Hepatic Arterial Mapping by CT Angiography, Cone Beam CT and Digital Subtraction Angiography

Abstract

Objectives: To determine the imaging modality that provided the greatest detail of the hepatic vasculature.Background: Due to the embryonic origin of the hepatic vasculature, variations can occur. Accurate knowledge of the hepatic arterial anatomy is essential in the field of transarterial liver interventions, including chemo-and radioembolisation of liver metastasis, allowing accurate tumour targeting whilst minimising the risk of non-target embolisation.Methods: 39 patients underwent work up for Selective Internal Radiotherapy. All had CT Angiography and Digital Subtraction Angiography (DSA) carried out and 22/39 underwent a DynaCT scan. The data was analysed retrospectively to determine vasculature branching, segmental vascularisation and Right Gastric Artery (RGA) origin. Results:The vasculature variations found in our patients was comparable to previous studies using Michel's Classification. The CT Angiography only located the RGA origin in 12.8% of the patients and it was seen in 87.1% of DSAs carried out. RGAs not found on DSA were located on DynaCT. Vascularisation was comparable to previous data, with segment 4 of the liver being supplied by leftsided circulation in 78% of patients with standard branching anatomy. Conclusion:Segmental vascularisation is a more relevant way to classify vasculature with respect to radioembolisation. DSA and DynaCT are useful at determining the RGA origin, with the latter providing more details of small vasculature.

Comprehensive Review on Current Controversies and Debate in Prostate Artery Embolization

“…Cone beam CT is an important intraprocedural technique that has transformed several areas of interventional radiology (IR) practice. 57 , 58 It allows a three-dimensional acquisition during the procedure with an associated dose penalty ( Figure 3 ). 59 How often and when to use it during a procedure is, therefore, a controversial issue to ensure a balance between radiation dose and that procedural safety/efficacy is maintained.…”