CardioVascular and Interventional Radiology

, Volume 42, Issue 2, pp 260–267 | Cite as

Visibility of Hypovascularized Liver Tumors during Intra-Arterial Therapy Using Split-Bolus Single-Phase Cone Beam CT

  • Martin JonczykEmail author
  • Federico Collettini
  • Dirk Schnapauff
  • Dominik Geisel
  • Georg Böning
  • Willie M. Lüdemann
  • Gero Wieners
  • Bernd Hamm
  • Bernhard Gebauer
Clinical Investigation Imaging
Part of the following topical collections:
  1. Imaging



To validate a split-bolus contrast injection protocol for single-phase CBCT in terms of detectability of hypovascular liver tumors compared to digital subtraction angiography (DSA).

Materials and Methods

In this retrospective, single-center study, 20 consecutive patients with in total 77 hypovascularized tumors referred for intra-arterial therapy received a split-bolus single-phase CBCT. Two readers rated the visibility of the target tumors scheduled for embolization in CBCT and DSA compared to the pre-interventional multiphasic CT or MRI used as reference on a 3-point scoring system (1 = optimal, 3 = not visible) and catheter-associated artifacts (1 = none, 3 = extended). SNR, CNR and contrast values were derived from 37 target tumors in CBCT and MRI. Statistical analysis included the kappa test to determine interrater reliability, the Friedman’s test for the inter-modality comparison evaluating tumor visibility in DSA and CBCT as well as for quantitative assessment. Post hoc analysis included the Wilcoxon signed-rank test. p values < 0.05 were considered significant.


Ninety percentage of target tumors were rated as visible in CBCT and 37.5% in DSA (p < 0.001). 70.1% of pre-interventionally detected hypovascularized tumors were depicted with CBCT and 31.2% by DSA (p < 0.001). 7.8% of known tumors were outside the FOV. Quantitative assessment showed higher image contrasts in CBCT (1.91 ± 7.01) compared to hepatobiliary-phase MRI (0.29 ± 0.14, p = 0.003) and to portal-venous (p.v.) MRI (0.31 ± 0.13, p < 0.001), but higher CNR for MRI (1.18 ± 0.80; 13.92 ± 15.82; 13.79 ± 6.65).


In conclusion, the split-bolus single-phase CBCT detects significantly more hypovascularized liver tumors compared to DSA performed through the proper hepatic artery with high image contrasts.

Level of Evidence

Level III, diagnostic study.


Cone beam CT DSA Transarterial chemoembolization Hypovascularized Liver tumors 



Dr. Martin Jonczyk and Dr. Federico Collettini participate in the BIH‐Charité Clinical Scientist Program (DM.BIH-04.15) funded by the Charité – Universitätsmedizin Berlin and the Berlin Institute of Health.

Compliance with Ethical Standards

Conflicts of interests

MJ reports Grants from BIH Clinical Scientist and Philips Healthcare during the conduct of the study; DG reports personal fees from Bayer AG during the conduct of the study; BH reports Grants from Philips Healthcare, Bayer AG, GE, Siemens and Terumo during the conduct of the study. All other authors have nothing to disclose in relation to this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of RadiologyCharité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of HealthBerlinGermany
  2. 2.Berlin Institute of Health (BIH)BerlinGermany

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