CIO 2021-32 Real-time Arteriography-directed Percutaneous Microwave Ablation Using Hybrid Angio-CT

Purpose: Conventional CT-guided percutaneous microwave ablation (pMWA) of hepatic tumors that are small or exhibit similar attenuation as the background liver parenchyma can be technically challenging. The goal of the present technical note is to report a single-institution’s experience in treating these tumors using real-time-arteriography directed pMWA (rad-pMWA) in a hybrid Angiography-Computed-Tomography (Angio-CT) suite.

Material and Methods: A single institutional review was performed to include patients who underwent rad-MWA in the Hybrid Angio-CT suite between April 2020 and August 2021. The following information was collected: patient age, tumor etiology, liver segment, tumor size, contrast usage, complication, length of hospital stay, complete ablation, and local progression. Intraprocedural images were also selected to provide a pictorial assay of the technique.

Results: A total of 11 patients that underwent rad-MWA due to poorly delineated hepatic lesions were included: 6 hepatocellular carcinoma, 2 colorectal cancer, 2 (NET), and 1 cholangiocarcinoma. The median longest axial diameter of the tumor was 1.6cm. Technical success was achieved in 11/11 (100%). Average contrast volume use was 55.5ml. One non-flowing-limiting celiac artery dissection occurred, which was managed conservatively. In another case, patient developed biloma after discharge, requiring drainage. No major transarterial access related complications. Complete ablation was achieved in all cases (9/9).

Conclusions: For small and poorly characterized lesions on plain CT, rad-pMWA in a hybrid Angio-CT room is safe and effective in improving tumor visibility and operator convenience. Tumors can be localized with low contrast dosage. The required dose of contrast during arteriography is low.