Hepatoma feeding arteriogram created by CT during aortography using IVR 64-multidetector-row CT for catheterization in transcatheter arterial chemoembolization for hepatocellular carcinoma

Abstract

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.

Efficacy of automated tumor‐feeder detection software using cone‐beam computed tomography technology in transarterial embolization through extrahepatic collateral vessels for malignant hepatic tumors

“…There is a possibility that tumor‐feeders arising from other arteries or the aorta may remain other than the embolized branches. CT during aortography may be useful to detect all tumor‐feeders from the hepatic and extrahepatic collateral vessels; however, it may require a large amount of contrast material. Third, TACE through the cystic, right colic and left gastric arteries was performed with complete confidence in AFD.…”

Combined Angio-CT Systems: A Roadmap Tool for Precision Therapy in Interventional Oncology

“…Nevertheless, combined CTHA and CTAP can outperform diagnostic CT (25,26) and affect choice of treatment, especially in those patients presenting with HCC recurrence (25) (Fig 2). The use of CTHA and CTAP during transarterial hepatic therapy procedures has been demonstrated to be a highly sensitive method not only to identify liver tumors and their hepatic feeding arteries but also to detect important extrahepatic feeding arteries (27,28) and hepatic arterial variations (Fig 3). Ozaki et al analyzed the visualization of extrahepatic feeding arteries at digital subtraction angiography (DSA) and CTHA; they reported that use of CTHA resulted in higher frequencies of detection of extrahepatic arterial branches than DSA (98.0% vs 40.6% for the same 943 patients) (29).…”

Volume-rendered hemorrhage-responsible arteriogram created by 64 multidetector-row CT during aortography: utility for catheterization in transcatheter arterial embolization for acute arterial bleeding

“…The protocol used for MDCT-AA follows that for detecting the feeding artery for hepatocellular carcinoma described in a previous report (Minamiguchi et al [2013]). In short, a 3 F pigtail catheter (70 cm, Medikit) was advanced so that its tip was positioned at the level of the tracheal bifurcation.…”

“…The hemorrhage-responsible arteriogram is created on the same basis as that reported for a hepatoma-feeding arteriogram (Minamiguchi et al [2013]). In short, the hemorrhage-responsible arteriogram using MDCTAo is synthesized using three basic VR images: a background bone VR image, an aorta–branch artery VR image, and a hemorrhage–responsible artery VR image.…”

“…Angio CT is particularly useful for investigating the hemodynamics of small hepatocellular carcinoma (HCC), and has enabled improved understanding of the growth process from early HCC to mature HCC (Matsui et al [1985]; Hayashi et al [2002]; Honda et al [2000]; Kitao et al [2009]; Matsui et al [2011]; Lee et al [2002]). Hepatoma-feeding arteriograms that were created by MDCT during aortography (MDCTAo) were previously reported to be displayed on the monitor in the angiography room and used for catheterization of feeding arteries to a HCC (Minamiguchi et al [2013]). Accordingly, it should be possible to apply MDCTAo to patients with acute arterial bleeding, to map the hemorrhage site and to navigate catheterization to the artery responsible for hemorrhage.…”