Multi-Detector CT Angiography With 3D Reconstruction Versus Digital Subtraction Angiography
NCT ID: NCT05304572
Last Updated: 2023-06-15
Study Results
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Basic Information
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COMPLETED
70 participants
OBSERVATIONAL
2022-05-01
2023-06-01
Brief Summary
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Detailed Description
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Tumor detection and assessment of the tumor-feeding vessel(s) are important for an effective treatment, while limiting non-target embolization. Usually, selection of the tumor-feeding vessels during TACE has been guided by 2D digital subtraction angiography (DSA). However; this method has a disadvantage of occasional misinterpretation of tumor-feeding vessels due to superimposition of vessels. To prevent such misinterpretation, multiple selective injections and oblique projections are performed during TACE with consequent increase in procedure time, volume of injected contrast material, and radiation doses.
A relatively new approach using three-dimensional (3D) cone-beam CT angiography during TACE is reported to be extremely helpful, especially in cases of complex hepatic arterial anatomy. However, the time required for processing and evaluating this 3D angiography images may discourage its routine use by intervention radiologists because it requires either a sterile remote control for in-room review or the operator exit from the angiographic room to access a workstation. A new automatic specifically designed softwares has been developed for detection of feeding vessels after Cone beam CT, but these softwares are not widely available.
Multiphasic contrast enhanced CT is one of the recommended imaging tools for diagnosis of HCC and is routinely done before TACE. There are few reports on the application of Multi-Detector CT angiography for detection of HCC feeding vessels before TACE.
This study aims to investigate the feasibility and accuracy of Multi-Detector CT angiography for assessment of tumor-feeding vessel in patients planned for TACE compared to DSA angiography acquired during TACE.
Conditions
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Study Design
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CASE_ONLY
PROSPECTIVE
Interventions
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Multi-Detector CT angiography
Multiphasic CT within 4 weeks interval prior to TACE will be done including non-enhanced, arterial, portal and venous phases using IV bolus injection of a 75-100-mLiodinated contrast material iopamidol at a rate of 3.0 mL/s. The images of arterial phase will be transferred to workstation to produce 3D angiographic reconstruction images .
Trans-arterial chemoembolization and DSA
Percutaneous arterial access is achieved through the common femoral artery (19 G needle) under local anesthesia with placement of a 5-Fr sheath. A 5-Fr Cobra (C2) or sidewinder (SIM1) catheter was used for catheterizing the coeliac trunk and SMA. Then celiac and superior mesenteric angiography was done by injecting 24 mL of iopamidol using forced manual injection method or using a pump at a rate of 6 mL/s according to the operator preferences.Then a microcatheter was used for selective and super-selective access of the hepatic arteries. The micro-catheter was placed in the feeding artery as close as possible to the tumor.The chemotherapeutic drugs (Doxorubicin 50 mg) solved within 5 ml of iodinated non-ionic contrast media and then mixed with 10 ml of iodized oil (lipiodol) will be delivered through the feeding hepatic artery and then embolized using Poly-vinyl Alcohol (PVA) particles.
Eligibility Criteria
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Inclusion Criteria
* CHILD class A/B cirrhosis.
* patent main portal vein.
* less than 50% involvement of the liver by the tumor.
* no vascular invasion or extrahepatic spread of the HCC.
* normal renal functions.
* bilirubin level \< 2 mg/dl .
Exclusion Criteria
* patients with only available Pre-TACE MRI images
* Failed TACE due to technical factors
* Non-selective TACE technique
ALL
No
Sponsors
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Assiut University
OTHER
Responsible Party
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Ramy Mohammed Ahmed
lecturer of interventional and diagnostic radiology
Principal Investigators
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Ramy M Ahmed, MD
Role: PRINCIPAL_INVESTIGATOR
Assiut University
Locations
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Assiut Universtiy Hospital; Alrajhy Liver institute
Asyut, , Egypt
Countries
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References
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Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018 Mar 31;391(10127):1301-1314. doi: 10.1016/S0140-6736(18)30010-2. Epub 2018 Jan 5.
