Usefulness of Cone-Beam Volume CT with Flat Panel Detectors in Conjunction with Catheter Angiography for Transcatheter Arterial Embolization

Abstract

To assess the usefulness of cone-beam volume computed tomography (CT) (cone-beam CT) with use of flat panel detectors of the direct conversion type in conjunction with conventional digital subtraction angiography (DSA) in the diagnosis and treatment of patients with hepatocellular carcinoma (HCC). Forty-nine consecutive patients (52 suspicious lesions) were prospectively examined. All patients underwent intraarterial rotational angiography with a flat panel detector system, and the cone-beam CT scans were reconstructed from the volume data set. The authors evaluated the diagnostic quality of cone-beam CT for the transcatheter arterial chemoembolization (TACE) procedure. The diagnostic quality of conventional DSA plus cone-beam CT with regard to tumor staining was superior to that of DSA alone. Cone-beam CT showed tumor staining in five lesions that were difficult to diagnose with confidence on the basis of the DSA findings alone. The extent of contrast medium perfusion was sufficiently visualized on all cone-beam CT scans at the tip of the catheter positioned in either the segmental or subsegmental hepatic arteries. In 42 of the 52 lesions (81%), cone-beam CT provided additional useful information for therapeutic decision making or TACE compared with DSA. Intraarterial cone-beam CT with a flat panel detector can provide clinically acceptable image quality in the assessment of HCC, thereby improving the detection of tumor staining due to HCC and the visualization of the extent of contrast medium perfusion.