Abstract
Cone-beam computed tomography (CBCT) using a flat-panel detector is an alternative method of obtaining cross-sectional images. This technique is now being used during transcatheter arterial chemoembolization (TACE) for inoperable hepatocellular carcinoma (HCC). Several CBCT techniques are performed to detect HCC lesions: CBCT during portography (CBCTAP), CBCT during hepatic arteriography (CBCTHA), CBCT after iodized oil injection (LipCBCT), CBCT during arteriography (CBCTA) of extrahepatic collaterals. Almost all HCC lesions can be detected using these CBCT images. Three-dimensional arteriography using maximum intensity projection from CBCTHA images can identify the tumor-feeding branch. In particular, this technique is useful when the tumor stain cannot be demonstrated on arteriography. In addition, dual-phase CBCTHA can improve the diagnostic accuracy for hypervascular HCCs because corona enhancement can be detected around the tumor. To monitor the embolized area during TACE, selective CBCTHA or LipCBCT at the embolization point is useful. Two sequential CBCT scans without and with contrast material injection is also useful to confirm each embolized area of two vessels. Furthermore, CBCTA can prevent nontarget embolization. Although the image quality of CBCT is low compared to that of conventional CT, CBCT provides useful information that helps perform TACE for HCCs safely and effectively.
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Miyayama S, Matsui O, Yamashiro M, Ryu Y, Kaito K, Ozaki K, et al. Ultraselective transcatheter arterial chemoembolization with a 2-F tip microcatheter for small hepatocellular carcinomas: relationship between local tumor recurrence and visualization of the portal vein with iodized oil. J Vasc Interv Radiol 2007;18:365–376.
Takayasu K, Moriyama N, Muramatsu Y, Shima Y, Ushio K, Yamada T, et al. Gallbladder infarction after hepatic artery embolization. AJR Am J Roentgenol 1985;144:135–138.
Arora R, Soulen MC, Haskal ZJ. Cutaneous complications of hepatic chemoembolization via extrahepatic collaterals. J Vasc Interv Radiol 1999;10:1351–1356.
Kim HC, Chung JW, Lee W, Jae HJ, Park JH. Recognizing extrahepatic collateral vessels that supply hepatocellular carcinoma to avoid complications of transcatheter arterial chemoembolization. Radiographics 2005;25:S25–S39.
Miyayama S, Matsui O, Taki K, Minami T, Ryu Y, Ito C, et al. Extrahepatic blood supply to hepatocellular carcinoma: angiographic demonstration and transcatheter arterial chemoembolization. Cardiovasc Intervent Radiol 2006;29:39–48.
Takayasu K, Muramatsu Y, Maeda T, Iwata R, Furukawa H, Muramatsu Y, et al. Targeted transarterial oily chemoembolization for small foci of hepatocellular carcinoma using a unified helical CT and angiography system: analysis of factors affecting local recurrence and survival rates. AJR Am J Roentogenol 2001;176:681–688.
Hirota S, Nakao N, Yamamoto S, Kobayashi K, Maeda H, Ishikawa R, et al. Cone-beam CT with flat-panel-detector digital angiography system: early experience in abdominal interventional procedures. Cardiovasc Intervent Radiol 2006;29:1034–1038.
Kakeda S, Korogi Y, Ohnari N, Moriya J, Oda N, Nishino K, et al. Usefulness of cone-beam CT with flat panel detectors in conjunction with catheter angiography for transcatheter arterial embolization. J Vasc Interv Radiol 2007;18:1508–1516.
Miyayama S, Matsui O, Yamashiro M, Ryu Y, Takata H, Takeda T, et al. Detection of hepatocellular carcinoma by CT during arterial portography using a cone-beam CT technology: comparison with conventional CTAP. Abdom Imaging 2009;34:502–506.
Miyayama S, Yamashiro M, Okuda M, Yoshie Y, Sugimori N, Igarashi S, et al. Usefulness of cone-beam computed tomography during ultraselective transcatheter arterial chemoembolization for small hepatocellular carcinomas that cannot be demonstrated on angiography. Cardiovasc Intervent Radiol 2009;32:255–264.
Tognolini A, Louie JD, Hwang GL, Hofmann LV, Sze DY, Kothary N. Utility of C-arm CT in patients with hepatocellular carcinoma undergoing transhepatic arterial chemoembolization. J Vasc Interv Radiol 2010;21:339–347.
Miyayama S, Yamashiro M, Okuda M, Yoshie Y, Nakashima Y, Ikeno H, et al. Detection of corona enhancement of hypervascular hepatocellular carcinoma by C-arm dual-phase conebeam CT during hepatic arteriography. Cardiovasc Intervent Radiol 2011;34:81–86.
Ueda K, Matsui O, Kawamori Y, Nakanuma Y, Kadoya M, Yoshikawa J, et al. Hypervascular hepatocellular carcinoma: evaluation of hemodynamics with dynamic CT during hepatic arteriography. Radiology 1998;206:161–166.
Kitao A, Zen Y, Matsui O, Gabata T, Nakanuma Y. Hepatocarcinogenesis: multistep changes of drainage vessels at CT during arterial portography and hepatic arteriography—radiologic-pathologic correlation. Radiology 2009;252:605–614.
Ueda K, Matsui O, Kawamori Y, Kadoya M, Yoshikawa J, Gabata T, et al. Differentiation of hypervascular hepatic pseudolesions from hepatocellular carcinoma: value of single-level dynamic CT during hepatic arteriography. J Comput Assist Tomogr 1998;22:703–708.
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Miyayama, S., Yamashiro, M., Hattori, Y. et al. Efficacy of cone-beam computed tomography during transcatheter arterial chemoembolization for hepatocellular carcinoma. Jpn J Radiol 29, 371–377 (2011). https://doi.org/10.1007/s11604-011-0568-8
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DOI: https://doi.org/10.1007/s11604-011-0568-8