Abstract
The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 dimensional (3D) diagnostic imaging in the interventional suite and can enhance minimally-invasive therapy beyond the limitations of 2D angiography alone. The role of CBCT has been recognized in transarterial chemo-embolization (TACE) treatment of hepatocellular carcinoma (HCC). The recent introduction of a CBCT technique: dual-phase CBCT (DP-CBCT) improves intra-arterial HCC treatment with drug-eluting beads (DEB-TACE). DP-CBCT can be used to localize liver tumors with the diagnostic accuracy of multi-phasic multidetector computed tomography (M-MDCT) and contrast enhanced magnetic resonance imaging (CE-MRI) (See the tumor), to guide intra-arterially guidewire and microcatheter to the desired location for selective therapy (Reach the tumor), and to evaluate treatment success during the procedure (Treat the tumor). The purpose of this manuscript is to illustrate how DP-CBCT is used in DEB-TACE to see, reach, and treat HCC.
Highlights
Image guidance is the backbone of interventional radiology
Verify the vessel path on cone-beam computed tomography (CBCT) images automatically detected from the early arterial phase CBCT and extracted by the software in sagittal, coronal and axial planes to ensure that the vessel chosen and path mapped do supply the desired tumor(s). 6
Adjust the 3 dimensional (3D) roadmap to better match on the fluoroscopy in case of patient movement to mitigate the need for creating a new roadmap and minimize the need for additional contrast injection and X-ray exposure. 5
Summary
Image guidance is the backbone of interventional radiology. Two relatively recent capabilities of the X-ray angiography equipment are threedimensional (3D) rotational angiography, and C-arm cone-beam computed tomography (CBCT). CBCT has enabled the acquisition of 3D volumetric imaging in the angiography suite with the advent of the C-arm, the flat panel detector and the Feldkamp back projection algorithm[1,2] These newer image acquisition capabilities have enabled clinicians to perform procedures not feasible with traditional fluoroscopy or digital subtraction angiography alone[3,4,5,6,7]. Tools for image acquisition, intraprocedural guidance, and therapeutic response assessment have been developed for use during TACE, to optimize TACE. The use of CBCT imaging during TACE has been shown to increase survival[19] The purpose of this manuscript is to describe the use of CBCT to execute the steps of DEB-TACE: seeing, reaching, and treating liver tumors. Modification of the DEB-TACE based upon DP-CBCT information is a common clinical scenario
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