title: Cone-beam CT hepatic arteriography in chemoembolization for hepatocellular carcinoma: angiographic image quality and its determining factors.
abstract: OBJECTIVE
  To analyze image quality and the factors that determine it for cone-beam computed tomography (CT) hepatic arteriography in chemoembolization for hepatocellular carcinoma (HCC).
  
  
  METHODS
  From September 2009-December 2010, 399 consecutive patients referred for chemoembolization of HCC were scheduled for cone-beam CT scan. There were 12 patients (3%) excluded because of difficulty with breath-hold. Of the 387 patients who underwent cone-beam CT hepatic arteriography, 100 patients were ultimately included in the study according to inclusion criteria. Maximum intensity projection images were scored for image quality of each segmental hepatic artery. Potential determining factors for image quality were diaphragmatic motion, portal vein enhancement, and hepatic artery-to-parenchyma enhancement ratio. The flow rate of contrast media, x-ray delay, and location of the catheter tip were also evaluated.
  
  
  RESULTS
  It was possible to trace at least subsegmental hepatic arteries in 625 of 700 segments (89.3%) on cone-beam CT hepatic arteriography. Diaphragmatic motion, prominent portal vein enhancement, and low hepatic artery-to-parenchyma enhancement ratio worsened image quality (P < .001, P = .022, and P = .017). Owing to cardiac motion artifacts, image quality of the left lateral segments (S2 and S3) was poorer compared with the remaining hepatic segments (S4-S8).
  
  
  CONCLUSIONS
  In most cases, the quality of cone-beam CT hepatic arteriography images was good enough to trace subsegmental hepatic arteries at a minimum. Respiratory and cardiac motion, portal vein enhancement, and hepatic artery-to-parenchyma enhancement ratio significantly affected the image quality of cone-beam CT hepatic arteriography.
authors.affiliation: Department of Radiology, National Cancer Center, Goyang-si Gyeonggi-do; Department of Radiology, Seoul National University College of Medicine, Seoul.
authors.forename: In Joon
authors.initials: IJ
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul; Institute of Radiation Medicine, Seoul National University Medical Research Center, Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Republic of Korea. Electronic address: chungjw@snu.ac.kr.
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Chung
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul; Institute of Radiation Medicine, Seoul National University Medical Research Center, Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Yong Hu
authors.initials: YH
authors.lastname: Yin
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul; Institute of Radiation Medicine, Seoul National University Medical Research Center, Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Hyo-Cheol
authors.initials: HC
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul; Institute of Radiation Medicine, Seoul National University Medical Research Center, Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Young Il
authors.initials: YI
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul; Institute of Radiation Medicine, Seoul National University Medical Research Center, Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Hwan Jun
authors.initials: HJ
authors.lastname: Jae
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul; Institute of Radiation Medicine, Seoul National University Medical Research Center, Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D062485:Breath Holding; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D054893:Cone-Beam Computed Tomography; D003287:Contrast Media; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009038:Motion; D011169:Portal Vein / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D056152:Respiratory Rate; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media