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Role of C-arm cone-beam CT in chemoembolization for hepatocellular carcinoma.

Kim HC - Korean J Radiol (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea.

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.

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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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Figure 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).

Mentions: The suggestive findings of extrahepatic collateral artery supplying HCCs includes a large tumor in a peripheral location, hypertrophied extrahepatic collateral artery, and peripheral viable/recurred tumor of a previously treated lesion on CT/MR, and missing tumor staining on angiography (31). When there are multiple small tumors or a large tumor with minimal blood supply by an extrahepatic collateral artery, it is hard to perceive the presence of extrahepatic collateral artery on 2D angiography. Comparison between preprocedural CT/MR and an axial image of C-arm CBCT can clearly show a non-enhancing small tumor or unenhanced part within a larger tumor, which indicates the presence of an extrahepatic collateral artery supplying the tumors (Fig. 5).


Role of C-arm cone-beam CT in chemoembolization for hepatocellular carcinoma.

Kim HC - Korean J Radiol (2015)

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).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296258&req=5

Figure 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).
Mentions: The suggestive findings of extrahepatic collateral artery supplying HCCs includes a large tumor in a peripheral location, hypertrophied extrahepatic collateral artery, and peripheral viable/recurred tumor of a previously treated lesion on CT/MR, and missing tumor staining on angiography (31). When there are multiple small tumors or a large tumor with minimal blood supply by an extrahepatic collateral artery, it is hard to perceive the presence of extrahepatic collateral artery on 2D angiography. Comparison between preprocedural CT/MR and an axial image of C-arm CBCT can clearly show a non-enhancing small tumor or unenhanced part within a larger tumor, which indicates the presence of an extrahepatic collateral artery supplying the tumors (Fig. 5).

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea.

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.

Show MeSH
Related in: MedlinePlus