CT during aortography (CTAo) using IVR 64-multidetector-row CT (IVR-64MDCT) enables the rapid and simultaneous depiction of both the hepatic and extrahepatic feeding arteries in hepatocellular carcinoma (HCC), and can be achieved using a reasonable volume of contrast medium. The scan time is approximately 6 s from the diaphragm to the kidney using CTAo with 64MDCT with a slice thickness and slice interval of 0.5 mm. The hepatoma feeding arteriogram appears in the angiographic monitor after CTAo, and can then be used to guide catheterization. We introduce the process for creating a hepatoma feeding arteriogram, synthesized from the following three volume-rendered images: background bone, aorta to hepatic-branch artery, and hepatoma to feeding artery. Uniquely, the hepatoma feeding arteriogram enables investigation of the feeding artery from the tumor side, rather than from the aorta side, and appears superior to selective arteriography in terms of detecting small HCC and its accompanying fine feeding arteries. Identification of these arteries by CT angiography with intravenous contrast medium injection is difficult because of the similarity in CT values between the feeding artery and the surrounding liver, thereby preventing the creation of a hepatoma feeding arteriogram. CTAo accelerates the process of deciding upon the catheter treatment strategy, shifting the decision to the point at which the feeding artery is investigated, because the hepatoma feeding arteriogram enables instant identification of the feeding artery and its connection to the hepatic branch artery. CTAo with IVR-64MDCT can potentially contribute to remarkable advances in IVR, especially transcatheter arterial chemoembolization for HCC.

Using the same scanning parameters as for clinical cases, air kerma values were greater with C-arm CT than with 64MDCT; at the dorsal side of the phantom, they were 5.24 times greater with C-arm CT compared with 64MDCT.

We describe an 85-year-old man suffering lower urinary tract symptoms, who underwent prostatic artery embolization (PAE) based on a prostate-supplying arteriogram created with multidetector-row computed tomography during pelvic arteriography. This arteriogram was synthesized from a background bone volume-rendered (VR) image, an aorta-pelvic artery VR image, and a prostate-supplying artery VR image. Because the bone background VR image is combined with the aorta-pelvic artery VR image, the prostate-supplying arteriogram can simultaneously show the pelvic branch arteries present on the ventral side, inside, and the dorsal side of the pelvic bone. It showed that the left prostatic artery supplied the urethra at the outlet of the urinary bladder. PAE of the left prostatic artery was performed with catheter navigation based on the prostate-supplying arteriogram. There was marked relief of the lower urinary tract symptoms at the 12-month follow-up.

We quantified to clarify the optimum factors for CT image reconstruction of an enhanced hepatocellular carcinoma (HCC) model in a liver phantom obtained by multi-level dynamic computed tomography (M-LDCT) with 64 detector rows. After M-LDCT scanning of a water phantom and an enhanced HCC model, we compared the standard deviation (SD, 1 ± SD), noise power spectrum (NPS) values, contrast-noise ratios (CNR), and the M-LDCT image among the reconstruction parameters, including the convolution kernel (FC11, FC13, and FC15), post-processing quantum filters (2D-Q00, 2D-Q01, and 2D-Q02) and slice thicknesses/slice intervals. The SD and NPS values were lowest with FC11 and 2D-Q02. The CNR values were highest with 2D-Q02. The M-LDCT image quality was highest with FC11 and 2D-Q02, and with slice thicknesses/slice intervals of 0.5 mm/0.5 mm and 0.5 mm/0.25 mm. The optimum factors were the FC11 convolution kernel, 2D-Q02 quantum filter, and 0.5 mm slice thickness/0.5 mm slice interval or less.

Aortography for detecting hemorrhage is limited when determining the catheter treatment strategy because the artery responsible for hemorrhage commonly overlaps organs and non-responsible arteries. Selective catheterization of untargeted arteries would result in repeated arteriography, large volumes of contrast medium, and extended time. A volume-rendered hemorrhage-responsible arteriogram created with 64 multidetector-row CT (64MDCT) during aortography (MDCTAo) can be used both for hemorrhage mapping and catheter navigation. The MDCTAo depicted hemorrhage in 61 of 71 cases of suspected acute arterial bleeding treated at our institute in the last 3 years. Complete hemostasis by embolization was achieved in all cases. The hemorrhage-responsible arteriogram was used for navigation during catheterization, thus assisting successful embolization. Hemorrhage was not visualized in the remaining 10 patients, of whom 6 had a pseudoaneurysm in a visceral artery; 1 with urinary bladder bleeding and 1 with chest wall hemorrhage had gaze tamponade; and 1 with urinary bladder hemorrhage and 1 with uterine hemorrhage had spastic arteries. Six patients with pseudoaneurysm underwent preventive embolization and the other 4 patients were managed by watchful observation. MDCTAo has the advantage of depicting the arteries responsible for hemoptysis, whether from the bronchial arteries or other systemic arteries, in a single scan. MDCTAo is particularly useful for identifying the source of acute arterial bleeding in the pancreatic arcade area, which is supplied by both the celiac and superior mesenteric arteries. In a case of pelvic hemorrhage, MDCTAo identified the responsible artery from among numerous overlapping visceral arteries that branched from the internal iliac arteries. In conclusion, a hemorrhage-responsible arteriogram created by 64MDCT immediately before catheterization is useful for deciding the catheter treatment strategy for acute arterial bleeding.