Tracking Navigation Imaging of Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma Using Three-Dimensional Cone-Beam CT Angiography

Abstract

Purpose: New tracking navigation imaging software was used to evaluate the usefulness of three dimensional (3D) CT angiography for transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Materials and Methods: Fifty-two patients with 73 HCCs were enrolled in this study retrospectively. Rotational angiography was performed from the hepatic artery for evaluation of the tumor feeding vessels. Arteries feeding the tumor were traced automatically by adjusting the region of interest around the targeted tumor on axial and coronal images using tracking navigation imaging with 3D cone-beam CT angiography. Results: Using final selective angiographic findings as the gold standard, the detection of feeding vessels was 90.4% (66/73) for tracking navigation imaging and 50.7% (37/73) for celiac trunk angiography. This difference was statistically significant (Wilcoxon rank sum test, p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value for the detection of feeding arteries were 97.1% (66/68), 80.0% (4/5), 98.5% (66/67), and 66.7% (4/6), respectively. The kappa coefficient had a value of 0.638 (95% CI: 0.471-0.805), which is considered to indicate a good degree of agreement. With the assistance of tracking navigation imaging, the disease control rate of TACE for HCC was 67.3% (35/52) according to the modified Response Evaluation Criteria in Solid Tumors. During follow-up periods of 1-11 months, 10 patients (19.2%) remained cancer-free after TACE. Conclusion: Tracking navigation imaging with 3D cone-beam CT angiography should be useful for TACE in HCC patients with complicated feeding arteries.

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

“…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.…”

Immune Checkpoint Blockade in Hepatocellular Carcinoma

“…The unmet needs in the treatment of HCC are present at various stages (early, intermediate, and advanced stages) and in various settings, such as neoadjuvant and/or adjuvant settings before and after resection [31,32] or ablation [33,34], adjuvant settings after transcatheter arterial chemoembolization [35,36], and first- or second-line treatment for advanced HCC. In combination treatment strategies with these locoregional therapies, the blockade of this novel PD-1/PD-L1 pathway will play a major role.…”