Radiation protection in CT-guided interventions: does real-time dose visualisation lead to a reduction in radiation dose to participating radiologists? A single-centre evaluation.

AIM: To evaluate if real-time dose visualisation during computed tomography (CT)-guided interventions leads to a reduction in radiation dose to participating radiologists. MATERIALS AND METHODS: The individual radiation dose radiologists are exposed to during CT interventions was measured using dedicated dosimeters (RaySafe i2-system, Unfors RaySafe GmbH, Billdal, Sweden) worn over the usual radiation protective apron. Initially, only the total radiation dose was measured, without visualisation (control group). In the following study period, the radiation dose was shown to participants on a live screen in real-time (experimental group). In both groups, the dose was recorded in 1-second intervals. The results collected were evaluated by comparison using descriptive statistics and mixed-effect models. In particular, the variables experience, gender, role, and position during the intervention were analysed. RESULTS: In total, 517 measurements of 304 interventions (n=249 with and n=268 without live screen) performed by 29 radiologists acting as interventionalists or assistants were analysed. All CT-guided interventions were performed percutaneously, the majority of which (n=280) were microwave ablations (MWA). Radiation doses in the group without visualisation were comparable with usual dose rates for the corresponding intervention type. The mean total radiation dose was reduced by 58.1% (11.6 versus 4.86 µSv) in the experimental group (p=0.034). The highest reduction of 78.5% (15.55 versus 3.35 µSv) was observed in radiologists with the role of assistant (p=0.002). Sub-analysis showed significant dose reduction (p<0.0001) for the use of live screen in general; considering all variables, the role "assistant" alone had a statistically significant influence (p=0.002). CONCLUSION: The real-time visualisation of active radiation dose during CT interventions leads to a relevant reduction in radiation dose to participating radiologists.

Coil embolization of a fistula from the right inferior phrenic artery to the right pulmonary artery with involvement of further arteries: A rare case report.

A 51-year-old female patient was presenting dyspnea for more than a year with no previous lung infections or surgery. Initially, a diagnostic computed tomography was made, showing a rare arterio-arterial malformation between the right inferior phrenic and right pulmonary artery leading into a vascular bundle in the middle lung lobe. Due to the patients' dyspnea and massive extent of malformation, the indication for transcatheter arterial embolization was made. The first transcatheter arterial embolization procedure involved the inferior phrenic and a selective branch of the internal thoracic artery. Interventional angiography as well as computed tomography revealed further extend of the malformation showing a connection of right lateral thoracic, hepatic, and inferior epigastric artery to the fistula. After one month, a second transcatheter arterial embolization of these arteries as well as a second approach of the proximal internal thoracic artery was performed. In the follow-up the patient described a substantial improvement of her dyspnea and showed no signs of infections. A phrenic artery to pulmonary artery fistula is an extremely rare case occurring congenital or acquired. Patients may be asymptomatic or present, among others, dyspnea, hemoptysis, pulmonary infections and congestive heart failure. Symptomatic patients require treatment using transcatheter arterial embolization or surgical resection. The patient had dyspnea and a substantial extent of malformation with possibly complicated clinical course. The recommended less invasive treatment using transcatheter arterial embolization was successfully performed. In conclusion, our patient represented a rare congenital case of systemic and pulmonary artery communication, which we were able to treat sufficiently with coil embolization.

The role of dynamic magnetic resonance imaging in exclusion of inguinal hernia in patients suffering from indefinitive groin pain.

RATIONALE AND OBJECTIVES: The objective of this study was to analyze the role of dynamic magnetic resonance imaging (MRI) in patients who suffered from groin pain and whose physical examination and ultrasound returned inconclusive/indefinite results, as well as in patients receiving an ongoing assessment for a previous herniotomy. MATERIAL AND METHODS: For this study, 25 patients 14 women and 11 men were selected with a mean age of 41.6 years, including clinical complaints, such as groin pain and or a previous herniotomies. These patients underwent dynamic MRI. Reports were created by a radiology resident and a radiology consultant. Clinical and ultrasound documentation were compared to with imaging results from the MRI. RESULTS: The results of the dynamic MRI were negative for 23 patients (92%) and positive for two patients (8%). One patient suffered from an indirect hernia and one from a femoral hernia. A repeated hernia was an excluding for the preoperated patients with pain and ongoing assessment. CONCLUSIONS: Dynamic MRI shows substantially higher diagnostic performance in exclusion of inguinal hernia, when compared to a physical examination and ultrasound. The examination can also be used in assessments to analyze the operation's results.

