The Role of Cone-Beam CT in Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

Purpose: To review available evidence, for use of cone-beam CT during transcatheter arterial chemoembolization in hepatocellular carcinoma (HCC) for detection of tumor and feeding arteries. Materials and Methods: Literature searches were conducted from inception to May 15, 2016, in PubMed (MEDLINE), Scopus, and Cochrane Central Register of Controlled Trials. Searches included cone beam, CBCT, C-arm, CACT, cone-beam CT, volumetric CT, volume computed tomography, volume CT, AND liver, hepatic*, hepatoc*. Studies that involved adults with HCC specifically and treated with transcatheter arterial chemoembolization that used cone-beam CT were included Results: Inclusion criteria were met by 18 studies. Pooled sensitivity of cone -beam CT for detecting tumor was 90% (95% confidence interval [CI], 82%-95%), whereas pooled sensitivity of digital subtraction angiography (DSA) for turner detection was 67% (95% CI, 51%-80%). Pooled sensitivity of cone-beam CT for detecting tumor feeding arteries was 93% (95% CI, 91%-: 95%), whereas pooled sensitivity of DSA was 55% (95% CI, 36%-74%). Conclusions: Cone -beam CT can significantly increase detection of tumors and tumor feeding arteries during transcatheter arterial chemoembolization; Cone-beam CT should be considered as an adjunct tool to DSA during transcatheter arterial chemoembolization treatments of HCC.