C-arm CT during hepatic arteriography tumour-to-liver contrast: intraindividual comparison of three different contrast media application protocols

Objective

To compare tumour-to-liver contrast (TLC) of C-arm CT during hepatic arteriography (CACTHA) acquired using three protocols in patients with HCC.

Methods

This prospective study was IRB approved and informed consent was obtained from each patient. Twenty-nine patients (mean age, 68?±?7 years; 27 men) with 55 HCCs (mean diameter, 2.6?±?1.5 cm) underwent three different CACTHA protocols in random order before chemoembolisation. Contrast medium (100 mg iodine/ml) was injected into the common hepatic artery (flow rate 4 ml/s). The imaging delay for the start of the CACTHA examination was 4 s (protocol A), 8 s (protocol B) and 12 s (protocol C) (total amount of injected contrast medium: 48 ml, 64 ml, 80 ml). TLC was measured by placing regions of interest (ROIs) in the HCC and liver parenchyma. Mixed model ANOVAs and Bonferroni corrected post hoc tests were used for statistical analysis.

Results

Mean values for TLC were 132?±?3.3 HU, 186?±?5.8 HU and 168?±?2.8 HU for protocols A, B and C. Protocol B provided significantly higher TLC than protocols A and C (p?<?0.001).

Conclusion

TLC was significantly higher using an imaging delay of 8 s compared with a delay of 4 or 12 s.

Key Points

? C-arm cone-beam CT (CACT) angiography offers additional information during hepatic intervention. ? CACT hepatic arteriography tumour-to-liver contrast is highest with an 8-s delay. ? An 8-s delay is recommended for early arterial phase CACTHA for hepatocelullar carcinoma.