title: Transcatheter CT arterial portography and CT hepatic arteriography for liver tumor visualization during percutaneous ablation.
abstract: OBJECTIVE
  To evaluate the feasibility of combining transcatheter computed tomography (CT) arterial portography or transcatheter CT hepatic arteriography with percutaneous liver ablation for optimized and repeated tumor exposure.
  
  
  METHODS
  Study participants were 20 patients (13 men and 7 women; mean age, 59.4 y; range, 40-76 y) with unresectable liver-only malignancies--14 with colorectal liver metastases (29 lesions), 5 with hepatocellular carcinoma (7 lesions), and 1 with intrahepatic cholangiocarcinoma (2 lesions)--that were obscure on nonenhanced CT. A catheter was placed within the superior mesenteric artery (CT arterial portography) or in the hepatic artery (CT hepatic arteriography). CT arterial portography or CT hepatic arteriography was repeatedly performed after injecting 30-60 mL 1:2 diluted contrast material to plan, guide, and evaluate ablation. The operator confidence levels and the liver-to-lesion attenuation differences were assessed as well as needle-to-target mismatch distance, technical success, and technique effectiveness after 3 months.
  
  
  RESULTS
  Technical success rate was 100%; there were no major complications. Compared with conventional unenhanced CT, operator confidence increased significantly for CT arterial portography or CT hepatic arteriography cases (P < .001). The liver-to-lesion attenuation differences between unenhanced CT, contrast-enhanced CT, and CT arterial portography or CT hepatic arteriography were statistically significant (mean attenuation difference, 5 HU vs 28 HU vs 70 HU; P < .001). Mean needle-to-target mismatch distance was 2.4 mm ± 1.2 (range, 0-12.0 mm). Primary technique effectiveness at 3 months was 87% (33 of 38 lesions).
  
  
  CONCLUSIONS
  In patients with technically unresectable liver-only malignancies, single-session CT arterial portography-guided or CT hepatic arteriography-guided percutaneous tumor ablation enables repeated contrast-enhanced imaging and real-time contrast-enhanced CT fluoroscopy and improves lesion conspicuity.
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands. Electronic address: a.vantilborg@vumc.nl.
authors.forename: Aukje A J M
authors.initials: AA
authors.lastname: van Tilborg
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands.
authors.forename: Hester J
authors.initials: HJ
authors.lastname: Scheffer
authors.affiliation: Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands.
authors.forename: Karin
authors.initials: K
authors.lastname: Nielsen
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands.
authors.forename: Jan Hein T M
authors.initials: JH
authors.lastname: van Waesberghe
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands.
authors.forename: Emile F
authors.initials: EF
authors.lastname: Comans
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: van Kuijk
authors.affiliation: Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands.
authors.forename: Petrousjka M
authors.initials: PM
authors.lastname: van den Tol
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands.
authors.forename: Martijn R
authors.initials: MR
authors.lastname: Meijerink
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000473:pathology; D003287:Contrast Media; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011172:Portography / Q000295:instrumentation / Q000379:methods*; D011237:Predictive Value of Tests; D015641:Radiography, Interventional / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000295:instrumentation; D016896:Treatment Outcome; D062666:Vascular Access Devices
chemical_list: D003287:Contrast Media