Clinical Study Of CT Hepatic Arteriography In The Transarterial Chemoembolization Treatment Of Hepatocellular Carcinoma

1. Impact of Multidetector CT Hepatic Arteriography on the Planningof Chemoembolization Treatment of Hepatocellular CarcinomaObjective: To evaluate the impact of multidetector CT hepatic arteriography (CTHA) on the planning of transarterial chemoembolization (TACE) treatment of hepatocellular carcinoma (HCC).Materials and Methods: Fifty-six patients with HCC were included in the prospective CTHA study. Preliminary plans for selective hepatic arteriography and TACE were prepared after examination of prior CT. The patients underwent complete hepatic angiography (DSA) after signing informed consent. The hypervascular masses identified were matched with those seen on previous CT. Any additional masses detected were recorded. Patients were then transferred to the CT room for two-phase CTHA. If needed, CTAP was performed. Images were immediately analyzed and compared with the prior diagnostic study; additional hypervascular lesions were identified and recorded. Afterwards, TACE was performed.Results: Hypervascular masses were detected in all 56 patients. Sixty-two, 70 and 92 Lesions were detected by prior CT, DSA and CTHA, respectively. The sensitivity of CTHA was significantly higher in detecting HCC than that of DSA and CT (p < 0.01) . CTHA results exactly matched the CT results in 38 patients (67.9%). Sixteen of the 18 patients who had the additional lesions were not in the same segment with main lesions and their preliminary TACE therapeutic regimes thus need to be altered. Fifteen of 49 patients were originally diagnosed with solitary lesions by CT had multiple lesions. In 13 (23.2%) patients, lesions detected by DSA were lesser than that by CTHA. In 6 patients whose tumor blood vessel could not be shown on DSA clearly, TACE was performed under guidance of 3D-CTHA.Conclusions: The sensitivity of CTHA was significantly higher than that of DSA and CT in detecting HCC. The preliminary TACE plans in 16 (28.6%) patients needed alter. 3D-CTHA is helpful to TACE in some patients with HCC.2. Study of CT hepatic arteriography in the following- up of HCC after TACEObjective: To compare the ability of CT, DSA and CTHA in detecting the local recurrence (residual viable) and distant recurrence (new foci) of HCC after TACE.Materials and Methods: Twenty-eight patients with HCC after 1-3 procedure (s) TACE were included in the CTHA study. The results of prior CT were recorded. After giving informed consent, patients underwent DSA and double-phase CTHA. Local recurrent lesions and distant recurrent lesions detected by DSA and CTHA were recorded, respectively. The results of DSA and CTHA were compared with the prior CT study, followed by TACE performance.Results: Of 72 original HCC lesions, 14, 28, and 37 showed local recurrence by Prior CT, DSA and CTHA, respectively. The sensitivity of CTHA was significantly higher in detecting local recurrence than that of Prior CT and DSA (p < 0.01) . All of 29 lesions which CT showed iodized oil defect CTHA detected local recurrence. The findings of local recurrence in CTHA were as follows. (1) Intensive or slightly enhancing in iodized oil defect part. (2) Nodular intensive enhancing near accumulation of iodized oil. (3) Original lesion showed enhancing in peripheral part and no enhancing in central part. Three, 7 and 8 distant recurrent lesions were shown by CT, DSA and CTHA, respectively.Conclusions: The sensitivity of CTHA was significantly higher in detecting local recurrent HCC lesions than that of CT (p < 0.05 ) . CTHA findings of local recurrent HCC lesions after TACE are valuable for the selection of optimal therapeutic regime.3. Preliminary study of CT-Guided TACE for HCC Objective: To evaluate the Preliminary therapeutic effect of CT-guided TACE for HCC and to analyze risk factors for local recurrence following TACE for HCC.Materials and Methods: For 32 patients with 34 small HCC lesions, CT-guided TACE was performed.The CT-guided TACE procedures were as follows. (1) The tumors in the liver were located by DSA, and two-phase CTHA. (2) The tip of the catheter was placed as near as possible to the tumor. (3) superselective CTHA that simulated the therapeutic injection. (4) An actual therapeutic TACE was performed. (5) The achieved distribution of the iodized oil was evaluated with CT just after TACE.Results: For 32 of 34 lesions, the catheterization to a subsegmental or more distal feeding artery could be performed. For other 2 lesions, the catheterization to a segmental feeding artery was performed. Local complete control were achieved in 26 cases and local recurrence was recognized in 6 cases after 173 to 539 d follow-up. The only independent risk factor that affected local recurrence was a central location (p =0. 0408).Conclusions: Single CT-guided TACE had a high local complete control rate and a low local recurrence rate for small HCC. A central location was the only independent risk factor for local recurrence.