Three-dimensional C-arm Cone-beam CT: Applications in the Interventional Suite

Wallace, Michael J.; Kuo, Michael; Glaiberman, Craig B.; Binkert, Christoph A.; Orth, Robert C.; Soulez, Gilles

doi:10.1016/j.jvir.2009.04.059

Cited by 111 publications

(65 citation statements)

References 9 publications

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“…CBCT-HA is the most common technique for intraprocedural HCC detection and is recommended as part of the CardioVascular and Interventional Radiological Society of Europe/Society of Interventional Radiology protocol guidelines for selective TACE (9,64,65,71). This technique involves a single CBCT acquisition with one contrast medium injection through a catheter or a microcatheter positioned in the celiac trunk, common hepatic artery, proper hepatic artery, or selective right or left hepatic artery.…”

Section: Cbct To “See” the Tumor: Rationale And Techniquesmentioning

confidence: 99%

How I Do It: Cone-Beam CT during Transarterial Chemoembolization for Liver Cancer

Tacher¹,

Radaelli²,

Lin³

et al. 2015

Radiology

144

119

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Cone-beam computed tomography (CBCT) is an imaging technique that provides computed tomographic (CT) images from a rotational scan acquired with a C-arm equipped with a flat panel detector. Utilizing CBCT images during interventional procedures bridges the gap between the world of diagnostic imaging (typically three-dimensional imaging but performed separately from the procedure) and that of interventional radiology (typically two-dimensional imaging). CBCT is capable of providing more information than standard two-dimensional angiography in localizing and/or visualizing liver tumors (“seeing” the tumor) and targeting tumors though precise microcatheter placement in close proximity to the tumors (“reaching” the tumor). It can also be useful in evaluating treatment success at the time of procedure (“assessing” treatment success). CBCT technology is rapidly evolving along with the development of various contrast material injection protocols and multiphasic CBCT techniques. The purpose of this article is to provide a review of the principles of CBCT imaging, including purpose and clinical evidence of the different techniques, and to introduce a decision-making algorithm as a guide for the routine utilization of CBCT during transarterial chemoembolization of liver cancer.

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Section: Cbct To “See” the Tumor: Rationale And Techniquesmentioning

confidence: 99%

How I Do It: Cone-Beam CT during Transarterial Chemoembolization for Liver Cancer

Tacher¹,

Radaelli²,

Lin³

et al. 2015

Radiology

144

119

View full text Add to dashboard Cite

show abstract

“…Quantitative image processing algorithms may be applied to an angiogram to assess tumor blood flow and the degree of stasis [91]. The emergence of cone beam CT, where a traditional C-arm is used to generate 3D imaging data, may help guide and monitor TACE [92–94]. A combination of cone beam CT and radiopaque DEBs may allow for intraprocedural determination of DEB and/or drug spatial distribution.…”

Section: Future Directions In Deb-tacementioning

confidence: 99%

Locoregional drug delivery using image-guided intra-arterial drug eluting bead therapy

Lewis

Dreher

2012

Journal of Controlled Release

102

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Lipiodol-based transarterial chemoembolization (TACE) has been performed for over 3 decades for the treatment of solid tumors and describes the infusion of chemotherapeutic agents followed by embolization with particles. TACE is an effective treatment for inoperable hepatic tumors, especially hypervascular tumors such as hepatocellular carcinoma. Recently, drug eluting beads (DEBs), in which a uniform embolic material is loaded with a drug and delivered in a single image-guided step, have been developed to reduce the variability in a TACE procedure. DEB-TACE results in localization of drug to targeted tumors while minimizing systemic exposure to chemotherapeutics. Once localized in the tissue, drug is eluted from the DEB in a controlled manner and penetrates hundreds of microns of tissue from the DEB surface. Necrosis is evident surrounding a DEB in tissue days to months after therapy; however, the contribution of drug and ischemia is currently unknown. Future advances in DEB technology may include image-ability, DEB size tailored to tumor anatomy and drug combinations.

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“…63 In addition, the more recent contrast-enhanced dual-phase CBCT, based on the accumulation of information provided by consecutive acquisitions performed at different phases (e.g., arterial, portal venous, or delayed), has allowed more sensitive detection of liver tumors and improved assessment of tumor-feeding vessel devascularization after DEB-TACE. 64,65 Furthermore, the feasibility of ultrafast CBCT, which uses the rotation of a double x-ray tube detector to acquire faster 3D volume data, has been studied with promising results for tumor and feeding vessel detection and catheter localization.…”

Section: Clinical Introduction and Standardization Of Cone-beam Ct Immentioning

confidence: 99%

Interventional Oncology in Hepatocellular Carcinoma

et al. 2016

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The clinical management of hepatocellular carcinoma has evolved greatly in the last decade mostly through recent technical innovations. In particular, the application of cutting edge image guidance has led to minimally invasive solutions for complex clinical problems and rapid advances in the field of interventional oncology. Many image-guided therapies, such as transarterial chemoembolization and radiofrequency ablation have meanwhile been fully integrated into interdisciplinary clinical practice, while others are currently being investigated. This review will summarize and evaluate the most relevant completed and ongoing clinical trials, provide a synopsis of recent innovations in the field of intra-procedural imaging and tumor response assessment, and offer an outlook on new technologies, such as radiopaque embolic materials. In addition, combination therapies consisting of loco-regional therapies and systemic molecular targeted agents (e.g., sorafenib) remains of major interest to the field and will also be discussed. Finally, we will address the many substantial advances in immune response pathways that have been related to the systemic effects of loco-regional therapies. Knowledge of these new developments is crucial as they continue to shape the future of cancer treatment, further establishing interventional oncology along with surgical, medical, and radiation oncology as the 4th pillar of cancer care.

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Three-dimensional C-arm Cone-beam CT: Applications in the Interventional Suite

Cited by 111 publications

References 9 publications

How I Do It: Cone-Beam CT during Transarterial Chemoembolization for Liver Cancer

How I Do It: Cone-Beam CT during Transarterial Chemoembolization for Liver Cancer

Locoregional drug delivery using image-guided intra-arterial drug eluting bead therapy

Interventional Oncology in Hepatocellular Carcinoma

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