TITLE: Three-dimensional rotational angiography: Usefulness in transcatheter arterial chemoembolization of hepatic tumors


AUTHORS: Katsuyuki Taguchi and Jean-Francois H. Geschwind






PURPOSE: To assess the clinical merit of adding three-dimensional rotational angiography (3D RA) to the routine digital subtraction angiography (DSA) runs during transcatheter arterial chemoembolization (TACE) procedures of hepatic tumors.


METHODS AND MATERIALS: Patients enrolled in this study underwent TACE for primary or metastatic liver lesions between 9/22/05 and 11/9/05. 3D RA was performed in addition to the standard DSA runs. Data regarding the possible clinical merit of adding 3D RA to the standard DSA runs were collected via the analysis of a questionnaire, which was filled in by attending and in-training physicians. Each study was evaluated for the combined use of 3D RA and DSA and compared this to the standard DSA angiograms for the following aspects: 1) level of certainty in delineating the hepatic vascular anatomy, 2) level of sensitivity in identifying the association between tumor and surrounding blood vessels, 3) level of confidence in identifying the dominant feeding artery 4) level of expediency in optimally positioning the catheter for lesion targeting. Data collected also included the amount of contrast medium injected for the 3D RA acquisition and extra time spent for each 3D RA.


RESULTS: Our study included 29 patients (20 men, 9 women; mean age, 60.3 years; age range, 41~87 years). Overall, 3D RA provided excellent visualization of the hepatic arterial anatomy. When compared to DSA alone, the combined utilization of 3D RA and DSA was superior for vessel detectability, identification of the association between tumor blush and surrounding vessels, and detection of the feeding artery, regardless of the level of training and experience of the radiologist performing the procedure (P < 0.001, 0.001, 0.01). In cases of complex hepatic arterial vasculature, the combined use of 3D RA and DSA showed to be more helpful for the attending experienced interventional radiologist. Interventional radiologists in training additionally found that the reference images from the combination of fluoroscopy, DSA and 3D RA were more useful than the reference images of fluoroscopy and DSA alone when positioning the catheter for optimal lesion targeting (P < 0.01). For each 3D RA, 8.8~3.4 min were spent and 35 mL of contrast medium were utilized.


CONCLUSIONS: The addition of 3D RA to the routine DSA runs during a chemoembolization procedure offers a clear three-dimensional view of hepatic and neoplastic vessels and facilitates optimal tumor targeting for trained and in-training interventional radiologists who perform the procedure.


FUNDING SOURCES: Philips Medical Systems (Best, The Netherlands)