Use of C-Arm Cone Beam CT During Hepatic Radioembolization: Protocol Optimization for Extrahepatic Shunting and Parenchymal Enhancement

• Published in: Cardiovascular and interventional radiology Vol. 39; no. 1; pp. 64 - 73
• Main Authors: van den Hoven, Andor F., Prince, Jip F., de Keizer, Bart, Vonken, Evert-Jan P. A., Bruijnen, Rutger C. G., Verkooijen, Helena M., Lam, Marnix G. E. H., van den Bosch, Maurice A. A. J.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2016; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; BIOMEDICAL RADIOGRAPHY; BLOOD VESSELS; BYPASSES; Cardiology; CAT SCANNING; Clinical Investigation; Collateral Circulation; Cone-Beam Computed Tomography - methods; Contrast Media; Female; Humans; Imaging; LIVER; Liver - blood supply; Liver - diagnostic imaging; Liver Circulation; Liver Neoplasms - blood supply; Liver Neoplasms - radiotherapy; Male; Medicine; Medicine & Public Health; MEETINGS; Middle Aged; NEOPLASMS; Nuclear Medicine; OPTIMIZATION; PATIENTS; Prospective Studies; RADIOEMBOLIZATION; Radiographic Image Enhancement; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiopharmaceuticals - administration & dosage; RECOMMENDATIONS; Regional Blood Flow; RESPIRATION; REVIEWS; SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY; Technetium Tc 99m Aggregated Albumin - administration & dosage; Triiodobenzoic Acids; Ultrasound; IDEAL; C-arm CT; Protocol optimization; Radioembolization; Cone beam CT
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-015-1146-8

Purpose To optimize a C-arm computed tomography (CT) protocol for radioembolization (RE), specifically for extrahepatic shunting and parenchymal enhancement. Materials and Methods A prospective development study was performed per IDEAL recommendations. A literature-based protocol was applied in patients with unresectable and chemorefractory liver malignancies undergoing an angiography before radioembolization. Contrast and scan settings were adjusted stepwise and repeatedly reviewed in a consensus meeting. Afterwards, two independent raters analyzed all scans. A third rater evaluated the SPECT/CT scans as a reference standard for extrahepatic shunting and lack of target segment perfusion. Results Fifty scans were obtained in 29 procedures. The first protocol, using a 6 s delay and 10 s scan, showed insufficient parenchymal enhancement. In the second protocol, the delay was determined by timing parenchymal enhancement on DSA power injection (median 8 s, range 4–10 s): enhancement improved, but breathing artifacts increased (from 0 to 27 %). Since the third protocol with a 5 s scan decremented subjective image quality, the second protocol was deemed optimal. Median CNR (range) was 1.7 (0.6–3.2), 2.2 (−1.4–4.0), and 2.1 (−0.3–3.0) for protocol 1, 2, and 3 ( p  = 0.80). Delineation of perfused segments was possible in 57, 73, and 44 % of scans ( p  = 0.13). In all C-arm CTs combined, the negative predictive value was 95 % for extrahepatic shunting and 83 % for lack of target segment perfusion. Conclusion An optimized C-arm CT protocol was developed that can be used to detect extrahepatic shunts and non-perfusion of target segments during RE.