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Original Article

Detecting hepatic nodules and identifying feeding arteries of

hepatocellular carcinoma: efficacy of cone-beam computed

tomography in transcatheter arterial chemoembolization

1
1
1
1,2
Yasuhiro Ushijima , Tsuyoshi Tajima , Akihiro Nishie , Yoshiki Asayama , Kousei Ishigami ,
1
1,3
1
Masakazu Hirakawa , Daisuke Kakihara , Daisuke Okamoto , Hiroshi Honda 1
1
1 Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
2 Department of Radiology, Graduate School of Medicine, Tokyo Women’s Medical University, Tokyo 162-8666, Japan.
3 Department of Radiology, Kyushu University Beppu Hospital, Oita 874-0838, Japan.
ABSTRACT
Aim: To evaluate the effectiveness of using cone-beam computed tomography (CBCT) in transcatheter arterial
chemoembolization (TACE) to detect hapatocellular carcinoma (HCC) nodules and their feeding arteries. Methods:
Twenty-four patients with HCCs who underwent TACE using CBCT in addition to conventional digital subtraction
angiography (DSA) were enrolled. After both conventional DSA and CBCT through the hepatic artery were acquired,
TACE were performed. The nodules were defined as an HCC when dense accumulation of iodized oil was found within
the nodule on CT obtained 2 weeks after the TACE. The number of detected nodules and identified feeding arteries, and
their correlations with anatomical locations were assessed. Results: A total of 39 HCC nodules (tumor diameter, 7-40 mm;
mean, 17.4 ± 7.9 mm) were detected. Thirty-one nodules were detected by DSA alone but 8 nodules were additionally
detected by adding CBCT to DSA. There were 53 feeding arteries associated with the 39 HCC nodules. Among these
arteries, 21 were identified by DSA alone; however, 47 were identified by combining CBCT with DSA. Additional feeding
arteries, especially for the nodules located at the right and caudate lobes, were identified by CBCT. On the other hand,
there was no difference in detection of nodules between the anatomical locations by CBCT. Conclusion: The use of CBCT
in addition to DSA offers potential for increasing the number of detected nodules, and the number of their feeding arteries at
the right and caudate lobes. CBCT might improve the quality of TACE procedure for HCC than DSA alone.

Key words: Hepatocellular carcinoma; transcatheter arterial chemoembolization; cone-beam computed tomography;
interventional procedure

Corresponding author:
Dr. Akihiro Nishie, Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku,
Fukuoka 812-8582, Japan. E-mail: anishie@radiol.med.kyushu-u.ac.jp
Received: 26-07-2016; Accepted: 28-07-2016

INTRODUCTION multiple lesions, and the ability to be utilized on lesions in
areas where percutaneous treatment is anatomically difficult
Transcatheter arterial chemoembolization (TACE), an to perform. In recent years, treatment with superselective
endovascular intervention for hepatocellular carcinoma catheterization has become easier, thanks to the advances
(HCC), is an established treatment procedure performed in angiography devices such as the microcatheter and
worldwide along with other therapeutic techniques such as micro-guide wire. Recent TACE treatment results, such as
surgical resection and percutaneous treatment. It has many
advantages such as less invasiveness, the ability to act on This is an open access article distributed under the terms of the Creative
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Website:
www.hrjournal.net How to cite this article: Ushijima Y, Tajima T, Nishie A, Asayama
Y, Ishigami K, Hirakawa M, Kakihara D, Okamoto D, Honda H.
Detecting hepatic nodules and identifying feeding arteries of
DOI: hepatocellular carcinoma: efficacy of cone-beam computed
10.20517/2394-5079.2016.32 tomography in transcatheter arterial chemoembolization. Hepatoma
Res 2016;2:231-6.
© 2016 Hepatoma Research | Published by OAE Publishing Inc. 231