Hepatoma feeding arteriogram created by CT during aortography using IVR 64-multidetector-row CT for catheterization in transcatheter arterial chemoembolization for hepatocellular carcinoma
Tóm tắt
CT during aortography (CTAo) using IVR 64-multidetector-row CT (IVR-64MDCT) enables the rapid and simultaneous depiction of both the hepatic and extrahepatic feeding arteries in hepatocellular carcinoma (HCC), and can be achieved using a reasonable volume of contrast medium. The scan time is approximately 6 s from the diaphragm to the kidney using CTAo with 64MDCT with a slice thickness and slice interval of 0.5 mm. The hepatoma feeding arteriogram appears in the angiographic monitor after CTAo, and can then be used to guide catheterization. We introduce the process for creating a hepatoma feeding arteriogram, synthesized from the following three volume-rendered images: background bone, aorta to hepatic-branch artery, and hepatoma to feeding artery. Uniquely, the hepatoma feeding arteriogram enables investigation of the feeding artery from the tumor side, rather than from the aorta side, and appears superior to selective arteriography in terms of detecting small HCC and its accompanying fine feeding arteries. Identification of these arteries by CT angiography with intravenous contrast medium injection is difficult because of the similarity in CT values between the feeding artery and the surrounding liver, thereby preventing the creation of a hepatoma feeding arteriogram. CTAo accelerates the process of deciding upon the catheter treatment strategy, shifting the decision to the point at which the feeding artery is investigated, because the hepatoma feeding arteriogram enables instant identification of the feeding artery and its connection to the hepatic branch artery. CTAo with IVR-64MDCT can potentially contribute to remarkable advances in IVR, especially transcatheter arterial chemoembolization for HCC.
Tài liệu tham khảo
Matsui O, Takashima T, Kadoya M, et al. Dynamic computed tomography during arterial portography: the most sensitive examination for small hepatocellular carcinomas. J Comput Assist Tomogr. 1985;9:19–24.
Hayashi M, Matsui O, Ueda K, Kawamori Y, Gabata T, Kadoya M. Progression to hypervascular hepatocellular carcinoma: correlation with intranodular blood supply evaluated with CT during intraarterial injection of contrast material. Radiology. 2002;225:143–9.
Honda H, Tajima T, Taguchi K, et al. Recent developments in imaging diagnostics for HCC: CT arteriography and CT arterioportography evaluation of vascular changes in premalignant and malignant hepatic nodules. J Hepatobiliary Pancreat Surg. 2000;7:245–51.
Kitao A, Zen Y, Matsui O, Gabata T, Nakanuma Y. Hepatocarcinogenesis: multistep changes of drainage vessels at CT during arterial portography and hepatic arteriography—radiologic–pathologic correlation. Radiology. 2009;252:605–14.
Matsui O, Kobayashi S, Sanada J, et al. Hepatocellular nodules in liver cirrhosis: hemodynamic evaluation (angiography-assisted CT) with special reference to multi-step hepatocarcinogenesis. Abdom Imaging. 2011;36:264–72.
Fishman EK, Ney DR, Heath DG, et al. Volume rendering versus maximum intensity projection in CT angiography: what works best, when, and why. Radiographics. 2006;26:905–22.
Lee KH, Sung KB, Lee DY, Park SJ, Kim KW, Yu JS. Transcatheter arterial chemoembolization for hepatocellular carcinoma: anatomic and hemodynamic considerations in the hepatic artery and portal vein. Radiographics. 2002;22:1077–91.
Kim HC, Chung JW, Lee W, Jae HJ, Park JH. Recognizing extrahepatic collateral vessels that supply hepatocellular carcinoma to avoid complications of transcatheter arterial chemoembolization. Radiographics. 2005;25:S25–9.
Miyayama S, Matsui O, Taki K, et al. Extrahepatic blood supply to hepatocellular carcinoma: angiographic demonstration and transcatheter arterial chemoembolization. Cardiovasc Intervent Radiol. 2006;29:39–48.
Gwon DI, Ko GY, Yoon HK, et al. Inferior phrenic artery: anatomy, variations, pathologic conditions, and interventional management. Radiographics. 2007;27:687–705.
Hirota S, Nakao N, Yamamoto S, et al. Cone-beam CT with flat-panel-detector digital angiography system: early experience in abdominal interventional procedures. Cardiovasc Intervent Radiol. 2006;29:1034–8.
Kakeda S, Korogi Y, Ohnari N, et al. Usefulness of cone-beam volume CT with flat panel detectors in conjunction with catheter angiography for transcatheter arterial embolization. J Vasc Interv Radiol. 2007;18:1508–16.
Iwazawa J, Ohue S, Mitani T, et al. Identifying feeding arteries during TACE of hepatic tumors: comparison of C-arm CT and digital subtraction angiography. Am J Roentgenol. 2009;192:1057–63.
Kothary N, Abdelmaksoud MH, Tognolini A, et al. Imaging guidance with C-arm CT: prospective evaluation of its impact on patient radiation exposure during transhepatic arterial chemoembolization. J Vasc Interv Radiol. 2011;22:1535–43.
Eide KR, Odegard A, Myhre HO, et al. DynaCT during EVAR—a comparison with multidetector CT. Eur J Vasc Endovasc Surg. 2009;37:23–30.
Nakai M, Sato M, Kawai N, et al. Hepatocellular carcinoma: involvement of the internal mammary artery. Radiology. 2001;219:147–52.