The value of combined soft-tissue and vessel visualisation before transarterial chemoembolisation of the liver using C-arm computed tomography

The purpose of the study was to prospectively evaluate intrahepatic vessel depiction on C-arm CT (CACT) and the influence of the additional combined tissue and three-dimensional vessel visualisation on the positioning of the TACE catheter in comparison to DSA alone. Thirty consecutive patients scheduled for their first transarterial chemoembolisation underwent biphasic CACT and DSA of the liver. After assessing the DSA images for procedure planning, the CACT images were reviewed. The number and origin of the tumour-feeding arteries and the ideal position of the catheter for TACE on both DSA and CACT were assessed and correlated. The number of vessels identified as tumour feeders in each patient was significantly higher using additional CACT than on DSA alone (CACT: 4.0 +/- 1.7; DSA: 3.3 +/- 1.4; P = 0.003, t-test). After considering CACT, in 50% of the patients the catheter position was changed for TACE. Segmental portal vein thrombosis was seen in three patients on CACT, but in only one on DSA. As CACT depicts soft tissue and small vessels with high spatial resolution, tumour vessel allocation is facilitated, and ideal catheter position for TACE can be more accurately identified. The high impact of CACT on the TACE procedure suggests the benefits of its routine use for all patients undergoing their first TACE.