Caren van Roekel

25 Radioembolization hole microcatheter is advanced over an atraumatic microguidewire for further selectively catheterization (Figure 2a,b). FIGURE 2A AND B. Figure 2a shows a digital subtraction angiography with contrast injection in the common hepatic artery. Figure 2b shows the angiographic reference: 1. Common hepatic artery; 2. Gastroduodenal artery; 3. Right gastric artery; 4. Left hepatic artery; 5. Right hepatic artery. Image reproduced from angiofellow.com, with permission from M. Smits. 3.1. Intraprocedural imaging During angiography, digital subtraction angiography (DSA) is performed (Figure 3). DSA provides two-dimensional images of the vasculature at a high spatial resolution. Moreover, it is possible to acquire cinematic DSA images during high rate contrast administration with a power injector. The study of Theysohn et al. shows that with DSA as much as 6.5% of extrahepatic shunt vessels is missed, leading to possible extrahepatic deposition of the microspheres. Therefore, other imaging modalities are needed in the work-up for radioembolization (42). Cone beam computed tomography (CBCT) is a relatively new imaging modality that has been integrated into the angiography suite and that provides 3D images. CBCT is based on the rotational movement of a C-arm equipped with a flat panel detector around the patient (43). It can be used to acquire, reconstruct and display 3D images of selective contrast-enhanced vessels and the surrounding soft-tissue. During radioembolization, CBCT is used to map the hepatic arterial anatomy, to identify extrahepatic branches and to rule out extrahepatic shunting 2