# Cone-beam CT-derived parenchymal blood volume imaging in transarterial chemoembolization for hypovascular hepatic metastases: a case report

## TL;DR

A new imaging technique using cone-beam CT helps guide treatment for hard-to-see liver tumors during a combined procedure.

## Contribution

Integrates PBV imaging with embolization guidance for precise treatment of hypovascular liver metastases.

## Key findings

- PBV mapping identified peripheral hyperperfusion in occult hypovascular tumors.
- Embolization guidance software enabled precise superselective catheterization.
- Post-TACE PBV changes confirmed complete treatment response.

## Abstract

This case report describes the innovative integration of Cone-beam CT (CBCT) – derived parenchymal blood volume (PBV) mapping with embolization guidance technology to successfully direct the combined treatment of transarterial chemoembolization (TACE) and cryoablation of in a 70-year-old female with recurrent, hypovascular gallbladder liver metastases. By utilizing PBV software to quantitatively analyze tumor perfusion patterns through cone-beam CT acquisitions, the interventional team overcame the diagnostic limitations of conventional angiography in visualizing these typically occult lesions, identifying a characteristic peripheral hyperperfusion signature. Subsequently, the embolization guidance software automatically detected the tumor-feeding arteries and projected this information onto real-time fluoroscopy, enabling precise superselective catheterization. Post-TACE lipiodol deposition served as a radiopaque marker for accurate cryoablation probe placement under CT guidance. The procedural endpoint was objectively confirmed by a quantifiable change in PBV values, transitioning from pre-operative hypoperfusion to a post-operative “black cavity” pattern, indicative of complete treatment response. This novel multi-modal image-guided approach establishes a new paradigm for managing complex hepatic metastases, providing a comprehensive single-session solution for lesion identification, targeted embolization, and verified ablation.