Cone-Beam CT Hepatic Arteriography in Chemoembolization for Hepatocellular Carcinoma: Angiographic Image Quality and Its Determining Factors

doi:10.1016/j.jvir.2014.04.011

Journal of Vascular and Interventional Radiology

Volume 25, Issue 9, September 2014, Pages 1369-1379

https://doi.org/10.1016/j.jvir.2014.04.011 Get rights and content

Abstract

Purpose

To analyze image quality and the factors that determine it for cone-beam computed tomography (CT) hepatic arteriography in chemoembolization for hepatocellular carcinoma (HCC).

Materials and Methods

From September 2009–December 2010, 399 consecutive patients referred for chemoembolization of HCC were scheduled for cone-beam CT scan. There were 12 patients (3%) excluded because of difficulty with breath-hold. Of the 387 patients who underwent cone-beam CT hepatic arteriography, 100 patients were ultimately included in the study according to inclusion criteria. Maximum intensity projection images were scored for image quality of each segmental hepatic artery. Potential determining factors for image quality were diaphragmatic motion, portal vein enhancement, and hepatic artery-to-parenchyma enhancement ratio. The flow rate of contrast media, x-ray delay, and location of the catheter tip were also evaluated.

Results

It was possible to trace at least subsegmental hepatic arteries in 625 of 700 segments (89.3%) on cone-beam CT hepatic arteriography. Diaphragmatic motion, prominent portal vein enhancement, and low hepatic artery-to-parenchyma enhancement ratio worsened image quality (P < .001, P = .022, and P = .017). Owing to cardiac motion artifacts, image quality of the left lateral segments (S2 and S3) was poorer compared with the remaining hepatic segments (S4–S8).

Conclusions

In most cases, the quality of cone-beam CT hepatic arteriography images was good enough to trace subsegmental hepatic arteries at a minimum. Respiratory and cardiac motion, portal vein enhancement, and hepatic artery-to-parenchyma enhancement ratio significantly affected the image quality of cone-beam CT hepatic arteriography.

Section snippets

Patients

This retrospective study was approved by our institutional review board, and the requirement for informed consent was waived. In our institution, the primary indications to perform cone-beam CT hepatic arteriography are (a) to evaluate detailed hepatic arterial anatomy and (b) to depict tumor feeders and generate three-dimensional images for superselective transarterial chemoembolization. Patients at initial presentation or with relatively small multinodular (five or fewer) HCCs are considered

Coverage of Liver and Radiation Dose in Cone-Beam CT Scanning

The liver was entirely covered by CT in only 29 of 100 cases. Incomplete coverage was found in the remaining 71 cases: one hepatic segment in 30 cases, two segments in 32 cases, three segments in 5 cases, four segments in 2 cases, and five segments in 2 cases. As a result, 127 (15.9%) of 800 hepatic segments were incompletely covered by cone-beam CT hepatic arteriography. The areas most often missed from the field of view of cone-beam CT were the left lateral segments and the inferior portion

Discussion

The results of the present study show the performance of MIP imaging of cone-beam CT hepatic arteriography was good enough to trace at least subsegmental hepatic arteries by demonstrating grade I–III image quality in ~90% of cases (Table E1, Table E2 [available online at www.jvir.org]). As a result, cone-beam CT hepatic arteriography could be used as a three-dimensional roadmap for microcatheter navigation to target vessels in subsegmental chemoembolization in most cases.

In the remaining 10% of

Acknowledgment

This study was supported by a grant from the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (Grant No. A100430).

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It is presumed that definite feeders in direct contact with the tumor could be better detected on CBCT MIP for fully identified enhancing tumors. There have been several studies on the performance of CBCT angiography in tumor embolization, but these were mainly conducted with patients who underwent TACE for HCC [11,13,14]. One study used CBCT angiography for renal tumor embolization, but it was concerned with renal segmental artery variation and multi-segmental tumor vascularization [6].
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To evaluate the effect of a motion artifact correction algorithm (MACA) on cone-beam computed tomography (CT) during transarterial chemoembolization for hepatic malignancies.
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The mean maximum intensity and sharpness increased from 2,792.01 HU ± 451.36 to 3,148.40 HU ± 594.46 and from 0.31 ± 0.02/mm to 0.34 ± 0.02/mm, respectively, using the MACA (both P < .001). The MACA decreased the mean FWHM from 2.02 mm ± 0.27 to 1.78 mm ± 0.26 (P < .001). The overall quality of the MIP images and the conspicuity of the tumor-supplying artery were enhanced from 2.5 to 3.0 points and from 3.0 to 4.0 points, respectively (both P < .001). Selective angiography was expected to be omitted in 7 cases (16.7%, 7/42) after using the MACA.
The MACA significantly improved both quantitative and qualitative image quality of cone-beam CT in selected patients with motion artifacts during transarterial chemoembolization for hepatic malignancies.
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: None of the authors have identified a conflict of interest.

: Tables E1–E3 are available online at www.jvir.org.

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Clinical StudyCone-Beam CT Hepatic Arteriography in Chemoembolization for Hepatocellular Carcinoma: Angiographic Image Quality and Its Determining Factors

Abstract

Purpose

Materials and Methods

Results

Conclusions

Section snippets

Patients

Coverage of Liver and Radiation Dose in Cone-Beam CT Scanning

Discussion

Acknowledgment

Lancet

Hepatology

Lancet

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

Clinical Study
Cone-Beam CT Hepatic Arteriography in Chemoembolization for Hepatocellular Carcinoma: Angiographic Image Quality and Its Determining Factors