European journal of radiology · 2026
Value of dual-energy CT in assessing therapeutic response after TACE for hepatocellular carcinoma: A retrospective comparative study with conventional CT.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Sun Ziying, Zhang Shuhang, Zhou Shuwei, Iezzi Roberto, Song Yu, Li Shuang, Gui Qianhui, Lu Yuqing, Chen Xunjun, Song Tiejun, Wang Yiwei, Chen Ke, Ju Shenghong, Wang Yuan-Cheng
Аннотация
BACKGROUND & AIMS: Conventional CT (CCT) is widely used to assess hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE), but its diagnostic performance is often limited by lipiodol-induced beam-hardening artifacts and poor contrast resolution. Dual-energy CT (DECT) with low-keV monochromatic imaging may improve detection of viable residual tumors, yet its clinical value remains to be fully established. This study compared diagnostic performance, image quality, spatial accuracy, and interobserver agreement of DECT versus CCT for identifying viable HCC post-TACE using MRI as the reference standard.
MATERIALS AND METHODS: This retrospective, single-center study included 48 patients with 76 HCC lesions who underwent both DECT and MRI within 3 months after conventional TACE. Conventional CT (CCT) and 40-keV monoenergetic (MonoE40) images were reconstructed from DECT data. Diagnoses were independently assessed by radiologists blinded to MRI results. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), Dice similarity coefficient (DSC) for spatial agreement, and Fleiss' kappa for interobserver agreement were analyzed.
RESULTS: Fifty-five lesions were viable per MRI. MonoE40 images showed significantly superior diagnostic performance compared to CCT (P < 0.05), especially for lesions with viable components < 2 cm (detection rates: 74.1 %-85.2 % vs. 25.9 %-48.1 %). MonoE40 also yielded higher diagnostic confidence, lesion conspicuity, and arterialphase CNR (P < 0.001). Dice coefficients for tumor delineation improved from 0.31 to 0.54 on CCT to 0.76-0.95 on MonoE40 (P < 0.05). Interobserver agreement at whole-lesion level was higher with MonoE40 (κ = 0.55) versus CCT (κ = 0.29), with the greatest improvement among less-experienced readers (κ from 0.35 to 0.59).
CONCLUSION: DECT with 40-keV monochromatic reconstruction significantly improves detection of viable residual HCC after TACE, enhances tumor boundary delineation, and increases consistency among radiologists compared with CCT, especially benefiting less-experienced readers. These results support incorporating DECT into standard post-TACE imaging protocols.
MATERIALS AND METHODS: This retrospective, single-center study included 48 patients with 76 HCC lesions who underwent both DECT and MRI within 3 months after conventional TACE. Conventional CT (CCT) and 40-keV monoenergetic (MonoE40) images were reconstructed from DECT data. Diagnoses were independently assessed by radiologists blinded to MRI results. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), Dice similarity coefficient (DSC) for spatial agreement, and Fleiss' kappa for interobserver agreement were analyzed.
RESULTS: Fifty-five lesions were viable per MRI. MonoE40 images showed significantly superior diagnostic performance compared to CCT (P < 0.05), especially for lesions with viable components < 2 cm (detection rates: 74.1 %-85.2 % vs. 25.9 %-48.1 %). MonoE40 also yielded higher diagnostic confidence, lesion conspicuity, and arterialphase CNR (P < 0.001). Dice coefficients for tumor delineation improved from 0.31 to 0.54 on CCT to 0.76-0.95 on MonoE40 (P < 0.05). Interobserver agreement at whole-lesion level was higher with MonoE40 (κ = 0.55) versus CCT (κ = 0.29), with the greatest improvement among less-experienced readers (κ from 0.35 to 0.59).
CONCLUSION: DECT with 40-keV monochromatic reconstruction significantly improves detection of viable residual HCC after TACE, enhances tumor boundary delineation, and increases consistency among radiologists compared with CCT, especially benefiting less-experienced readers. These results support incorporating DECT into standard post-TACE imaging protocols.