with DynaCT on liver cancer patients undergoing transcatheter arterial chemoembolization (TACE) and its influence on the prognosis of patients. Methods A total of 73 patients with primary liver cancer who attended The Second Affiliated Hospital of North Sichuan Medical College from May 2017 to May 2019 were enrolled and randomly divided into observation group with 38 patients and control group with 35 patients. The patients in the control group underwent TACE under 2D-DSA angiography, and those in the observation group underwent DynaCT angiography after 2D-DSA angiography. The two groups were compared in terms of time of operation, X-ray exposure, amount of contrast agent used, intrahepatic tumor lesions detected and blood supplying arteries displayed by 2D-DSA angiography versus DynaCT angiography, and lipiodol deposition in tumor lesions evaluated by postoperative two-dimensional X-ray fluoroscopy versus plain DynaCT scan. The two-independent-samples t test was used for comparison between two groups, and the chi-square test was used for comparison of categorical data between two groups; the Kaplan-Meier survival curve was plotted for survival analysis, and the log-rank test was used for comparison between two groups. Results There were no significant differences between the two groups in time of operation, X-ray exposure, and amount of contrast agent used (all P >0.05). For the observation group, a total of 93 tumor lesions were detected, among which 79 (84.95%) were positive for blood supplying arteries, while in the control group, a total of 61 tumor lesions were detected, among which 34 (55.74%) were positive for blood supplying arteries, suggesting that the proportion of lesions positive for blood supplying arteries in the observation group was significantly higher than that in the control group ( χ 2 =16.088, P < 0.05). After surgery, 113 lesions of the two groups were analyzed for lipiodol deposition; two-dimensional X-ray fluoroscopy showed that lipiodol was evenly deposited in 89 lesions and was partially or completely missing in 24 lesions, while plain DynaCT scan showed that lipiodol was evenly deposited in 78 lesions and was partially or completely missing in 35 lesions. The observation group had significantly better overall survival than the control group ( χ 2 =4.347, P =0.037). Conclusion DynaCT can increase the detection rate of ischemic lesions and overlapping lesions in the liver without increasing the amount of intraoperative X-ray exposure and contrast agent used, thereby improving the accuracy of intubation and reducing the patient's vascular injury, and at the same time, it can be used to evaluate the deposition of lipiodol after embolization. It has an important application value in TACE for liver cancer and can help to improve the survival of patients after surgery.