Image fusion of preprocedural CTA with real-time fluoroscopy to guide proper hepatic artery catheterization during transarterial chemoembolization of hepatocellular carcinoma: a feasibility study.
OBJECTIVE
To assess feasibility of proper hepatic artery catheterization using a 3D model obtained from preprocedural computed tomographic angiography (CTA), fused with real-time fluoroscopy, during transarterial chemoembolization of hepatocellular carcinoma.


METHODS
Twenty consecutive cirrhotic patients with hepatocellular carcinoma undergoing transarterial chemoembolization were prospectively enrolled onto the study. The early arterial phase axial images of the preprocedural CTA were postprocessed on an independent workstation connected to the angiographic system (Innova 4100; GE Healthcare, Milwaukee, WI), obtaining a 3D volume rendering image (VR) that included abdominal aorta, splanchnic arteries, and first and second lumbar vertebrae. The VR image was manually registered to the real-time X-ray fluoroscopy, with the lumbar spine used as the reference. The VR image was then used as guidance to selectively catheterize the proper hepatic artery. The procedure was considered successful when performed with no need for intraarterial contrast injections or angiographic acquisitions.


RESULTS
The procedure was successful in 19 (95 %) of 20 patients. In one patient, celiac trunk angiography was required for the presence of a significant ostial stenosis that was underestimated at computed tomography. Time for image reconstruction and registration was <10 min in all cases.


CONCLUSIONS
The use of preprocedural CTA model with fluoroscopy enables confident and direct catheterization of the proper hepatic artery with no need for preliminary celiac trunk angiography, thus reducing radiation exposure and contrast media administration.
Department of Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy. irenebargellini@hotmail.com
Irene
I
Bargellini
Francesca
F
Turini
Elena
E
Bozzi
Dario
D
Lauretti
Antonio
A
Cicorelli
Alessandro
A
Lunardi
Roberto
R
Cioni
Carlo
C
Bartolozzi
D000792:Angiography / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006499:Hepatic Artery; D006801:Humans; D021621:Imaging, Three-Dimensional; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
D003287:Contrast Media