Usefulness of Cone-Beam Computed Tomography During Ultraselective Transcatheter Arterial Chemoembolization for Small Hepatocellular Carcinomas that Cannot be Demonstrated on Angiography

Abstract

This study evaluated the usefulness of cone-beam computed tomography (CBCT) during ultraselective transcatheter arterial chemoembolization (TACE) for hepatocellular carcinomas (HCC) that could not be demonstrated on angiography. Twenty-eight patients with 33 angiographically occult tumors (mean diameter 1.3 +/- 0.3 cm) were enrolled in the study. The ability of CBCT during arterial portography (CBCTAP), during hepatic arteriography (CBCTHA), and after iodized oil injection (LipCBCT) to detect HCC lesions was retrospectively analyzed. The technical success of TACE was divided into three grades: complete (the embolized area included the entire tumor with at least a 5-mm wide margin), adequate (the embolized area included the entire tumor but without a 5-mm wide margin in parts), and incomplete (the embolized area did not include the entire tumor) according to computed axial tomographic (CAT) images obtained 1 week after TACE. Local tumor progression was also evaluated. CBCTAP, CBCTHA, and LipCBCT detected HCC lesions in 93.9% (31 of 33), 96.7% (29 of 30), and 100% (29 of 29) of patients, respectively. A single branch was embolized in 28 tumors, and 2 branches were embolized in five tumors. Twenty-seven tumors (81.8%) were classed as complete, and 6 (18.2%) were classed as adequate. None of the tumors were classed as incomplete. Twenty-five tumors (75.8%) had not recurred during 12.0 +/- 6.2 months. Eight tumors (24.2%), 5 (18.5%) of 27 complete success and 3 (50%) of 6 adequate success, recurred during 10.1 +/- 6.2 months. CBCT during TACE is useful in detecting and treating small HCC lesions that cannot not be demonstrated on angiography.

Can C-Arm Cone-Beam CT Detect a Micro-Embolic Effect After TheraSphere Radioembolization of Neuroendocrine and Carcinoid Liver Metastasis?

“…For example, CBCT is equally as sensitive as multiphasic MRI in detecting tumors. [7][8][9][10] A recent improvement of the CBCT is DualPhase CBCT (DPCBCT). DPCBCT (Philips Healthcare, Best, The Netherlands) can acquire multi-phasic scans using only one injection of contrast media.…”

A new angiographic imaging platform reduces radiation exposure for patients with liver cancer treated with transarterial chemoembolization

“…Thus, the relative impact of DSA on the cumulative DAP decreased from 61 % to 38 %, and the relative impact of DF and CBCT increased from 27 to 38 % and from 12 % to 24 %, respectively. Given the steady increase in the use of CBCT in TACE procedures because of its proven benefits [20][21][22][23][24][25][26], dose reduction for this imaging modality should be the next logical step to decrease cumulative radiation exposure even further.…”

Cone-Beam CT Angiography for Hepatocellular Carcinoma: Current Status

“…Iwazawa et al [29] also showed that the sensitivity in detecting tumor feeders was 87.7%. Therefore, automatic computed analysis software is able to achieve greater than 90% sensitivity in tumor feeding artery detection of hypervascular HCC lesions, which is 29-50% higher than visual identification on a nonselective DSA study [26,30,31,32,33]. Automated software may also be used to detect parasitic feeding artery from other than the proper hepatic artery and the cystic artery and select the optimal microcatheter position for drug delivery to avoid non-target embolization [34] (fig.…”