The Added Value of Transcatheter CT Hepatic Angiography (CTHA) Image Guidance in Percutaneous Thermal Liver Ablation: An Experts' Opinion Pictorial Essay.

Simple Summary: Image-guided tumor ablation has become an indispensable part of oncological care, with an increasing demand and need for novel implements to optimize treatment outcomes. The purpose of this pictorial essay was to illustrate the added value of intra-arterial contrast administration during CT-guided liver tumor ablation procedures. Eight clinical cases from three tertiary referral institutions demonstrate the ability to improve the conspicuity of the target liver tumor(s) and identify surrounding critical vascular structures, promptly detect 'vanished' and/or additional tumors, differentiate local tumor progression from non-enhancing scar tissue, and instantly detect and respond to iatrogenic hemorrhagic events. In conclusion, although at the cost of adding a minor but safe intervention, the use of an intra-arterial-administered contrast agent during a CT-guided thermal ablation procedure is a potential quality-improving real-time image-guiding method and should therefore be embedded in (inter)national standards of practice. With the rapidly evolving field of image-guided tumor ablation, there is an increasing demand and need for tools to optimize treatment success. Known factors affecting the success of (non-)thermal liver ablation procedures are the ability to optimize tumor and surrounding critical structure visualization, ablation applicator targeting, and ablation zone confirmation. A recent study showed superior local tumor progression-free survival and local control outcomes when using transcatheter computed tomography hepatic angiography (CTHA) guidance in percutaneous liver ablation procedures. This pictorial review provides eight clinical cases from three institutions, MD Anderson (Houston, TX, USA), Gustave Roussy (Paris, France), and Amsterdam UMC (Amsterdam, The Netherlands), with the intent to demonstrate the added value of real-time CTHA guided tumor ablation for primary liver tumors and liver-only metastatic disease. The clinical illustrations highlight the ability to improve the detectability of the initial target liver tumor(s) and identify surrounding critical vascular structures, detect 'vanished' and/or additional tumors intraprocedurally, differentiate local tumor progression from non-enhancing scar tissue, and promptly detect and respond to iatrogenic hemorrhagic events. Although at the cost of adding a minor but safe intervention, CTHA-guided liver tumor ablation minimizes complications of the actual ablation procedure, reduces the number of repeat ablations, and improves the oncological outcome of patients with liver malignancies. Therefore, we recommend adopting CTHA as a potential quality-improving guiding method within the (inter)national standards of practice. [ABSTRACT FROM AUTHOR]