Efficacy of cone-beam computed tomography during transcatheter arterial chemoembolization for hepatocellular carcinoma

Abstract

Cone-beam computed tomography (CBCT) using a flat-panel detector is an alternative method of obtaining cross-sectional images. This technique is now being used during transcatheter arterial chemoembolization (TACE) for inoperable hepatocellular carcinoma (HCC). Several CBCT techniques are performed to detect HCC lesions: CBCT during portography (CBCTAP), CBCT during hepatic arteriography (CBCTHA), CBCT after iodized oil injection (LipCBCT), CBCT during arteriography (CBCTA) of extrahepatic collaterals. Almost all HCC lesions can be detected using these CBCT images. Three-dimensional arteriography using maximum intensity projection from CBCTHA images can identify the tumor-feeding branch. In particular, this technique is useful when the tumor stain cannot be demonstrated on arteriography. In addition, dual-phase CBCTHA can improve the diagnostic accuracy for hypervascular HCCs because corona enhancement can be detected around the tumor. To monitor the embolized area during TACE, selective CBCTHA or LipCBCT at the embolization point is useful. Two sequential CBCT scans without and with contrast material injection is also useful to confirm each embolized area of two vessels. Furthermore, CBCTA can prevent nontarget embolization. Although the image quality of CBCT is low compared to that of conventional CT, CBCT provides useful information that helps perform TACE for HCCs safely and effectively.

How I Do It: Cone-Beam CT during Transarterial Chemoembolization for Liver Cancer

“…The combination of high spatial resolution and intraarterial administration of iodinated contrast material compensates for the lower contrast resolution and provides a high-quality tumor depiction along with detailed vascular anatomy. As a result, CBCT has been shown to provide diagnostic information during TACE comparable to the level of imaging modalities such as multidetector CT and magnetic resonance (MR) imaging (49–51). Nevertheless, CBCT images are susceptible to artifacts due to noise, scatter, partial volume effects, truncation artifacts, beam hardening, ring artifacts, and motion artifacts.…”

A new angiographic imaging platform reduces radiation exposure for patients with liver cancer treated with transarterial chemoembolization

“…Thus, the relative impact of DSA on the cumulative DAP decreased from 61 % to 38 %, and the relative impact of DF and CBCT increased from 27 to 38 % and from 12 % to 24 %, respectively. Given the steady increase in the use of CBCT in TACE procedures because of its proven benefits [20][21][22][23][24][25][26], dose reduction for this imaging modality should be the next logical step to decrease cumulative radiation exposure even further.…”

Arterial blood supply to the caudate lobe of the liver from the proximal branches of the right inferior phrenic artery in patients with recurrent hepatocellular carcinoma after chemoembolization

“…Therefore, interventional radiologists should become thoroughly familiar with the possible branches of the RIPA supplying the caudate lobe in order to attempt a selective TACE procedure. CBCT during the TACE procedure may be helpful to prevent nontarget embolization and to determine whether equivocal staining on the RIPA angiography is a tumor [18].…”