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Dual-phase Cone-beam Computed Tomography to See, Reach, and Treat Hepatocellular Carcinoma during Drug-eluting Beads Transarterial Chemo-embolization

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 ...

The Johns Hopkins Hospital

To evaluate the precision and reproducibility of a semiautomatic tumor segmentation software in measuring tumor volume of hepatocellular carcinoma (HCC) before the first transarterial chemo-embolization (TACE) on contrast-enhancement magnetic resonance imaging (CE-MRI) and intraprocedural dual-phase C-arm cone beam computed tomography (DP-CBCT) images.

Semiautomatic volumetric tumor segmentation for hepatocellular carcinoma: comparison between C-arm cone beam computed tomography and MRI.

C-Arm CT (CACT) is a new imaging modality in liver oncology therapy that allows for the acquisition of 3D images intra-procedurally. CACT has been used to enhance intra-arterial therapies for the liver by improving lesion detection, avoiding non-target embolization, and allowing for more selective delivery of agents. However, one of the limitations of this technology is image artifacts created by respiratory motion. Purpose: To determine in this preliminary study improvements in image acquisition, motion compensation, and high resolution 3D reconstruction that can improve CACT image quality (IQ).

Image quality improvements in C-Arm CT (CACT) for liver oncology applications: preliminary study in rabbits.

To evaluate the feasibility of image fusion (IF) of preprocedural arterial-phase computed tomography with intraprocedural fluoroscopy for roadmapping in endovascular repair of complex aortic aneurysms, and to compare this approach versus current roadmapping methods (ie, two-dimensional [2D] and three-dimensional [3D] angiography).

Image Guidance for Endovascular Repair of Complex Aortic Aneurysms: Comparison of Two-dimensional and Three-dimensional Angiography and Image Fusion.

Assessment of patient performance status is often subjective. Sarcopenia-measurement of muscle wasting-may be a more objective means to assess performance status and therefore mortality risk following intra-arterial therapy (IAT).

Impact of Sarcopenia on Outcomes Following Intra-arterial Therapy of Hepatic Malignancies.

To evaluate the ability of cone-beam computed tomography (CBCT) performed directly after transarterial chemoembolization to assess ethiodized oil (Lipiodol) deposition in hepatocellular carcinoma (HCC) and compare it with unenhanced multidetector computed tomography (CT).

Quantitative Assessment of Lipiodol Deposition after Chemoembolization: Comparison between Cone-Beam CT and Multidetector CT.

Image-guided intraarterial therapies play an important role in the treatment of patients with hepatic malignancies. These therapies provide the dual benefit of reduced systemic toxicity and effective local tumor control. As a result, procedures such as transarterial chemoembolization have been included in the official treatment guidelines for hepatocellular carcinoma (HCC) and are fully accepted for the treatment of patients with intermediate stage disease. In this review, we will describe the scientific rationale for intraarterial therapies and discuss the available clinical evidence for primary liver cancer. Finally, we will touch on the current trends consisting of combining intraarterial approaches with systemically administered targeted agents.

Intraarterial therapies for primary liver cancer: state of the art.

Cardiac metastasis in thyroid cancer is extremely rare. Iodine-131-d whole-body scan has been used widely to detect thyroid metastasis. However, in dedifferentiated cases, iodine scan has low diagnostic value particularly for diagnosing cardiac metastasis. In the absence of 131 I uptake, 18 F-fluoro-2-deoxyglucose positron emission tomography ( 18 F-FDG PET) can be used as an alternative and has a high sensitivity for thyroid metastasis, but still low sensitivity for cardiac metastasis. Therefore, meticulous attention to the pattern of uptake and comparison with patients' previous studies is critical. Additionally, cardiac magnetic resonance imaging (MRI) can provide additional and critical information.

Vania Tacher

Russell H. Morgan Department of Radiology and Radiological Science,
Division of Vascular and Interventional Radiology,
Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology

The Johns Hopkins Hospital

Dual-phase Cone-beam Computed Tomography to See, Reach, and Treat Hepatocellular Carcinoma during Drug-eluting Beads Transarterial Chemo-embolization