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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Angiography, Digital Subtraction, Bile Duct Neoplasms, Chemoembolization, Therapeutic, Cholangiocarcinoma, Cohort Studies, Cone-Beam Computed Tomography, Female, Humans, Liver, Magnetic Resonance Imaging, Male, Middle Aged, Observer Variation, Radiography, Interventional, Reproducibility of Results, Retrospective Studies.
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Does delayed-Phase Cone-Beam CT improve Detectability of Intrahepatic Cholangiocarcinoma During Conventional Transarterial Chemoembolization? Context: To evaluate the detectability of intrahepatic cholangiocarcinoma (ICC) on dual-phase cone-beam CT (DPCBCT) during conventional transarterial chemoembolization (cTACE) compared to that of digital subtraction angiography (DSA) with respect to pre-procedure contrast-enhanced magnetic resonance imaging (CE-MRI) of the liver. This retrospective study included 17 consecutive patients (10 male, mean age 64) with ICC who underwent pre-procedure CE-MRI of the liver, and DSA and DPCBCT (early-arterial phase (EAP) and delayed-arterial phase (DAP)) just before cTACE. The visibility of each ICC lesion was graded by two radiologists on a three-rank scale (complete, partial, and none) on DPCBCT and DSA images, and then compared to pre-procedure CE-MRI. Of 61 ICC lesions, only 45.9% were depicted by DSA, whereas EAP- and DAP-CBCT yielded a significantly higher detectability rate of 73.8% and 93.4%, respectively (p < 0.01). Out of the 33 lesions missed on DSA, 18 (54.5%) and 30 (90.9%) were revealed on EAP- and DAP-CBCT images, respectively. DSA depicted only one lesion that was missed by DPCBCT due to streak artifacts caused by a prosthetic mitral valve. DAP-CBCT identified significantly more lesions than EAP-CBCT (p < 0.01). Conversely, EAP-CBCT did not detect lesions missed by DAP-CBCT. For complete lesion visibility, DAP-CBCT yielded significantly higher detectability (78.7%) compared to EAP (31.1%) and DSA (21.3%) (p < 0.01).
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DPCBCT, and especially the DAP-CBCT, significantly improved the detectability of ICC lesions during cTACE compared to DSA. We recommend the routine use of DAP-CBCT in patients with ICC for per-procedure detectability and treatment planning in the setting of TACE. Final Decision: yes