Dual-energy CT to detect recurrent HCC after TACE: Initial experience of color-coded iodine CT imaging

Abstract Objectives To evaluate the feasibility of diagnosing recurrence of HCC after TACE color-coded iodine CT (CICT) based on arterial phase scans obtained by a dual-energy CT (DECT) scanner. Methods A CICT scan was acquired from an iodine map after applying material decomposition of the liver tissue and setting a threshold attenuation level for viable tumors. Two radiologists reviewed both conventional and CICT sets in 31 patients who had a history of TACE for HCC. The performances in detecting local tumor progression (LTP) were evaluated by alternative free-response receiver operating characteristics. The rate of uncertain diagnosis and interobserver agreement of the diagnosis were explored. Additionally, the reading time and radiation dose were also investigated. Results The mean figures of merit of the conventional and CICT sets for LTP were 0.818 and 0.847, respectively ( p = 0.459). The rate of uncertain diagnosis was significantly decreased in CICT sets (34.5% vs. 0%), and interobserver agreement was improved ( k = 0.527 vs. 0.718). On the CICT set, mean reading time was reduced by 49 s and mean radiation dose was also decreased by 18.3% when replacing the non-contrast CT with CICT. Conclusions CICT is comparable to conventional liver CT protocol in demonstrating viable HCCs, while it allows a reduction in radiation dose.