Image fusion of preprocedural CTA with real-time fluoroscopy to guide proper hepatic artery catheterization during transarterial chemoembolization of hepatocellular carcinoma: a feasibility study.

Irene Bargellini, Francesca Turini, Elena Bozzi, Dario Lauretti, Antonio Cicorelli, Alessandro Lunardi, Roberto Cioni, Carlo Bartolozzi

Department of Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy. irenebargellini@hotmail.com

Cardiovascular and interventional radiology 2013 Apr

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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. 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. 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. 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.

Citation

Irene Bargellini, Francesca Turini, Elena Bozzi, Dario Lauretti, Antonio Cicorelli, Alessandro Lunardi, Roberto Cioni, Carlo Bartolozzi. Image fusion of preprocedural CTA with real-time fluoroscopy to guide proper hepatic artery catheterization during transarterial chemoembolization of hepatocellular carcinoma: a feasibility study. Cardiovascular and interventional radiology. 2013 Apr;36(2):526-30