The added value of cone-beam CT to the successful endovascular treatment of hepatic malignancies
Peter Tamaska MD, Gergely Raski MD, Julia Koncz MD, Istvan Lazar MD, PhD
Department of Interventional Radiology, Borsod County University Teaching Hospital, Miskolc, Hungary
Purpose: The role of interventional radiology in the treatment of hepatic malignancies is steeply raising. Our purpose is to present the importance of cone-beam CT (CBCT) during transarterial chemoembolization (TACE) procedures for liver tumors in illustrative cases.
Patients and methods: Between 1st of June 2013 and 31st of July 2016, we performed 130 consecutive TACE procedures in 64 patients in the Borsod University Teaching Hospital at Miskolc. During certain treatments of 44 patients CBCT was also performed. Contrast enhanced (CE) CBCT was performed to mark the proper microcatheter position for the treatment while non-CE examination was carried out to assess the actual treatment result either with conventional or drug-eluting beads(DEB)-TACE.
Results: All procedures were successful and carried out safely. CBCT gave new information that influenced either the actual or further treatment in 22,7 %. It helped to precisely localize tumors, corrected the number or the size of hepatic malignancies. With CBCT it was easier to identify the feeding arteries of the tumor, plan the actual treatment and also to assess the efficacy of the previous treatment.
Discussion: The gold standard therapy of intermediate-stage HCC (according to Barcelona’s criterias) is TACE. Beside, it can be safely and efficacely performed also in early stage or advanced stage in cases of contraindications for alternative therapies. Cone-beam CT is a dynamic examination which gives you an intraoperative, 3D CT-like imaging in the angio suit, without moving the table or the catheterised patient. Literature has already cited preliminary data about prolonged survival for those patients treated with the help of CBCT intraoperatively.
Conclusion: Intraoperative CBCT in patients with TACE treatment for hepatic malignancies can provide information, that can improve the therapeutic results. Therefore we suggest the routine use of this imaging option during all TACE procedures if patients are eligible.