Impact of a Guiding CT prior to angiographic Intervention

With these two cases we want to demonstrate the additional impact of contrast enhanced multi-detector-row-CT angiography (MDR-CTA) compared to digital subtraction angiography (DSA) for planning of angiographic intervention. In selected cases a pre-interventional CTA can be useful to facilitate angiographic intervention. We selected two patients with different disease entities (bleeding caused by hepatic aneurysmosis; hepatocellular carcinoma (HCC) prior to transarterial chemoembolization (TACE) with aberrant arteries) from our collective who underwent CTA prior to angiographic intervention. The CT scans were performed using a 16 channel Multi-Detector-Row-CT (Philips Mx8000 IDT). Both multiplanar reconstructions (MPR) and slab maximum intensity projections (slab MIP) were performed. After CTA, patients underwent angiographic intervention (coil embolisation in the first case, TACE in the second case). MDR-CTA can not only find the cause of hemorrhage but also demonstrate the exact localization of the specific vascular pathology (first case). These findings facilitate the intervention, resulting in decreased table time in the angio suite and a reduction in radiation exposure. The second case illustrates the anatomic detail achievable with MDR-CTA. Even very small aberrant arteries (crucial to the success of TACE) are revealed. These arteries did not show in overview DSA and required superselective catheterization (only performed after MDR-CTA). These cases show that MDR-CTA can provide important informations in planning of interventional procedures. (orig.)