The Impact of the Use of C-Arm Cone-Beam CT During Chemoemboliza-tion for Hepatocellular Carcinoma

Objective: The objective of the study was to investigate the consequences of using C-Arm Cone-Beam computed Tomography (CBCT) on super-selective catheterization of Hepatic Artery (HA) branches during chemoembolization of hepatocellular carcinoma. Methods: Two groups of patients were created according to the dates of their treatment sessions. Group A and Group B included patients who had their treatment sessions in 2004-2005 and 2008-2010, respectively. The sessions performed in 2006 and 2007 were excluded to allow for the adop-tion and incorporation of CBCT imaging into clinical practice. All chemoembolized HA branches were categorized according to selection order (0-1, 2, or ≥3). Other procedure variables were docu-mented. Results: A total of 58 and 183 sessions were included in Groups A and B, respectively, for 144 pa-tients. C-arm CBCT was used in 2 (3%) sessions and 142 (78%) sessions in groups A and B, re-spectively. The average number of vessels treated was significantly higher in group B (1.8) compared to group A (1.3) (P < .0001). A shift to an increased selection order in group B (0-1, 44 [24%]; 2, 85 [46%]; ≥3, 54 [30%]) was more significant (P = .0004) than that in group A (0-1, 32 [55%]; 2, 18 [31%]; ≥3, 8 [14%]). The average duration of the procedure was significantly longer in group B (P = .0002). Conclusion: Using C-arm CBCT during chemoembolization has a positive impact on increasing the number and order of HA selected and chemoembolized. This comes at the expense of an increase in the duration of the procedure.