Journal List > J Korean Soc Radiol > v.67(5) > 1087187

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Shin, Kang, Kim, Kim, Heo, Jeong, Seon, and Lee: Dual Energy Computed Tomography to Evaluate Hepatocellular Carcinoma Treated with Transcatheter Arterial Chemo-Embolization: Comparison between the Linear Blending and Nonlinear Moidal Blending Methods
Abdominal Radiology
Journal of the Korean Society of Radiology

Journal of the Korean Society of Radiology 2012; 67(5): 371-380.

Published online: 21 November 2012

DOI: https://doi.org/10.0000/jksr.2012.67.5.371

Dual Energy Computed Tomography to Evaluate Hepatocellular Carcinoma Treated with Transcatheter Arterial Chemo-Embolization: Comparison between the Linear Blending and Nonlinear Moidal Blending Methods

Sang Soo Shin, MD1, Heoung Keun Kang, MD2, Hyeong Wook Kim, MD1, Jin Woong Kim, MD2, Suk Hee Heo, MD2, Yong Yeon Jeong, MD2, Hyun Ju Seon, MD2, Daun Lee, MD1

1Department of Radiology, Chonnam National University Hospital and Medical School, Gwangju, Korea.

2Department of Radiology, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea.

Corresponding author: Heoung Keun Kang, MD. Department of Radiology, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun 519-763, Korea. Tel. 82-61-379-7101, Fax. 82-61-379-7133, hkkang@jnu.ac.kr

Received 11 July 2012       Accepted 17 August 2012

Copyright © 2012 The Korean Society of Radiology

Abstract

Purpose

To compare the linear blending image with the nonlinear moidal blending image using dual energy CT for the evaluation of the viable portion of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE).

Materials and Methods

One-hundred and twenty three HCC patients incompletely treated after TACE were enrolled in this study. The dual energy mode (80 kVp and Sn140 kVp) was only applied in the late arterial phase scanning. A paired t-test was used to compare the lesion-to-liver contrast-to-noise ratio (CNR) and the image noise between the two blending images. Lesion conspicuity, image sharpness, image noise and the overall image quality between the two blending images were compared using the Wilcoxon matched-pair signed-ranks test.

Results

The lesion-to-liver CNR was significantly higher on the moidal blending image (5.6 ± 3.2) than on the linear blending image (2.7 ± 1.6) (p < 0.001). The image noise was significantly lower on the moidal blending image (10.9 ± 3.5) than on the linear blending image (17.5 ± 5.5) (p < 0.001). The lesion conspicuity and overall image quality were significantly better on the moidal blending image for both reviewers (p < 0.001). However, with respect to image sharpness, the linear blending image was significantly better for both reviewers (p > 0.01).

Conclusion

The nonlinear moidal blending image of dual energy CT showed an increased lesion-to-liver CNR, decreased noise and improved overall image quality for the evaluation of the viable portion of HCC after TACE.

Keywords: Liver, Hepatocellular Carcinoma, Dual Energy CT, Image Fusion, Chemo-Embolization

Figures and Tables

Fig. 1
A 59-year-old man who underwent two sessions of transcatheter arterial chemoembolization for HCC.
A. The unenhanced CT image shows a sparsely iodized oil-retaining lesion at the right hepatic dome (arrows).
B. The linear blending image obtained during the late arterial phase shows a questionable area of enhancement (arrows) within a sparsely iodized oil-retaining lesion at the right hepatic dome.
C. The moidal blending image obtained during the late arterial phase more clearly demonstrates the hypervascular enhancing portion (arrows) within a sparsely iodized oil-retaining lesion at the right hepatic dome.
D. The celiac axis angiogram reveals hypervascular staining (arrows) fed by branches of the right hepatic artery at the right hepatic dome.
Note.-HCC = hepatocellular carcinoma
jksr-67-371-g001
Table 1
Comparison of the Attenuation Values of the Lesions and Liver Parenchyma, the Image Noise and the Lesion-to-Liver CNR between the Linear Blending and Moidal Blending Images
jksr-67-371-i001

The data is expressed as mean ± standard deviations.

Note.-CNR = contrast-to-noise ratio, HU = Hounsfield unit

Table 2
Comparison of Qualitative Assessment between the Linear Blending and Moidal Blending Images
jksr-67-371-i002

Note.-HCC = hepatocellular carcinoma

Table 3
Inter-Observer Agreement between the Two Reviewers
jksr-67-371-i003

Notes

This study was supported by a grant (CRI12013-1) from the Chonnam National University Hospital Research Institute of Clinical Medicine in South Korea.

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