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HCC - residual tumor targeted

Supported by syngo DynaCT

Author: Tobias F. Jakobs, MD,
Head of the Department of Radiology, Hospital Barmherzige Brüder Munich, Germany

 

“syngo DynaCT enables the interventional radiologist to quickly identify the tumor feeding vessel and targeting the residual tumor without treating non tumor-bearing, healthy liver parenchyma.”1
Tobias F. Jakobs, MD
Hospital Barmherzige Brüder Munich, Germany

 

Patient history
A 78-year-old male with alcohol induced liver cirrhosis and a single HCC (8 cm) in the right liver lobe (fig. 1, yellow arrow). A single transarterial chemoembolisation (TACE) with drug eluting beads (100-300 μm) loaded with 100 mg doxorubicin was performed six weeks before. First control MR imaging revealed residual, nodular contrast enhancement in the anterior portion of the former tumor, representing residual tumor tissue (fig. 2, yellow arrow). It was decided to retreat the patient by means of TACE.
 

Diagnosis
Hepatocellular Carcinoma (HCC)

 

Treatment
On the day of repeated TACE the initial angiogram (fig. 3) performed with a 4F Cobra catheter being placed in the right hepatic artery showed the potential tumor feeders (arrowheads) supplying the tumor (yellow arrow). One of these potentially feeding arteries was catheterized and an additional run was performed (fig. 4). At this point it remained unclear whether the whole residual tumor would be covered from this position or whether the other potential feeders needed to be explored as well. A syngo DynaCT was performed (fig. 5a-c and 6) which demonstrated, that (compared to the pre-treatment MRI) the residual HCC would be completely covered from this position (and nearly no healthy liver parenchyma) and no efforts are needed to search for additional feeders. Drug eluting beads have been infused safely from this catheter position.
 

Comments
Performing syngo DynaCT ensured the interventional radiologist that the whole residual tumor would be covered from the displayed catheter position and that there is no necessity to search for additional tumor feeding arteries.

figure 1

Initial MRI illustrating single HCC with a size of 8 cm in the right liver lobe (arrow)

figure 2

Control MRI revealing residual tumor tissue (arrow) in the anterior portion of the former tumor

figure 3

Angiography shows which vessels (arrowheads) potentially supply the tumor (yellow arrow).

figure 4

Selective angiogram of one of the feeding arteries.

figure 5

The complete coverage of the residual HCC could be verified by syngo DynaCT (MIP representation)

figure 6

Complete coverage of residual HCC shown by syngo DynaCT (VRT representation).

Date: 2012-11-01


Angiography - Case Studies

1 The statements by Siemens' customers described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.

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