Single-room transcatheter CT hepatic angiography for microwave liver ablation: a feasibility and safety study

Transcatheter CT hepatic angiography (CTHA) enhances liver tumour ablation by enabling multiple direct intra-arterial contrast injections during a single procedure. We report the implementation of a single-room CTHA workflow using a mobile fluoroscopic C-arm, focusing on feasibility and safety.

A prospective service evaluation was conducted following a radiation risk assessment and training at an expert centre. Feasibility-defined as the ability to integrate CTHA into a four-hour ablation session-was assessed alongside technical success, which was defined as acquisition of CTHA images. All CTHA-related adverse events were recorded and graded using the Common Terminology Criteria for Adverse Events (CTCAE). Radiation dose, contrast volume, and tumour visualization were also documented.

Twenty patients (14 men, median age 66 years) underwent 21 CTHA procedures (April-September 2024). Feasibility and technical success were 100%, without any instance of CTHA-related complications. Median catheterization time was 10 min16 s, contrast dose was 174 mL (7 acquisitions), and radiation dose-area product was 18.86 Gy·cm2. Ninety-seven percent of tumours (32/33) were visible. All these tumours were completely covered by an ablation zone using image fusion software.

Single-room CTHA using a mobile C-arm is feasible and safe for liver tumour ablation. This technique enhances tumour and ablation zone visibility whilst requiring low contrast volumes, enabling multiple acquisitions and real-time margin assessment. Our technique can be readily implemented without expensive infrastructure, holding significant promise in improving liver ablation outcomes and broadening access to advanced interventional oncology techniques.

Single-room CTHA can be readily implemented in centres with catheterization experience, without expensive infrastructure. The method holds significant promise in improving liver ablation outcomes and broadening access to state-of-the-art interventional oncology techniques globally.