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Master Thesis

Intérêt de l’imagerie spectrale dans l’évaluation des carcinomes hépatocellulaires traités par chimio-embolisation artérielle lipiodolée

Abstract : Introduction : Hepatocellular carcinoma (HCC) is one of the most common cancers in the world with a high mortality rate. This cancer is monitored using conventional CT or MRI. One of the available treatments is arterial chemoembolization with an anti-cancer agent with Lipiodol. Since Lipiodol is a product with a high concentration of iodine, it is responsible for important conventional scanner artifacts that can interfere with image interpretation. Studies have shown that dual energy scanning allows better visualization and therefore a better rate of detection of hypervascular liver tumors. Only one article has studied the contribution of the dual energy CT in this context. We therefore wanted to study the contribution of the dual energy CT in this application. Objective : The purpose of this study was to demonstrate the superiority of dual energy CT in the evaluation and investigation of HCC tumor residues treated by arterial chemoembolization with Lipiodol compared to conventional single-energy CT. Methods : A double energy CT with a multiphasic injection protocol was performed in 26 patients with cirrhosis and HCC prospectively. Two readers independently performed double-blind images of 39 nodules selected for analysis. A first reading was done with only image reconstructions equivalent to the conventional scanner. A second reading was done with the addition of reconstructions "iodine mapping" from the double energy CT. The gold standard for control was MRI, a 6-month control scanner or anatomopathology. Results : For reader 1 and reader 2, 33/39 and 34/39 nodules, respectively, were well diagnosed with conventional CT versus 36/39 with a double energy CT with a small increase in accuracy percentage from 84.6% to 92.3% and 87.2% to 92.3%, respectively, but not significant p = 0.453 (> 0.05) and p = 0.625 (> 0.05). Conclusion : Dual energy CT did not show superiority over conventional CT for the detection of HCC tumor residues in these patients. The sensitivity of the dual energy CT is still high, and although not significant it seems to enhance the diagnostic certainty compared to conventional CT with a decrease in the number of lesions classified as "doubtful". Studies with a larger staff will have to be conducted.
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https://dumas.ccsd.cnrs.fr/dumas-01961861
Contributor : Faculté de Médecine Amu <>
Submitted on : Thursday, December 20, 2018 - 11:28:22 AM
Last modification on : Monday, July 6, 2020 - 4:46:59 PM
Long-term archiving on: : Friday, March 22, 2019 - 11:44:24 AM

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Alexandre Allary. Intérêt de l’imagerie spectrale dans l’évaluation des carcinomes hépatocellulaires traités par chimio-embolisation artérielle lipiodolée. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01961861⟩

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