Comparison between C-arm cone beam computed tomography and interventional angiography in transarterial chemoembolization of hepatocellular carcinoma

Ibraheim Ahmed Diab,Shaimaa Abdel-Hamid Hassanein,Hala Hafez Mohamed

doi:10.1186/s43055-019-0053-4

Abstract

BackgroundHepatocellular carcinoma (HCC) is the most common primary hepatic malignancy of adults. One of the established treatment procedures performed worldwide for HCC is transcatheter arterial chemoembolization (TACE). By using conventional angiography in TACE, we can detect and identify the vascular anatomy of the liver through obtaining 2D images. Recently C-arm cone beam computed tomography (CBCT) is introduced for obtaining cross-sectional and three-dimensional (3D) images for better visualization of small tumors and their feeding arteries.ResultsThe number of detected focal lesions by angiography was 51 compared to 87 focal lesion detected by CBCT; of those, 45 and 77 were active lesions by both procedures respectively. For lesions, less than 1 cm CBCT detected 23 lesions while angiography detected only one lesion. Angiography detected 87 feeding arterial branch while cone beam CT-HA detected 130 branches to the same number of target lesion. Feeder tractability and confidence were better by CBCT.ConclusionCBCT is superior to angiography in tumor detectability, detection of lesions less than 1 cm, feeder detection, and feeder traction; however, conventional angiography and DSA are irreplaceable. Thus, combination of CBCT with angiography during TACE produces better results and less complication.

Highlights

Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy of adults
Twenty-five patients were included in our study
Our study reported that the confidence of tumor feeding branches was much better using cone beam computed tomography (CBCT) than angiography; there was good confidence in 80% of the reviewed arteries, fair confidence in 15.3% of the reviewed feeders, and poor confidence in 4.7% of the reviewed feeders

Summary

Introduction

Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy of adults. One of the established treatment procedures performed worldwide for HCC is transcatheter arterial chemoembolization (TACE). By using conventional angiography in TACE, we can detect and identify the vascular anatomy of the liver through obtaining 2D images. C-arm cone beam computed tomography (CBCT) is introduced for obtaining cross-sectional and three-dimensional (3D) images for better visualization of small tumors and their feeding arteries. It is the sixth most common cancer worldwide [1]. One of the established HCC treatments, along with other treatments such as surgical resection and percutaneous ablation, is transcatheter arterial chemoembolization (TACE). With the recent new technologies, TACE treatment outcomes, namely the local suppression rate and survival rate, are improved compared with previous results [5,6,7]

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