Evaluation of two different transarterial chemoembolization protocols using Lipiodol and degradable starch microspheres in therapy of hepatocellular carcinoma: a prospective trial.

BACKGROUND: This prospective randomized trial is designed to compare the performance of conventional transarterial chemoembolization (cTACE) using Lipiodol-only with additional use of degradable starch microspheres (DSM) for hepatocellular carcinoma (HCC) in BCLC-stage-B based on metric tumor response. METHODS: Sixty-one patients (44 men; 17 women; range 44-85) with HCC were evaluated in this IRB-approved HIPPA compliant study. The treatment protocol included three TACE-sessions in 4-week intervals, in all cases with Mitomycin C as a chemotherapeutic agent. Multiparametric magnetic resonance imaging (MRI) was performed prior to the first and 4 weeks after the last TACE. Two treatment groups were determined using a randomization sheet: In 30 patients, TACE was performed using Lipiodol only (group 1). In 31 cases Lipiodol was combined with DSMs (group 2). Response according to tumor volume, diameter, mRECIST criteria, and the development of necrotic areas were analyzed and compared using the Mann-Whitney-U, Kruskal-Wallis-H-test, and Spearman-Rho. Survival data were analyzed using the Kaplan-Meier estimator. RESULTS: A mean overall tumor volume reduction of 21.45% (± 62.34%) was observed with an average tumor volume reduction of 19.95% in group 1 vs. 22.95% in group 2 (p = 0.653). Mean diameter reduction was measured with 6.26% (± 34.75%), for group 1 with 11.86% vs. 4.06% in group 2 (p = 0.678). Regarding mRECIST criteria, group 1 versus group 2 showed complete response in 0 versus 3 cases, partial response in 2 versus 7 cases, stable disease in 21 versus 17 cases, and progressive disease in 3 versus 1 cases (p = 0.010). Estimated overall survival was in mean 33.4 months (95% CI 25.5-41.4) for cTACE with Lipiosol plus DSM, and 32.5 months (95% CI 26.6-38.4), for cTACE with Lipiodol-only (p = 0.844), respectively. CONCLUSIONS: The additional application of DSM during cTACE showed a significant benefit in tumor response according to mRECIST compared to cTACE with Lipiodol-only. No benefit in survival time was observed.

Comparison of contrast-enhanced videofluoroscopy to unenhanced dynamic MRI in minor patients following surgical correction of velopharyngeal dysfunction.

OBJECTIVES: To compare dynamic magnetic resonance imaging (MRI) with videofluoroscopy (VFS) regarding image quality and assessment of gap size between soft palate (SP) and posterior pharyngeal wall (PPW) in children and adolescents following surgical correction of velopharyngeal dysfunction (VPD). METHODS: Twenty-one patients undergoing unenhanced 3-T MRI and contrast-enhanced VFS were included in this IRB-approved prospective study. The MRI scan protocol comprised refocused gradient-echo sequences in transverse and sagittal planes during speech, with TE 1.97 ms, TR 3.95 ms, flip angle 8°, matrix size 128 × 128, and 5-mm slice thickness. Radial k-space sampling and sliding window reconstruction were used to achieve an image acquisition rate of 28 frames per second (fps). VFS with 30 fps was similarly performed in both planes. Closure of the velopharyngeal port during phonation was evaluated by two experienced radiologists. RESULTS: Eleven (52.4%) patients displayed a complete closure, whereas ten (47.6%) patients showed a post-operative gap during speech. VFS and MRI equally identified the cases with persistent or recurrent VPD. Differences in SP-PPW distance between VFS (3.9 ± 1.6 mm) and MRI (4.1 ± 1.5 mm) were not statistically significant (p = 0.5). The subjective overall image quality of MRI was rated inferior (p < 0.001) compared with VFS, with almost perfect inter-rater agreement (κ = 0.90). The presence of susceptibility artifacts did not limit anatomical measurements. CONCLUSION: Dynamic MRI is equally reliable as VFS to assess persistent or recurrent inadequate velum closure in patients following surgical treatment of VPD. KEY POINTS: • Unenhanced 3-T dynamic MRI and contrast-enhanced videofluoroscopy are equally useful for the identification of patients with incomplete velopharyngeal closure during speech. • MRI using refocused gradient-echo acquisition with radial k-space sampling and sliding window reconstruction generates diagnostic images with 28 frames per second. • MRI can offer a radiation-free alternative to currently established videofluoroscopy for young patients.

