Selective doxorubicin drug eluting beads chemoembolization of hypovascular hepatocellular carcinoma using cone beam computed tomography

Abstract

Hepatocellular carcinoma (HCC) of the liver is the third most common cause of cancer-related deaths in the world. Only one-third of patients with HCC are suitable candidates for hepatic resection. Transarterial chemoembolization (TACE) is performed in unresectable HCC. Drug-eluting beads (DEB) TACE is a modification of TACE, in which doxorubicin beads are used as embolizing material. These beads deliver the drug and embolize the vessels; however, it carries the risk of non-target embolization and it is difficult in cases with absent arterial blush on digital subtraction angiography (DSA). This is resolved using C-arm cone-beam computed tomography in the DSA suite. It identifies the tumor-feeding vessels, their area of supply, and differentiates between tumor and normal liver parenchyma. In addition, it is very useful in the embolization of hypovascular HCC. It helps and guides the radiologist in performing TACE effectively and also prevents non-target embolization of normal liver parenchyma.

Agitated saline sonography: a simple technique for intraprocedural feeder identification during transcatheter arterial chemoembolization of hepatocellular carcinoma

“…Guidance to tumor vessels is usually by two-dimensional angiography, coupled with a prior knowledge of vascular anatomy based on an arterial phase multi-detector CT scan done before the procedure (2, 3). Accurate feeder vessel cannulation for embolization is required so that the intended dose of chemotherapeutic drug reaches the tumor and maximum residual liver parenchymal blood supply is preserved (2,4). Liver tissue preservation is especially important in patients who already have mild to moderate liver cell dysfunction, where inadvertent necrosis can land the patient in hepatic encephalopathy.…”

“…TACE is a widely used treatment modality for hepatocellular carcinoma not amenable for surgery or percutaneous ablative treatments (1)(2)(3)(4). Guidance to tumor vessels is usually by two-dimensional angiography, coupled with a prior knowledge of vascular anatomy based on an arterial phase multi-detector CT scan done before the procedure (2, 3).…”

“…T ranscatheter arterial chemoembolization (TACE) is an excellent treatment modality for patients with hepatocellular carcinoma not amenable for surgery or percutaneous ablation therapies (1)(2)(3)(4). The success of TACE depends on selectiveness and adequacy of chemoembolic agent delivery within the tumor vascular bed, preserving maximal liver cell function.…”

“…Arterial phase computed tomography (CT) is done as part of planning TACE to locate tumor, map feeder vessels, and look for extrahepatic tumor arterial supply (1). Intraprocedural catheter placement is routinely guided by two-dimensional cine and digital subtraction angiography acquisitions; however, confident superselective catheter placement cannot be possible with such guidance alone in certain situations (2)(3)(4). This problem has been overcome with the advent of cone beam (C-arm) CT and vessel detection software; however, they are not widely available (2)(3)(4)(5).…”

“…Intraprocedural catheter placement is routinely guided by two-dimensional cine and digital subtraction angiography acquisitions; however, confident superselective catheter placement cannot be possible with such guidance alone in certain situations (2)(3)(4). This problem has been overcome with the advent of cone beam (C-arm) CT and vessel detection software; however, they are not widely available (2)(3)(4)(5). The cases presented here illustrate application of an easily available and simple method that uses a portable ultrasonography (US) machine for distinguishing tumor vessels from normal vessels prior to embolization.…”