Patient Population:
Over a 41-month period,
65 TACE procedures were performed in 38 patients.
Baseline dynamic CT-based volumetric analysis was performed in 15 patients.
CT-based Volumetric Analysis details:
Portal venous phase series of images from the preoperative dynamic multi-phase CT scans were used for total liver volumetry.
Set of axial images with a slice thickness of 3-5 mm was used for the analysis.
Three observers (JG,
DT and JQ,
observers 1,
2,
and 3,
respectively) performed liver volumetry for all patients on an iMac using OsiriX® / Kanteron Software Systems.
Total liver volume,
residual volume,
and tumor volume were determined using OsiriX® / Kanteron Software Systems (observers 1-3).
For liver volume,
the gall bladder,
inferior caval vein and portal vein and branches were excluded in the regions of interest (ROIs),
and biliary structures were included (Figure 1).
Prior to volume calculation,
RIOs based 3-D reconstructions were performed (Figure 2).
Tumor volume was determined using the arterial phase of the dynamic CT scans.
ROIs were drawn around tumor boundaries (Figure 3).
A 3-D tumor reconstruction was performed prior to volume calculation (Figure 4).
Volume Calculation
After selecting all of the regions of interest within one series,
OsiriX® / Kanteron Software Systems automatically calculated the volume by multiplying surface and slice thickness and then adding up individual slice volumes.
Post-operative analysis.
Imaging post-operative outcomes were determined according to the mRecist criteria (Figure 5).
End-points:
Primary end-point:
A composed outcome variable was determined named liver-related adverse events was determined,
as follows: new occurrence of ascites,
encephalopathy and/or death;
Secondary end-points:
Function impairment as determined by variations on liver function tests (AST and ALT).
Statistical analysis:
Non-parametric tests were used for univariate analysis.
Correlation analysis using the Spearman test was used to determine correlation between ALT/AST variations and residual volume.