R Adamus1, M Pfister, M Uder, R W Loose. 1. Institut für Radiologie, Klinikum Nürnberg Nord, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland, Adamus@klinikum-nuernberg.de.
Abstract
CLINICAL/METHODICAL ISSUE: To avoid non-targeted embolization in liver tumors, arteries important for embolization must be detected. In transarterial chemoembolization (TACE) arteries for particle embolization have to be detected and in selective internal radiotherapy (SIRT) extrahepatic arteries which must be protected from embolization have to be detected. In transjugular intrahepatic portosystemic shunt (TIPS) the problem is to achieve an exactly targeted puncture of the portal vein. STANDARD RADIOLOGICAL METHODS: In TACE and SIRT detection of the vessels is performed from various angles by digital subtraction angiography (DSA). In TIPS puncture is guided by ultrasound or performed blindly. METHODICAL INNOVATIONS: Using cone beam CT (CBCT) very small vessels in the liver can be visualized and 2D-3D back projection is able to detect the exact position of the portal vein in TIPS. ACHIEVEMENTS: The use of CBCT and 2D-3D back projection significantly enhances navigation of vessels. PRACTICAL RECOMMENDATIONS: If flat detector technique is available CBCT should be used in TACE and SIRT and 2D-3D navigation needs hardware and software updates.
CLINICAL/METHODICAL ISSUE: To avoid non-targeted embolization in liver tumors, arteries important for embolization must be detected. In transarterial chemoembolization (TACE) arteries for particle embolization have to be detected and in selective internal radiotherapy (SIRT) extrahepatic arteries which must be protected from embolization have to be detected. In transjugular intrahepatic portosystemic shunt (TIPS) the problem is to achieve an exactly targeted puncture of the portal vein. STANDARD RADIOLOGICAL METHODS: In TACE and SIRT detection of the vessels is performed from various angles by digital subtraction angiography (DSA). In TIPS puncture is guided by ultrasound or performed blindly. METHODICAL INNOVATIONS: Using cone beam CT (CBCT) very small vessels in the liver can be visualized and 2D-3D back projection is able to detect the exact position of the portal vein in TIPS. ACHIEVEMENTS: The use of CBCT and 2D-3D back projection significantly enhances navigation of vessels. PRACTICAL RECOMMENDATIONS: If flat detector technique is available CBCT should be used in TACE and SIRT and 2D-3D navigation needs hardware and software updates.
Authors: Shyamkumar N Keshava; Gopi Krishna Kota; Thomas Mammen; R Jeyamani; Vinu Moses; Shalini Govil; George Kurian; George Chandy Journal: Indian J Gastroenterol Date: 2006 Sep-Oct