Usefulness of cone-beam volume CT with flat panel detectors in conjunction with catheter angiography for transcatheter arterial embolization.
OBJECTIVE
To assess the usefulness of cone-beam volume computed tomography (CT) (cone-beam CT) with use of flat panel detectors of the direct conversion type in conjunction with conventional digital subtraction angiography (DSA) in the diagnosis and treatment of patients with hepatocellular carcinoma (HCC).


METHODS
Forty-nine consecutive patients (52 suspicious lesions) were prospectively examined. All patients underwent intraarterial rotational angiography with a flat panel detector system, and the cone-beam CT scans were reconstructed from the volume data set. The authors evaluated the diagnostic quality of cone-beam CT for the transcatheter arterial chemoembolization (TACE) procedure.


RESULTS
The diagnostic quality of conventional DSA plus cone-beam CT with regard to tumor staining was superior to that of DSA alone. Cone-beam CT showed tumor staining in five lesions that were difficult to diagnose with confidence on the basis of the DSA findings alone. The extent of contrast medium perfusion was sufficiently visualized on all cone-beam CT scans at the tip of the catheter positioned in either the segmental or subsegmental hepatic arteries. In 42 of the 52 lesions (81%), cone-beam CT provided additional useful information for therapeutic decision making or TACE compared with DSA.


CONCLUSIONS
Intraarterial cone-beam CT with a flat panel detector can provide clinically acceptable image quality in the assessment of HCC, thereby improving the detection of tumor staining due to HCC and the visualization of the extent of contrast medium perfusion.
Department of Radiology, University of Occupational and Environmental Health School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan. kakeda@med.uoeh-u.ac.jp
Shingo
S
Kakeda
Yukunori
Y
Korogi
Norihiro
N
Ohnari
Junji
J
Moriya
Nobuhiro
N
Oda
Kazuyoshi
K
Nishino
Wataru
W
Miyamoto
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000295:instrumentation* / Q000379:methods; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media; D015251:Epirubicin / Q000008:administration & dosage; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage; D006499:Hepatic Artery; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D007479:Iopamidol / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000295:instrumentation; D015641:Radiography, Interventional / Q000295:instrumentation*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D016896:Treatment Outcome; D014963:X-Ray Intensifying Screens
D000903:Antibiotics, Antineoplastic; D003287:Contrast Media; D015251:Epirubicin; D007459:Iodized Oil; D007479:Iopamidol