Usefulness of Cone-Beam Volume CT with Flat Panel Detectors in Conjunction with Catheter Angiography for Transcatheter Arterial Embolization

Kakeda, Shingo; Korogi, Yukunori; Ohnari, Norihiro; Moriya, Junji; Oda, Nobuhiro; Nishino, Ko; Miyamoto, Wataru

doi:10.1016/j.jvir.2007.08.003

Cited by 112 publications

(65 citation statements)

References 21 publications

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“…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.…”

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confidence: 99%

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

Pellerin

Lin²,

Bhagat

et al. 2013

Cancer Biotherapy and Radiopharmaceuticals

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Rational and Objective: Radioembolization with yttrium-90 microspheres is a therapy that is used for hepatic tumors. 20-30 lm microspheres loaded with Y90 are supposedly occluding tumor vessels at the capillary level. Then, these spheres deliver high-dose radiation to the tumor. However, this theoretical embolic effect has never been appreciated in imaging. Dual-Phase cone-beam computed tomography (DPCBCT) is a multi-phasic intraprocedural scan that uses only one contrast media injection to visualize early (feeding vessel) and delayed (capillary level) tumor enhancement. The purpose of this study was to determine whether there is a microembolic effect induced by TheraSpheresÒ (MDS Nordion, Ottawa, Ontario, Canada) at the capillary level by using DPCBCT imaging. Materials and Methods: 14 patients with 72 carcinoid or neuroendocrine tumors were treated with radioembolization, and all underwent DPCBCT (Allura Xper, Philips Healthcare) imaging before and immediately after radioembolization with TheraSpheresÒ. Tumor enhancement was measured in each phase by drawing a region of interest within the tumors. Results: 72 tumors were evaluated: average tumor density in the early arterial phase was 241 and 230 Hounsfield units (HU) ( p < 0.001) before and after radioembolization, respectively; the average density in the delayed arterial phase was 226 and 161 HU ( p < 0.001) before and after radioembolization, respectively. Average difference in tumor attenuation before and after radioembolization in early arterial and delayed phase was 11 HU and 64 HU ( p < 0.001), respectively. Conclusion: The significant decrease in tumor enhancement in the DPCBCT delayed phase after TheraSpheresÒ injection indicates that there is an appreciable microembolic effect at the tumor capillary bed level.

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confidence: 99%

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

Pellerin

Lin²,

Bhagat

et al. 2013

Cancer Biotherapy and Radiopharmaceuticals

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Schernthaner

Durán

Chapiro

et al. 2015

Journal of Vascular and Interventional Radiology

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Objectives To quantify the reduction of radiation liver cancer patients are exposed to during transarterial chemoembolization (TACE), while maintaining diagnostic image quality, using a new C-arm imaging platform. Methods In this prospective, HIPAA-compliant, IRB-approved, two-arm trial, 78 consecutive patients with primary or secondary liver cancer were treated with TACE on a C-arm imaging platform before and after an upgrade incorporating optimized acquisition parameters and advanced real-time image processing algorithms. Dose area product (DAP) and radiation time of each digital fluoroscopy (DF), digital subtraction angiography (DSA) and cone beam CT (CBCT) were recorded. DSA image quality was assessed by two blinded and independent readers on a four-rank scale. Results Both cohorts showed no significant differences with regard to patient characteristics and tumour burden. The new system resulted in a statistically significant reduction of cumulative DAP of 66 % compared to the old platform (median 132.9 vs. 395.8 Gy cm 2 ). Individually, DAP of DF, DSA and CBCT decreased by 52 %, 79 % and 15 % (p<0.01, p<0.01, p=0.51), respectively. No statistically significant differences in DSA image quality were found between the two imaging platforms. Conclusions The new imaging platform significantly reduced radiation exposure for TACE procedures without increased radiation time or negative impact on DSA image quality. Key Points• The new C-arm system allowed reduction of radiation exposure by two thirds • The procedure's course was not affected by the new platform • No decrease in DSA image quality was observed after the radiation reduction

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“…Although 3D rotational angiography has been one of the most commonly used interventional neuroradiology procedures, its use has also been applied to renal (23), uterine (24) and liver procedures (25)(26)(27). In previous studies, the use of conventional 3D rotational angiography helped to delineate complex vascular anatomy and this facilitated the subsequent delivery of a microcatheter to the target vessels.…”

Section: Discussionmentioning

confidence: 99%

Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

2011

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Objective: We wanted to assess the usefulness of rotational angiography after endoscopic marking with a metallic clip in upper gastrointestinal bleeding patients with no extravasation of contrast medium on conventional angiography. Materials and Methods: In 16 patients (mean age, 59.4 years) with acute bleeding ulcers (13 gastric ulcers, 2 duodenal ulcers, 1 malignant ulcer), a metallic clip was placed via gastroscopy and this had been preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. All patients had negative results from their angiographic studies. To localize the bleeding focus, rotational angiography and high pressure angiography as close as possible to the clip were used. Results: Of the 16 patients, seven (44%) had positive results after high pressure angiography as close as possible to the clip and they underwent transcatheter arterial embolization (TAE) with microcoils. Nine patients without extravasation of contrast medium underwent TAE with microcoils as close as possible to the clip. The bleeding was stopped initially in all patients after treatment of the feeding artery. Two patients experienced a repeat episode of bleeding two days later. Of the two patients, one had subtle oozing from the ulcer margin and that patient underwent endoscopic treatment. One patient with malignant ulcer died due to disseminated intravascular coagulation one month after embolization. Complete clinical success was achieved in 14 of 16 (88%) patients. Delayed bleeding or major/minor complications were not noted. Conclusion: Rotational angiography after marking with a metallic clip helps to localize accurately the bleeding focus and thus to embolize the vessel correctly.

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Usefulness of Cone-Beam Volume CT with Flat Panel Detectors in Conjunction with Catheter Angiography for Transcatheter Arterial Embolization

Cited by 112 publications

References 21 publications

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

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

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

Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

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