CT-guided percutaneous biopsy of suspect pancreatic lesions: radiological and clinical outcome.

AIM: To evaluate the clinical utility of computed tomography (CT)-guided percutaneous biopsies of suspect pancreatic lesions regarding safety, efficiency, radiation dose, intervention time, diagnostic yield, and complications. MATERIALS AND METHODS: Between 2015 and 2018, 48 patients (18 female, 30 male; mean age: 64.2 years) with suspect pancreatic lesions underwent CT-guided percutaneous biopsy. Ultrasound-guided biopsy of all lesions was not possible or without any result. CT-guided interventions were compared according to the following intervention parameters: radiation dose, procedure duration, number of needle correction scans. Evaluation criteria included technical success as well as major and minor complications according to the Society of Interventional Radiology. RESULTS: Biopsies were performed successfully in 100% of patients. No major side effects occurred during intervention. As a minor complication, 29.2% showed focal haemorrhage. Seventy-seven percent of lesions had a malignant appearance, and benign inflammatory lesions were found in 23%. The mean size of the target lesions was 2.9 cm (range: 0.7-2.3 cm). The mean target access path within the patient was 8 cm (range: 3-14 cm). The duration to completion was 12 minutes (range: 3 minutes 30 seconds to 30 minutes). The dose-length product of the intervention was 89.5 mGy·cm (range: 11-350 mGy·cm). The average number needle correction scans was 31.1 (range: 6-36). CONCLUSION: CT-guided biopsy of suspect pancreatic lesions is an efficient and safe method. It can be performed within short intervention times and low radiation exposure for differentiation of unclear lesions.

CT-guided hook-wire localisation prior to video-assisted thoracoscopic surgery of pulmonary lesions.

AIM: To assess the feasibility, safety, and efficacy of computed tomography (CT)-guided pulmonary nodule localisation using a hooked guide wire before video-assisted thoracoscopic surgery (VATS). MATERIALS AND METHODS: The study included 79 patients with a history of malignancies outside the lung associated with pulmonary nodules. Mean lesion size was 0.7 cm (range 0.5-1.8 cm) and the mean lesion distance to the pleural surface was 1.5 cm (range 0.2-5 cm). All lesions (n=82) were marked with a 22-G hook wire. The technique was designed to insert the tip of the hook wire within or maximally 1 cm from the edge of the lesion. The Mann-Whitney U-test was used for univariate analyses and Fisher's exact test for categorical values. RESULTS: The hooked guide wire was positioned successfully in all 82 pulmonary nodules within mean time of 9 minutes (8-20 minutes, SD: 2.5 minutes). The procedure time was inversely proportional to the size of the lesion (Spearman correlation factor 0.7). Minimal pneumothoraces were observed in five patients (7.6%). Pneumothorax was not correlated to the histopathology of the pulmonary nodules (p>0.09). Focal perilesional pulmonary haemorrhage developed in four patients (5%). Both haemorrhage and pneumothorax were significantly correlated to lesions <10 mm (p=0.02 and 0.01 respectively). The volume of resected lung tissue was significantly correlated to lesions of increased distance from the pleural surface ≥2.5 cm in comparison to lesions of <2.5 cm from the pleural surface. CONCLUSION: CT-guided pulmonary nodule localisation prior to VATS could enable safe, accurate surgical guidance for the localisation of small pulmonary nodules.

Intra-individual comparison of CAIPIRINHA VIBE technique with conventional VIBE sequences in contrast-enhanced MRI of focal liver lesions.

