Cone-Beam Computed Tomography in Hepatic Interventional Oncology

Cone-beam computed tomography (CBCT) has emerged as a pivotal imaging tool in the planning, guidance and assessment of minimally invasive therapies for primary and secondary liver tumours. By delivering high-resolution, three-dimensional angiographic volumes within the interventional suite, CBCT enables precise characterisation of tumour vascularisation, identification of feeding arteries and real-time evaluation of therapy distribution. Its integration into transarterial chemoembolization (TACE) and radioembolization workflows has enhanced lesion detectability, reduced non-target embolisation and improved post-procedural assessment of therapeutic endpoints. Owing to rapid acquisition, on-demand volumetric reconstructions and seamless fusion with pre-procedural cross-sectional studies, CBCT supports adaptive decision-making during embolic and ablative interventions. Innovations such as motion compensation, metal artifact reduction and quantitative perfusion mapping have further refined image quality and diagnostic confidence. Together, these advances position CBCT as a cornerstone of precision interventional oncology for hepatocellular carcinoma and metastatic liver disease, with the potential to shorten procedure times, limit radiation exposure and personalise treatment strategies.

Research from Nature Portfolio

Recent studies have demonstrated that advanced reconstruction algorithms can substantially mitigate artefacts arising from metallic devices during radioembolization work-up. In a cohort of patients undergoing pre-treatment CBCT, a dedicated metal artifact reduction (MAR) algorithm was applied to uncorrected datasets. Quantitative and reader-based assessments revealed marked improvements in overall image quality, vessel delineation and tumour conspicuity, especially in regions adjacent to coils and catheters. Inter-observer agreement was enhanced on MAR-processed volumes, indicating greater diagnostic reliability. These findings support the integration of tailored reconstruction pipelines into routine CBCT protocols to optimise the visualisation of both target lesions and adjacent structures.

Cone-Beam Computed Tomography in Hepatic Interventional Oncology publication trend

The graph below shows the total number of articles in cone-beam computed tomography in hepatic interventional oncology across all publications each year (not limited to Nature Index journals).

Technical terms

Cone-Beam Computed Tomography (CBCT): A rotational angiographic technique that acquires a volumetric dataset in the interventional suite for real-time three-dimensional imaging.

Transarterial Chemoembolization (TACE): A loco-regional therapy that delivers chemotherapeutic agents and embolic particles into tumour-feeding arteries to induce ischaemia and cytotoxicity.

Radioembolization: An intra-arterial treatment in which radioactive microspheres are infused into hepatic arteries to deliver targeted radiotherapy to neoplastic tissue.

Metal Artifact Reduction (MAR) Algorithm: A reconstruction software module designed to identify and suppress streak artefacts caused by high-density objects within CBCT volumes.

Motion Correction Reconstruction: A computational approach that compensates for patient movement during CBCT acquisition to enhance image sharpness and structural fidelity.

References

1. Should Hypervascular Incidentalomas Detected on Per-Interventional Cone Beam Computed Tomography during Intra-Arterial Therapies for Hepatocellular Carcinoma Impact the Treatment Plan in Patients Waiting for Liver Transplantation?. Cancers (2024).
2. Evaluation of a prototype metal artifact reduction algorithm for cone beam CT in patients undergoing radioembolization. Scientific Reports (2024).
3. Evaluation of a Motion Correction Algorithm for C-Arm Computed Tomography Acquired During Transarterial Chemoembolization. CardioVascular and Interventional Radiology (2020).
4. Use of C-Arm Cone Beam CT During Hepatic Radioembolization: Protocol Optimization for Extrahepatic Shunting and Parenchymal Enhancement. CardioVascular and Interventional Radiology (2015).