EURORAD ESR

Case 13594

Cone-beam CT during TACE: a useful tool!

Author(s)
Fabio Pozzi Mucelli, Roberta Pozzi Mucelli, Antonio Giulio Gennari, Maria Assunta Cova

Struttura Complessa di Radiologia,
Az. Ospedaliero-Universitaria Ospedali Riuniti di Trieste,
Strada di Fiume
34135 Trieste, Italy;
Email:fabio.pozzimucelli@alice.it
 
Patient
male, 62 year(s)
 
 
  • Figure 1
    Pre-treatment CT
     

    CT (arterial phase): mild hypervascular nodule in the segment 4.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Coronal CT scan in the arterial phase better shows the enhancing nodule in the segment 4.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Coronal CT in the portal phase shows the fast wash-out of the nodule typical of HCC.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    In the US examination the nodule is poorly visible (arrow) and located in an unfavourable position for thermal ablation.

     
    Area of Interest: Liver; Imaging Technique: Ultrasound; Procedure: Ablation procedures; Special Focus: Neoplasia;
     
     
  • Figure 2
    Preliminary angiography

    A diagnostic catheter was advanced at the origin of the left hepatic artery: a hypervascular nodule is visible in segment 4.

     
    Area of Interest: Vascular; Imaging Technique: Catheter arteriography; Procedure: Chemoembolisation; Special Focus: Neoplasia;
     
     
  • Figure 3
    Superselective catheterization (the movie)

    A microguidewire (Phatom, Boston) and a microcatheter (Prowler plus, Codman) were advanced in the segmental branch for the 4th segment.

     
    Area of Interest: Vascular; Imaging Technique: Catheter arteriography; Procedure: Chemoembolisation; Special Focus: Neoplasia;
     
     
  • Figure 4
    Diagnostic angiography

    The hand injection with a 5 mm syringe confirms the correct position.

     
    Area of Interest: Vascular; Imaging Technique: Catheter arteriography; Procedure: Chemoembolisation; Special Focus: Neoplasia;
     
     
  • Figure 5
    XPER-CT during superselective injection in the 4th segment

    The movie shows the liver (from the bottom to the top) with the enhancement of the 4th segment and of the nodule confirming the correct position of the microcatheter.

     
    Area of Interest: Vascular; Imaging Technique: CT-Angiography; Procedure: Chemoembolisation; Special Focus: Neoplasia;
     
     
  • Figure 6
    Single-shot film after selective drug injection

    The yellow arrows shows the nodule filled with contrast media after superselective drug injection in the segmental branch for segment 4.

     
    Area of Interest: Liver; Imaging Technique: Catheter arteriography; Procedure: Chemoembolisation; Special Focus: Neoplasia;
     
     
  • Figure 7
    CT follow-up
     

    CT follow-up: the nodule appears completely hypodense with a pattern of complete response (mRECIST criteria).

     
    Area of Interest: Interventional vascular; Imaging Technique: CT-Angiography; Procedure: Chemoembolisation; Special Focus: Neoplasia;

    See above

     
    Area of Interest: Abdomen; Imaging Technique: Catheter arteriography; Procedure: Chemoembolisation; Special Focus: Neoplasia;

    See above

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Chemoembolisation; Special Focus: Neoplasia;
     
     
CT (arterial phase): mild hypervascular nodule in the segment 4.
 
Coronal CT scan in the arterial phase better shows the enhancing nodule in the segment 4.
 
Coronal CT in the portal phase shows the fast wash-out of the nodule typical of HCC.
 
In the US examination the nodule is poorly visible (arrow) and located in an unfavourable position for thermal ablation.
 
A diagnostic catheter was advanced at the origin of the left hepatic artery: a hypervascular nodule is visible in segment 4.
 
A microguidewire (Phatom, Boston) and a microcatheter (Prowler plus, Codman) were advanced in the segmental branch for the 4th segment.
 
The hand injection with a 5 mm syringe confirms the correct position.
 
The movie shows the liver (from the bottom to the top) with the enhancement of the 4th segment and of the nodule confirming the correct position of the microcatheter.
 
The yellow arrows shows the nodule filled with contrast media after superselective drug injection in the segmental branch for segment 4.
 
CT follow-up: the nodule appears completely hypodense with a pattern of complete response (mRECIST criteria).
 
See above
 
See above
 
 
 
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