European Radiology

, Volume 19, Issue 9, pp 2302–2309 | Cite as

The value of combined soft-tissue and vessel visualisation before transarterial chemoembolisation of the liver using C-arm computed tomography

  • B. C. MeyerEmail author
  • M. Witschel
  • B. B. Frericks
  • M. Voges
  • W. Hopfenmüller
  • K.-J. Wolf
  • F. K. Wacker


The purpose of the study was to prospectively evaluate intrahepatic vessel depiction on C-arm CT (CACT) and the influence of the additional combined tissue and three-dimensional vessel visualisation on the positioning of the TACE catheter in comparison to DSA alone. Thirty consecutive patients scheduled for their first transarterial chemoembolisation underwent biphasic CACT and DSA of the liver. After assessing the DSA images for procedure planning, the CACT images were reviewed. The number and origin of the tumour-feeding arteries and the ideal position of the catheter for TACE on both DSA and CACT were assessed and correlated. The number of vessels identified as tumour feeders in each patient was significantly higher using additional CACT than on DSA alone (CACT: 4.0 ± 1.7; DSA: 3.3 ± 1.4; P = 0.003, t-test). After considering CACT, in 50% of the patients the catheter position was changed for TACE. Segmental portal vein thrombosis was seen in three patients on CACT, but in only one on DSA. As CACT depicts soft tissue and small vessels with high spatial resolution, tumour vessel allocation is facilitated, and ideal catheter position for TACE can be more accurately identified. The high impact of CACT on the TACE procedure suggests the benefits of its routine use for all patients undergoing their first TACE.





The authors express their gratitude to Bonnie Hami, MA, USA, for her helpful editorial assistance in preparing and reviewing the manuscript.


  1. 1.
    Llovet JM, Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology 37:429–442PubMedCrossRefGoogle Scholar
  2. 2.
    Peters S, Voelter V, Zografos L, Pampallona S, Popescu R, Gillet M, Bosshard W, Fiorentini G, Lotem M, Weitzen R et al (2006) Intra-arterial hepatic fotemustine for the treatment of liver metastases from uveal melanoma: experience in 101 patients. Ann Oncol 17:578–583PubMedCrossRefGoogle Scholar
  3. 3.
    Kim HC, Chung JW, Lee W, Jae HJ, Park JH (2005) Recognizing extrahepatic collateral vessels that supply hepatocellular carcinoma to avoid complications of transcatheter arterial chemoembolization. Radiographics 25 Suppl 1:S25–S39CrossRefGoogle Scholar
  4. 4.
    Meyer BC, Frericks BB, Voges M, Borchert M, Martus P, Justiz J, Wolf KJ, Wacker FK (2008) Visualization of hypervascular liver lesions during TACE: comparison of angiographic C-arm CT and MDCT. AJR Am J Roentgenol 190:W263–W269PubMedCrossRefGoogle Scholar
  5. 5.
    Meyer BC, Frericks BB, Albrecht T, Wolf KJ, Wacker FK (2007) Contrast-enhanced abdominal angiographic CT for intra-abdominal tumor embolization: a new tool for vessel and soft tissue visualization. Cardiovasc Intervent Radiol 30:743–749PubMedCrossRefGoogle Scholar
  6. 6.
    Lin LI (1989) A concordance correlation coefficient to evaluate reproducibility. Biometrics 45:255–268PubMedCrossRefGoogle Scholar
  7. 7.
    Murakami R, Yoshimatsu S, Yamashita Y, Sagara K, Arakawa A, Takahashi M (1994) Transcatheter hepatic subsegmental arterial chemoembolization therapy using iodized oil for small hepatocellular carcinomas. Correlation between lipiodol accumulation pattern and local recurrence. Acta Radiol 35:576–580PubMedGoogle Scholar
  8. 8.
    Hirai T, Korogi Y, Ono K, Maruoka K, Harada K, Aridomi S, Takahashi M (2001) Intraarterial chemotherapy or chemoembolization for locally advanced and/or recurrent hepatic tumors: evaluation of the feeding artery with an interventional CT system. Cardiovasc Intervent Radiol 24:176–179PubMedCrossRefGoogle Scholar
  9. 9.
    Sze DY, Razavi MK, So SK, Jeffrey RB Jr. (2001) Impact of multidetector CT hepatic arteriography on the planning of chemoembolization treatment of hepatocellular carcinoma. AJR Am J Roentgenol 177:1339–1345PubMedGoogle Scholar
  10. 10.
    Heran NS, Song JK, Namba K, Smith W, Niimi Y, Berenstein A (2006) The utility of DynaCT in neuroendovascular procedures. AJNR Am J Neuroradiol 27:330–332PubMedGoogle Scholar
  11. 11.
    Benndorf G, Strother CM, Claus B, Naeini R, Morsi H, Klucznik R, Mawad ME (2005) Angiographic CT in cerebrovascular stenting. AJNR Am J Neuroradiol 26:1813–1818PubMedGoogle Scholar
  12. 12.
    Hirota S, Nakao N, Yamamoto S, Kobayashi K, Maeda H, Ishikura R, Miura K, Sakamoto K, Ueda K, Baba R (2006) Cone-beam CT with flat-panel-detector digital angiography system: early experience in abdominal interventional procedures. Cardiovasc Intervent Radiol 29:1034–1038PubMedCrossRefGoogle Scholar
  13. 13.
    Virmani S, Ryu RK, Sato KT, Lewandowski RJ, Kulik L, Mulcahy MF, Larson AC, Salem R, Omary RA (2007) Effect of C-arm angiographic CT on transcatheter arterial chemoembolization of liver tumors. J Vasc Interv Radiol 18:1305–1309PubMedCrossRefGoogle Scholar
  14. 14.
    Meyer BC, Peter O, Nagel M, Hoheisel M, Frericks BB, Wolf KJ, Wacker FK (2008) Electromagnetic field-based navigation for percutaneous punctures on C-arm CT: experimental evaluation and clinical application. Eur Radiol 18:2855–2864PubMedCrossRefGoogle Scholar
  15. 15.
    Wallace MJ, Murthy R, Kamat PP, Moore T, Rao SH, Ensor J, Gupta S, Ahrar K, Madoff DC, McRae SE et al (2007) Impact of C-arm CT on hepatic arterial interventions for hepatic malignancies. J Vasc Interv Radiol 18:1500–1507PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • B. C. Meyer
    • 1
    Email author
  • M. Witschel
    • 1
  • B. B. Frericks
    • 1
  • M. Voges
    • 1
  • W. Hopfenmüller
    • 2
  • K.-J. Wolf
    • 1
  • F. K. Wacker
    • 1
    • 3
  1. 1.Department of Radiology and Nuclear MedicineCharité-University Hospital, Campus Benjamin FranklinBerlinGermany
  2. 2.Department of Biometry and Clinical EpidemiologyCharité-University Hospital, Campus Benjamin FranklinBerlinGermany
  3. 3.Radiology Department, Division of Vascular and Interventional RadiologyThe Johns Hopkins HospitalBaltimore, MDUSA

Personalised recommendations