PURPOSE: To evaluate the impact of controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) volume interpolated breath-hold examination (VIBE) magnetic resonance imaging (MRI) technique on image quality, reader confidence, and inter-observer agreement for the assessment of focal liver lesions in comparison with the standard VIBE approach. MATERIAL AND METHODS: In this IRB-approved intra-individual comparison study, abdominal arterial and portal-venous contrast-enhanced MRI studies were retrospectively analyzed in 38 patients with malignant liver lesions. Each patient underwent both CAIPIRINHA and conventional VIBE 3T MRI within 3 months, showing stable disease. Images were evaluated using 5-point rating scales by two blinded radiologists with more than 20 and 5 years of experience in MRI, respectively. Readers scored dignity of liver lesions and assessed which liver segments were affected by malignancy (ranging from 1=definitely benign/not affected to 5=definitely malignant/affected by malignancy). Readers also rated overall image quality, sharpness of intrahepatic veins, and diagnostic confidence (ranging from 1=poor to 5=excellent). RESULTS: Reviewers achieved a higher inter-observer reliability using CAIPIRINHA when they reported which liver segments were affected by malignancy compared to traditional VIBE series (κ=0.62 and 0.54, respectively, p<0.05). Similarly, CAIPIRINHA showed a slightly higher inter-rater agreement for the dignity of focal liver lesions versus the standard VIBE images (κ=0.50 and 0.49, respectively, p<0.05). CAIPIRINHA series also scored higher in comparison to standard VIBE sequences (mean scores: image quality, 4.2 and 3.5; sharpness of intrahepatic vessels, 3.8 and 3.2, respectively, p<0.05) for both reviewers and allowed for higher subjective diagnostic confidence (ratings, 3.8 and 3.2, respectively, p<0.05). CONCLUSION: Compared to the standard VIBE approach, CAIPIRINHA VIBE technique provides improved image quality and sharpness of intrahepatic veins, as well as higher diagnostic confidence. Additionally, this technique allows for higher inter-observer agreement when reporting focal liver lesions for both dignity and allocation.

Radiation dose and quickness of needle CT-interventions using a laser navigation system (LNS) compared with conventional method.

PURPOSE: The aim of this study was to analyse the radiation dose and quickness of needle interventions using a Laser Navigation System (LNS-group) compared with conventional method (control-group). MATERIALS AND METHODS: In this prospective, randomized, comparative study 58 patients (19 females, 39 males; mean age, 62.9 years) were punctured either with LNS (n=29) or with conventional method with a skin mark of the puncture site (n=29). In the LNS method the puncture site was marked with laser without additional CT. Thoracic and abdominal intervention was performed in 30 and 28 patients, respectively. Radiation dose and time of the procedures were analysed. Statistical significance was calculated according to the Mann-Whitney-U-test. RESULTS: Mean target access path in the patients of the LNS group was 6.0 cm (range, 3.0-10.1cm) and in the control group 6.0 cm (range, 1.0-10.3 cm). Time duration of complete intervention in the LNS group was 20:25 min (range, 07:00-34:00 min) and in the control group 28:00 min (range, 13:00-51:00 min). The dose-length-product (DLP) of intervention scan of the LNS group was 42.3 mGy cm (range, 10-125 mGy cm), and of the control group 59.7 mGy cm (range, 25-176.42 mGy cm). CONCLUSION: Using the LNS for CT-guided interventions results in faster intervention time with a lower dose.

Body packers on your examination table: How helpful are plain x-ray images? A definitive low-dose CT protocol as a diagnosis tool for body packers.

AIM: To analyze the clinical value and radiation dose of plain x-rays and CT in examining patients suspected of ingesting drug-filled packets. MATERIALS AND METHODS: Thirty-eight patients with suspected internal concealment of drug-filled packets who were examined with plain x-rays or CT or both were included in the study. CT studies were performed using low-dose and standard-dose techniques. All radiographic images were analysed by two radiologists regarding identification of the packets and estimating the effective radiation dose from standard- and low-dose CT versus conventional x-ray examinations. Descriptive calculations were made regarding the number and density of packs and radiation dosage. The diagnostic performance of both radiologists with standard- and low-dose CT was calculated by analysing differences in the mean number of packs found. RESULTS: Thirty-one patients were positively identified as body packers with an average of 13 packs (min: n = 1, max: n = 58, total: n = 390); seven patients were not concealing drug packets. X-ray images were taken of 24 patients prior to CT, thus allowing a direct comparison between the two methods. The correct diagnosis was made in 42%, in 33% the radiologists were uncertain, and in 25% of drug packets were either not or wrongly identified. X-ray imaging had a positive predictive value of 20% with a negative predictive value of 81%. A total of 55 CT examinations were performed on all patients with a mean effective dose of 2 mSv (low dose) versus 9.3 mSv (standard dose). The visibility of packets on low-dose CT images compared to high-dose CT was not reduced: the radiologists identified 385 and 381 of the packets, respectively, with no difference regarding the examination technique (p = 0.24 and p = 0.253, respectively). The radiodensity of all drug-filled packets at CT ranged from 26-292 HU (mean 181.2 HU). CONCLUSION: X-ray imaging of supposed body packers leads to a significant risk of diagnostic errors and additional need for CT. Instead, a single abdominal low-dose CT examination will deliver the correct diagnoses in most cases, leading to safe clinical management of the suspects.

