Impact of multidetector CT hepatic arteriography on the planning of chemoembolization treatment of hepatocellular carcinoma

OBJECTIVES. We examined the impact of the increased sensitivity for hyperva scular masses of multidetector CT hepatic arteriography on treatment decisi ons involving selective chemoembolization of hepatocellular carcinomas. SUBJECTS AND METHODS: Thirty patients were referred for chemoembolization o f unresectable hepatocellular carcinoma. Initial selective chemoembolizatio n plans were formulated on the basis of diagnostic biphasic CT or MR imagin g. Ultrafast CT hepatic arteriography was performed using a multidetector C T scanner and selective contrast material injection into the hepatic artery . The entire liver was scanned in a single breath-hold of approximately 20 sec with a slice thickness of 1 mm, Lesions and their arterial supplies wer e identified, and these data were immediately used to formulate a final pla n for chemoembolization. RESULTS. Hypervascular masses were detected in 29 patients. In 16 (53%) of the patients, preprocedural CT or MR imaging underestimated the number of l esions. In nine (30%) of these 16 patients, the additional lesions were det ected only on CT hepatic arteriography, not on conventional angiography. CT hepatic ateriography findings had a major impact on planning the way in wh ich chemoembolization treatment was performed. In three of the nine patient s, the previously undetected lesions were treated with additional supersele ctive chemoembolization. In the other six patients, chemoembolization was p erformed less selectively than originally planned. CONCLUSION. Primarily because of the high sensitivity of multidetector CT h epatic arteriography in revealing small and multifocal hepatomas, findings of this modality frequently alter treatment plans involving selective admin istration of chemoembolic material.