Intravenous contrast-enhanced cone beam computed tomography (IVCBCT) of intrahepatic tumors and vessels

Purpose Liver tumors are challenging to visualize on cone beam computed tomography (CBCT) without intravenous (IV) contrast. Image guidance for liver cancer stereotactic body ablative radiation therapy (SABR) could be improved with the direct visualization of hepatic tumors and vasculature. This study investigated the feasibility of the use of IV contrast-enhanced CBCT (IV-CBCT) as a means to improve liver target visualization. Methods and Materials Patients on a liver SABR protocol underwent IV-CBCT before 1 or more treatment fractions in addition to a noncontrast CBCT. Image acquisition was initiated 0 to 30 seconds following injection and acquired over 60 to 120 seconds. “Stop and go” exhale breath-hold CBCT scans were used whenever feasible. Changes in mean CT number in regions of interest within visible vasculature, tumor, and adjacent liver were quantified between CBCT and IV-CBCT. Results Twelve pairs of contrast and noncontrast CBCTs were obtained in 7 patients. Intravenous-CBCT improved hepatic tumor visibility in breath-hold scans only for 3 patients (2 metastases, 1 hepatocellular carcinoma). Visible tumors ranged in volume from 124 to 564 mL. Small tumors in free-breathing patients did not show enhancement on IVCBT. Conclusions Intravenous-CBCT may enhance the visibility of hepatic vessels and tumor in CBCT scans obtained during breath hold. Optimization of IV contrast timing and reduction of artifacts to improve tumor visualization warrant further investigation.

[1]  L. Dawson,et al.  Individualized image guided iso-NTCP based liver cancer SBRT , 2006, Acta oncologica.

[2]  Kumiko Ando,et al.  Evaluation of vascular supply with cone-beam computed tomography during intraarterial chemotherapy for a skull base tumor , 2006, Radiation Medicine.

[3]  R. Baron,et al.  Understanding and optimizing use of contrast material for CT of the liver. , 1994, AJR. American journal of roentgenology.

[4]  Andrea Bezjak,et al.  Interfraction and intrafraction changes in amplitude of breathing motion in stereotactic liver radiotherapy. , 2010, International journal of radiation oncology, biology, physics.

[5]  M. V. van Herk,et al.  Respiratory correlated cone beam CT. , 2005, Medical physics.

[6]  Kristy K Brock,et al.  Accuracy of daily image guidance for hypofractionated liver radiotherapy with active breathing control. , 2005, International journal of radiation oncology, biology, physics.

[7]  David A Jaffray,et al.  Improving image-guided target localization through deformable registration , 2008, Acta oncologica.

[8]  N. Noordhoek,et al.  Contrast-Enhanced Angiographic Cone-Beam CT of Cerebrovascular Stents: Experimental Optimization and Clinical Application , 2010, American Journal of Neuroradiology.

[9]  David Jaffray,et al.  Assessment of residual error in liver position using kV cone-beam computed tomography for liver cancer high-precision radiation therapy. , 2006, International journal of radiation oncology, biology, physics.

[10]  K. Brock,et al.  Interfraction liver shape variability and impact on GTV position during liver stereotactic radiotherapy using abdominal compression. , 2011, International journal of radiation oncology, biology, physics.

[11]  J. Wong,et al.  Flat-panel cone-beam computed tomography for image-guided radiation therapy. , 2002, International journal of radiation oncology, biology, physics.

[12]  Michael Velec,et al.  Effect of breathing motion on radiotherapy dose accumulation in the abdomen using deformable registration. , 2011, International journal of radiation oncology, biology, physics.

[13]  E. Malinen,et al.  Feasibility of contrast-enhanced cone-beam CT for target localization and treatment monitoring. , 2010, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[14]  N. Spry,et al.  Effect of contrast media on megavoltage photon beam dosimetry. , 2008, Medical dosimetry : official journal of the American Association of Medical Dosimetrists.

[15]  R. Mohan,et al.  Correlation between internal fiducial tumor motion and external marker motion for liver tumors imaged with 4D-CT. , 2007, International journal of radiation oncology, biology, physics.

[16]  L. Dawson,et al.  Lack of influence of intravenous contrast on head and neck IMRT dose distributions , 2008, Acta oncologica.

[17]  V. Budach,et al.  Image guided respiratory gated hypofractionated Stereotactic Body Radiation Therapy (H-SBRT) for liver and lung tumors: Initial experience , 2006, Acta oncologica.

[18]  O. Matsui,et al.  Detection of hepatocellular carcinoma by CT during arterial portography using a cone-beam CT technology: comparison with conventional CTAP , 2009, Abdominal Imaging.

[19]  Y Seppenwoolde,et al.  Treatment precision of image-guided liver SBRT using implanted fiducial markers depends on marker–tumour distance , 2011, Physics in medicine and biology.

[20]  Ruola Ning,et al.  Flat panel detector-based cone-beam volume CT angiography imaging: system evaluation , 2000, IEEE Transactions on Medical Imaging.

[21]  Jan J W Lagendijk,et al.  MRI/linac integration. , 2008, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[22]  Contrast medium-assisted stereotactic image-guided radiotherapy using kilovoltage cone-beam computed tomography , 2008, Radiation Medicine.

[23]  Jan-Jakob Sonke,et al.  Inter- and intrafraction variability in liver position in non-breath-hold stereotactic body radiotherapy. , 2009, International journal of radiation oncology, biology, physics.

[24]  K. Brock,et al.  Determination of ventilatory liver movement via radiographic evaluation of diaphragm position. , 2001, International journal of radiation oncology, biology, physics.

[25]  G Kleinszig,et al.  Antiscatter grids in mobile C-arm cone-beam CT: effect on image quality and dose. , 2011, Medical physics.

[26]  Masoom A. Haider,et al.  Comparison of liver tumor motion with and without abdominal compression using cine-magnetic resonance imaging. , 2011, International journal of radiation oncology, biology, physics.

[27]  Pietro Mancosu,et al.  Contrast enhanced 4D-CT imaging for target volume definition in pancreatic ductal adenocarcinoma. , 2008, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[28]  Masoom A Haider,et al.  Three-dimensional motion of liver tumors using cine-magnetic resonance imaging. , 2008, International journal of radiation oncology, biology, physics.

[29]  Ken Ueda,et al.  Cone-Beam CT with Flat-Panel-Detector Digital Angiography System: Early Experience in Abdominal Interventional Procedures , 2006, CardioVascular and Interventional Radiology.

[30]  Maria Hawkins,et al.  Reproducibility of liver position using active breathing coordinator for liver cancer radiotherapy. , 2006, International journal of radiation oncology, biology, physics.

[31]  Tinsu Pan,et al.  4D-CT imaging with synchronized intravenous contrast injection to improve delineation of liver tumors for treatment planning. , 2008, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[32]  Jabbari Nasrollah,et al.  Influence of the intravenous contrast media on treatment planning dose calculations of lower esophageal and rectal cancers. , 2014, Journal of cancer research and therapeutics.