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Bildführungstechniken und Navigation bei TACE, SIRT und TIPS

Image guiding techniques and navigation for TACE, SIRT and TIPS

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Zusammenfassung

Klinisches/methodisches Problem

Bei der Lebertumorembolisation müssen die für die Embolisation wichtigen Gefäße detektiert werden, um Fehlembolisationen zu vermeiden. Bei der transarteriellen Chemoembolisation (TACE) müssen die Gefäße zur Partikelembolisation bestimmt werden, bei der selektiven internen Radiotherapie (SIRT) die extraheptischen Gefäße, die geschont werden müssen. Beim TIPS-Shunt (transjugulärer intrahepatischer portosystemischer Stent) besteht das Problem, eine zielgenaue Punktion der Pfortader zu erreichen.

Radiologische Standardverfahren

Bei TACE und SIRT erfolgt die Gefäßzuordnung durch DSA-Serien (digitale Subtraktionsangiographie) in verschiedenen Winkeln. Beim TIPS erfolgt meist eine Blind- oder Ultraschall(US)-gesteuerte Punktion der Pfortader.

Methodische Innovationen

Durch eine Cone-beam-CT (CBCT) an der DSA-Anlage können kleinste Gefäße der Leber dargestellt werden. Eine 2-D-3-D-Rückprojektion kann die exakte Punktionslokalisation beim TIPS bestimmen.

Bewertung

Cone-beam-CT und 2-D-3-D-Rückprojektion verbessern die Gefäßnavigation erheblich.

Empfehlung für die Praxis

Wenn die erforderliche Flachdetektortechnik verfügbar ist, sollte die CBCT bei TACE und SIRT eingesetzt werden. Die 2-D-3-D-Navigation bedarf einer Hard- und Softwarenachrüstung.

Abstract

Clinical/methodical issue

To avoid non-targeted embolization in liver tumors, arteries important for embolization must be detected. In transarterial chemoembolization (TACE) arteries for particle embolization have to be detected and in selective internal radiotherapy (SIRT) extrahepatic arteries which must be protected from embolization have to be detected. In transjugular intrahepatic portosystemic shunt (TIPS) the problem is to achieve an exactly targeted puncture of the portal vein.

Standard radiological methods

In TACE and SIRT detection of the vessels is performed from various angles by digital subtraction angiography (DSA). In TIPS puncture is guided by ultrasound or performed blindly.

Methodical innovations

Using cone beam CT (CBCT) very small vessels in the liver can be visualized and 2D-3D back projection is able to detect the exact position of the portal vein in TIPS.

Achievements

The use of CBCT and 2D-3D back projection significantly enhances navigation of vessels.

Practical recommendations

If flat detector technique is available CBCT should be used in TACE and SIRT and 2D-3D navigation needs hardware and software updates.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. R. Adamus, M. Pfister, M. Uder, R.W. Loose geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Institut für Radiologie, Klinikum Nürnberg Nord, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland

    R. Adamus & R.W. Loose

  2. Siemens Healthcare, Forchheim, Deutschland

    M. Pfister

  3. Institut für Radiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland

    M. Uder

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  1. R. Adamus
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  2. M. Pfister
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  3. M. Uder
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  4. R.W. Loose
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Correspondence to R. Adamus.

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Adamus, R., Pfister, M., Uder, M. et al. Bildführungstechniken und Navigation bei TACE, SIRT und TIPS. Radiologe 53, 1009–1016 (2013). https://doi.org/10.1007/s00117-012-2464-3

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