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

Cynthia L Eccles, Regina V Tse, Maria A Hawkins, Mark T Lee, Douglas J Moseley, Laura A Dawson, Cynthia L Eccles, Regina V Tse, Maria A Hawkins, Mark T Lee, Douglas J Moseley, Laura A Dawson

Abstract

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.

Figures

Figure 1
Figure 1
Intravenous cone bean computed tomography (IV-CBCT) images demonstrating tumor enhancement in patient 1. (A) Axial CT slices comparing noncontrast CBCT (left) with simulation CT (middle) and IV-CBCT (right) from a single fraction. Arrows indicate gross tumor volume (top) and gross tumor volume contour (black) from planning CT shown on bottom. Note the artifact from clips in the CBCTs. (B) Sagittal CBCT slices with (left) and without (right) IV contrast demonstrating tumor visibility with contrast.
Figure 2
Figure 2
Intravenous cone bean computed tomography (IV-CBCT) images demonstrating normal tissue. (A) Coronal views of IV-CBCT demonstrating hepatic vasculature (patient 3). (B) Kidney architecture with (left) and without (right) IV contrast (patient 1).

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