Efficacy of CO2-DSA in embolization

Area of Science:

• Interventional Radiology
• Hepatobiliary Imaging
• Oncology

Background:

• Hepatocellular carcinoma (HCC) management often requires transcatheter arterial therapies.
• Accurate detection of arteriovenous (AV) and arterioportal (AP) shunts is crucial for effective treatment planning in HCC.
• Conventional iodinated contrast angiography has limitations in shunt detection.

Purpose of the Study:

• To evaluate the efficacy of carbon dioxide intra-arterial digital subtraction angiography (CO2-IA-DSA) in detecting AV and AP shunts in patients with unresectable HCC.
• To compare the shunt detection capabilities of CO2-IA-DSA with conventional iodinated contrast hepatic intra-arterial digital subtraction angiography (IA-DSA).
• To assess the utility of CO2-IA-DSA in guiding transcatheter arterial injection strategies.

Main Methods:

• CO2-IA-DSA was performed in 31 patients with unresectable HCC, alongside selective arteriography using iodinated contrast.
• Shunt detection rates and types (AV vs. AP) were compared between CO2-IA-DSA and conventional IA-DSA.
• Treatment strategies, including embolization techniques (Gelfoam, metallic coils) and chemotherapeutic agent delivery (Lipiodol and Farmorubicin - FARM), were tailored based on shunt presence and type.

Main Results:

• CO2-IA-DSA detected a total of 20 shunts (4 AV, 16 AP) in 31 patients.
• Conventional hepatic IA-DSA identified only 3 AP shunts.
• CO2-IA-DSA demonstrated significantly superior sensitivity for detecting both AV and AP shunts compared to conventional IA-DSA.

Conclusions:

• CO2-IA-DSA is a highly effective imaging modality for detecting AV and AP shunts in the liver of HCC patients.
• The superior shunt detection by CO2-IA-DSA aids in optimizing the selection of transcatheter arterial therapies.
• This technique facilitates personalized treatment approaches for unresectable HCC by accurately characterizing vascular abnormalities.