Ruediger Egbert Schernthaner MD, Presenter: Nothing to Disclose

MingDe Lin PhD, Abstract Co-Author: Employee, Koninklijke Philips NV

Rafael Duran MD, Abstract Co-Author: Nothing to Disclose

Julius Chapiro MD, Abstract Co-Author: Nothing to Disclose

Zhijun Wang MD, Abstract Co-Author: Nothing to Disclose

Jean-Francois H. Geschwind MD, Abstract Co-Author: Consultant, BTG International Ltd Consultant, Bayer AG Consultant, Guerbet SA Consultant, Nordion, Inc Grant, BTG International Ltd Grant, F. Hoffmann-La Roche Ltd Grant, Bayer AG Grant, Koninklijke Philips NV Grant, Nordion, Inc Grant, ContextVision AB Grant, CeloNova BioSciences, Inc Founder, PreScience Labs, LLC CEO, PreScience Labs, LLC

The open trajectory CBCT acquisition allows more complete depiction of the whole liver.

Cone-beam CT (CBCT) facilitates intra-procedural visualization and assessment of liver cancer during intra-arterial therapies (IAT). However, high BMI patients present a challenge to the image acquisition in terms of capturing the liver region of interest while still allowing for the C-arm to rotate around the patient. The geometric motion of the C-arm at our institution (Allura FD20, Philips Healthcare, Best, The Netherlands) was modified to rotate from 55 to -185 degrees (open trajectory) instead of 120 to -120 degrees (closed trajectory). All other imaging parameters are the same. This opens up room for asymmetrical positioning of the patient, allowing for centering of the liver, rather than the spine, in the field of view (FOV).

The purpose of this study was to evaluate the open trajectory in visualizing more of the liver. 10 patients who underwent two sessions of IAT had CBCT acquisitions with both the closed (during 1st IAT session) and open (during 2nd IAT session) trajectories. The volume of the whole liver as seen on intra-procedural CBCT for both trajectories and the pre-IAT MRI were measured using a 3D segmentation software. The CBCT volumes were compared to the corresponding pre-interventional MRI in terms of measured liver volume and number of missed or partially depicted lesions. MRI was used as the standard given its larger FOV to capture the entire liver and all lesions.

Two patients had severe breathing artifacts during CBCT acquisition and had to be excluded, leaving 8 patients for further analysis. The median BMI of these patients was 27.5 (range 15.8-39.3). The closed CBCT trajectory covered a median liver volume of 89% (1630 cc) that of the MRI, whereas the open trajectory covered 96% (1711 cc). In 3 out of 8 patients (37.5%), intrahepatic lesions were either missed or only partially depicted due to the limited coverage of the close trajectory. All lesions (100%) were completely depicted using the open trajectory.

Schernthaner, R, Lin, M, Duran, R, Chapiro, J, Wang, Z, Geschwind, J, Open Trajectory Cone-beam CT Acquisition Improves Liver Visualization during IR Procedures.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14019038.html