Korean J Radiol.  2015 Feb;16(1):114-124. 10.3348/kjr.2015.16.1.114.

Role of C-Arm Cone-Beam CT in Chemoembolization for Hepatocellular Carcinoma

• Kim HC

• KMID: 2069989
• DOI: http://doi.org/10.3348/kjr.2015.16.1.114

Abstract

With the advent of C-arm cone-beam computed tomography (CBCT), minimally-invasive procedures in the angiography suite made a new leap beyond the limitations of 2-dimensional (D) angiography alone. C-arm CBCT can help interventional radiologists in several ways with the treatment of hepatocellular carcinoma (HCC); visualization of small tumors and tumor-feeding arteries, identification of occult lesion and 3D configuration of tortuous hepatic arteries, assurance of completeness of chemoembolization, suggestion of presence of extrahepatic collateral arteries supplying HCCs, and prevention of nontarget embolization. With more improvements in the technology, C-arm CBCT may be essential in all kinds of interventional procedures in the near future.

Keyword

Hepatocellular carcinoma; Chemoembolization; C-arm cone-beam CT

MeSH Terms

Carcinoma, Hepatocellular/radiography/*therapy
Chemoembolization, Therapeutic
Cone-Beam Computed Tomography
Hepatic Artery/radiography
Humans
Imaging, Three-Dimensional
Liver Neoplasms/radiography/*therapy
Severity of Illness Index

Figure

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  Fig. 1 60-year-old man with hepatocellular carcinoma.A. C-arm cone-beam CT shows nodular tumor (arrow) supplied by adjacent subsegmental hepatic artery (arrowhead). B. Maximum intensity projection image of C-arm cone-beam CT obtained at common hepatic artery shows small nodular tumor (arrow) supplied by subsegmental hepatic artery (arrowhead) which was noted on axial image (A). Note another subsegmental hepatic artery (curved arrow) feeding nodular tumor.

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  Fig. 2 2. 58-year-old woman with hepatocellular carcinoma.A. Hepatobiliary phase image of gadoxetic acid-enhanced MRI shows two small nodules of hypointensity (arrowheads). These two nodules show no enhancement on arterial phase images of MRI and on arterial phase of CT scan (not shown). B. Axial image of C-arm cone-beam CT shows enhancement of these two nodules (arrowheads). Note motion artifact of hepatic artery caused by inadequate breath-hold. C, D. Unenhanced CT scan images obtained immediately after chemoembolization show dense accumulation of iodized oil in these two nodules (arrowheads) with surrounding parenchymal accumulation of iodized oil.

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  Fig. 3 42-year-old man with hepatocellular carcinoma.A. Axial CT scan shows small subtle enhancing lesion (arrowhead) in right lobe of liver. Wash-out of this nodule is equivocal on delayed image. B. Axial image of C-arm cone-beam CT shows subtle nodular enhancing lesion (arrowhead). This lesion was treated by iodized oil emulsion. C. Unenhanced CT scan obtained immediately after chemoembolization shows no nodular accumulation of iodized oil. During 2-year follow-up, this subtle nodule has persisted on follow-up CT scan without morphological change, which was thought to be benign arterioportal shunt.

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  Fig. 4 47-year-old man with hepatocellular carcinoma and Child-Pugh C class disease.A. Axial CT scan shows exophytic enhancing nodule (arrowhead) in gallbladder bed. B. Celiac angiography shows tumor staining (arrowhead). C. Volume-rendering image of C-arm cone-beam CT with left anterior oblique projection of 30 degree shows tumor-feeding artery from S5 hepatic artery (arrowheads). D. Volume-rendering image of C-arm cone-beam CT with right anterior oblique projection of 20 degree and cranial oblique projection of 15 degree shows tumor-feeding artery from deep cystic artery (arrowhead). E. Spot image during chemoembolization shows tip (arrowhead) of microcatheter advanced into S5 hepatic artery. F. Spot image during chemoembolization shows tip (arrowhead) of microcatheter advanced into deep cystic artery.

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  Fig. 5 78-year-old man with hepatocellular carcinoma.A. Arterial phase images of gadoxetic acid-enhanced MRI shows exophytic nodule (arrowhead) with faint enhancement. B. Celiac angiography shows hypervascular tumor staining (arrow). C. Maximum-intensity-projection image of C-arm cone-beam CT shows hypervascular tumor staining. D. Axial image of C-arm cone-beam CT shows non-enhancing part (arrowhead) of tumor which suggests presence of extrahepatic collateral artery supplying tumor. E. Angiography of right inferior phrenic artery shows tumor staining (arrowhead).

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