Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA) to Improve Tumor Visualization, Navigation and Margin Confirmation in Percutaneous Liver Tumor Ablation

Abstract

Purpose We present a technique that combines Hepatic Arteriography with C-arm CT-Guided Ablation (HepACAGA) to improve tumor visualization, navigation and margin confirmation for percutaneous ablation of liver tumors. Materials and Methods All consecutive patients scheduled for HepACAGA between April 20th, 2021, and November 2nd, 2021, were included in this retrospective, cohort study. HepACAGA was performed in an angiography-suite under general anesthesia. The hepatic artery was catheterized for selective contrast injection. C-arm CT and guidance software were then used to visualize the tumor and the microwave antenna was inserted during apnea. Pre- and post-ablation C-arm CTs were performed and ablation margins assessed. Technical success, antenna placement deviation, number of repositions, tumor recurrence, and safety were evaluated. Technical success was defined as a tumor that was ablated according to the HepACAGA technique. Results A total of 21 patients (28 tumors) were included. The main tumor type was colorectal cancer liver metastases (11/21, 52%), followed by hepatocellular carcinoma (7/21, 33%), neuroendocrine tumor metastases (1/21, 5%), and other tumor types (2/21, 10%). The technical success rate was 93% (26/28 tumors) with two small hypovascular lesions unable to be identified. A single microwave antenna was used in all patients. The median antenna placement deviation was 1 mm (range 0–6 mm). At a median follow-up time of 16 months (range 5–22 months), there was no tumor recurrence in any patient. Safety analysis showed a complication rate of 5% grade 2 and 5% grade 3. Conclusion HepACAGA was demonstrated to be a safe and effective percutaneous ablation technique, without any local tumor recurrence in this study. Graphic Abstract

The Added Value of Transcatheter CT Hepatic Angiography (CTHA) Image Guidance in Percutaneous Thermal Liver Ablation: An Experts’ Opinion Pictorial Essay

“…Although arterial and portal venous phases may exhibit reduced tumor delineation when selective catheterization of the common or proper hepatic artery did not succeed, in the vast majority of cases, in our opinion, tip dislocation during bed-to-bed movements did not significantly compromise the images when higher dosages of contrast agents were administered. Extra bed-to-bed movements can be prevented either by using a mobile C-arm system in the CT suite, if suitable for the CT system, or by performing the entire ablation procedure in the angiography suite using a combined hybrid angiography-CT system [ 21 , 26 , 27 , 28 ].…”

“…In MD Anderson Cancer Center, ablations are either performed by conventional CTHA guidance or by using a combined hybrid angiography-CT system for the more recent cases (Nexaris Angio-CT, Siemens Healthineers AG, Erlangen, Germany) [ 20 ]. In Utrecht UMC, the ablation is performed using the C-arm Cone-beam CT within the angiography system (Philips Azurion; Philips Healthcare, Best, The Netherlands) [ 21 ]. Each case is accompanied by diagnostic imaging and intraprocedural CTHA images.…”

“…Local tumor progression in segment 8 after parenchymal-sparing hepatectomy and intra-operative and percutaneous microwave ablations. After administration of 20 mL intra-arterial contrast (Visipaque™, iodixanol, 320 mg Iodine/mL, GE Healthcare Inc., Marlborough, MA, USA) in the common hepatic artery, the recurring tumor tissue became visible by a clear ‘incomplete ring sign’ adjacent to the prior ablation zone (( A ), CTHA with a combined hybrid angio-CT system) [ 21 ]. Intraprocedural CTHA imaging depicted an incidental contrast agent within the bile duct (arrow), consistent with hemobilia ( B ).…”

Conventional versus Hepatic Arteriography and C-Arm CT-Guided Ablation of Liver Tumors (HepACAGA): A Comparative Analysis

“…Patient transfer increases the risk of catheter dislodgment and contamination. Moreover, this two-room procedure can pose logistical challenges [15].…”

“…The initial results of HepACAGA were promising, with a high technical success rate and a low tumor recurrence rate [15]. The aim of this study was to compare the outcomes of patients treated with HepACAGA with patients treated with conventional US-/CT-guided ablation.…”