Transcatheter CT Arterial Portography and CT Hepatic Arteriography for Liver Tumor Visualizationduring Percutaneous Ablation

摘要

Purpose: To evaluate the feasibility of combining transcaiheier computed tomography (CT) arterial portography or transeatheter CT hepatic arieriography with percutaneous licr ablation for optimized and repeated tumor exposure. Materials and 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 intrnhcpatic 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 artcr> (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-lo-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-io-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 needlc-to-targct mismatch distance was 2.4 mm ?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 lluoroscopy and improves lesion conspicuity.