Brown DB, Geschwind JF, Soulen MC, Millward SF, Sacks D. Society of Interventional Radiology position statement on chemoembolization of hepatic malignancies. J Vasc Interv Radiol. 2009 Jul;20(7 Suppl):S317-23. doi: 10.1016/j.jvir.2009.04.015. No abstract available.
Marelli L, Stigliano R, Triantos C, Senzolo M, Cholongitas E, Davies N, Tibballs J, Meyer T, Patch DW, Burroughs AK. Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol. 2007 Jan-Feb;30(1):6-25. doi: 10.1007/s00270-006-0062-3.
Liapi E, Hong K, Georgiades CS, Geschwind JF. Three-dimensional rotational angiography: introduction of an adjunctive tool for successful transarterial chemoembolization. J Vasc Interv Radiol. 2005 Sep;16(9):1241-5. doi: 10.1097/01.RVI.0000174283.03032.8E.
Kakeda S, Korogi Y, Ohnari N, Moriya J, Oda N, Nishino K, Miyamoto W. Usefulness of cone-beam volume CT with flat panel detectors in conjunction with catheter angiography for transcatheter arterial embolization. J Vasc Interv Radiol. 2007 Dec;18(12):1508-16. doi: 10.1016/j.jvir.2007.08.003.
Miyayama S, Yamashiro M, Okuda M, Yoshie Y, Sugimori N, Igarashi S, Nakashima Y, Matsui O. Usefulness of cone-beam computed tomography during ultraselective transcatheter arterial chemoembolization for small hepatocellular carcinomas that cannot be demonstrated on angiography. Cardiovasc Intervent Radiol. 2009 Mar;32(2):255-64. doi: 10.1007/s00270-008-9468-4. Epub 2008 Dec 9.
Chiaradia M, Izamis ML, Radaelli A, Prevoo W, Maleux G, Schlachter T, Mayer J, Luciani A, Kobeiter H, Tacher V. Sensitivity and Reproducibility of Automated Feeding Artery Detection Software during Transarterial Chemoembolization of Hepatocellular Carcinoma. J Vasc Interv Radiol. 2018 Mar;29(3):425-431. doi: 10.1016/j.jvir.2017.10.025. Epub 2018 Feb 3.
Deschamps F, Solomon SB, Thornton RH, Rao P, Hakime A, Kuoch V, de Baere T. Computed analysis of three-dimensional cone-beam computed tomography angiography for determination of tumor-feeding vessels during chemoembolization of liver tumor: a pilot study. Cardiovasc Intervent Radiol. 2010 Dec;33(6):1235-42. doi: 10.1007/s00270-010-9846-6.
Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, Christensen E, Pagliaro L, Colombo M, Rodes J; EASL Panel of Experts on HCC. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001 Sep;35(3):421-30. doi: 10.1016/s0168-8278(01)00130-1. No abstract available.
Huang JH, Fan WJ, Li CJ, Gu YK, Zhang L, Gao F, Lu LW, Li WQ. Application of multislice spiral CT angiography on transcatheter arterial chemoembolization for hepatocellular carcinoma. Ai Zheng. 2009 Feb;28(2):159-63. Epub 2009 Feb 15.
Kim I, Kim DJ, Kim KA, Yoon SW, Lee JT. Feasibility of MDCT angiography for determination of tumor-feeding vessels in chemoembolization of hepatocellular carcinoma. J Comput Assist Tomogr. 2014 Sep-Oct;38(5):742-6. doi: 10.1097/RCT.0000000000000103.
Ahmed RM, Ali WA, AbdelHakam AM, Ahmed SH. Detection of hepatocellular carcinoma feeding vessels: MDCT angiography with 3D reconstruction versus digital subtraction angiography. BMC Med Imaging. 2024 Sep 18;24(1):250. doi: 10.1186/s12880-024-01408-z.
Other Identifiers
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MDCT angiography HCC
Identifier Type: -
Identifier Source: org_study_id
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