MR-guided laser-induced thermotherapy (LITT) in patients with liver metastases of uveal melanoma.

PURPOSE: Evaluation of the local tumour control rate and survival data for magnetic resonance (MR) imaging-guided laser ablation of uveal malignant melanoma liver metastases by using laser-induced interstitial thermotherapy (LITT). MATERIALS AND METHODS: The LITT was performed in 18 patients with liver metastases (n = 44) from uveal malignant melanoma. All patients tolerated this intervention well. With the Kaplan-Meier method, the survival rates were calculated. Indications for the procedure were defined for patients with no more than five metastases, none of which were larger than 5 cm in diameter: The Indication for LITT treatment were recurrent liver metastases after partial liver resection (22%), locally non-resectable tumours (17%) or metastases in both liver lobes (61%). RESULTS: The mean survival rate for all treated patients was 3.6 years (95% CI: 2.19, 5.06). We started the calculation on the date of diagnosis of the metastases treated with LITT. The median survival was 1.83 years; 1-year survival, 88%; 3-year survival 47%, 5-year survival 17%. Calculated after the first LITT treatment the median survival was 2.8 years (95% CI: 1.0, 5.0). 10 patients were treated by transarterial chemoembolization before LITT. CONCLUSION: MR-guided LITT treatment shows a high local tumour control and survival rates in patients with liver metastases of uveal malignant melanoma.

Hepatic arterial infusion with irinotecan in patients with liver metastases of colorectal cancer: results of an extended phase I study.

BACKGROUND: To define the maximum tolerated dose (MTD) tolerability and efficacy of intra-arterial chemotherapy with irinotecan in patients with liver metastases of colorectal carcinoma (CRC). METHODS: Superselective intra-arterial irinotecan was applied on days 1, 14, 28 and 42. The initial dose was 140 mg/m² with escalation in the subsequent patient group to 160 mg/m². The final protocol toxicity evaluation was 260 mg/m². Patients required histologically proven disease and adequate bone marrow, liver and renal function, no extrahepatic metastasis and a life expectancy >12 weeks. results: Thirty-three patients were enrolled (median age 65, range 49-78 years). On dose level VI (240 mg/m²), 1 case of dose-limiting toxicity (DLT) (granulocytopenia) was observed, leading to an enlarged cohort of 6 patients. As no additional DLT was detected on this level, an escalation to level VII was performed. On the dose level of 260 mg/m², irinotecan DLTs were observed, resulting in the termination of escalation and the declaration of dose level VI as MTD. Imaging follow-up with Response Evaluation Criteria in Solid Tumors (RECIST) criteria revealed a complete response in 1 patient, stable disease in 31 patients, and progressed disease in 1 patient. The median time to progression was 4.7 months, the median overall survival 15.6 months. CONCLUSION: The method of intra-arterial chemotherapy with irinotecan is well tolerated and shows promising local response rates in liver metastases of CRC.

First human study in treatment of unresectable liver metastases from colorectal cancer with irinotecan-loaded beads (DEBIRI).

The objective of this pilot clinical study was to assess the safety, technical feasibility, pharmacokinetic (PK) profile and tumour response of DC Bead™ with irinotecan (DEBIRI™) delivered by intra-arterial embolisation for the treatment of metastatic colorectal cancer. Eleven patients with unresectable liver metastases from CRC, tumour burden <30% of liver volume, adequate haematological, liver and renal function, performance status of <2 were included in this study. Patients received up to 4 sessions of TACE with DEBIRI at 3-week intervals. Feasibility of the procedure, safety and tumour response were assessed after each cycle. PK was measured after the first cycle. Patients were followed up to 24 weeks. Only mild to moderate adverse events were observed. DEBIRI is a technically feasibile procedure; no technical complications were observed. Average Cmax for irinotecan and SN-38 was 194 ng/ml and 16.7 ng/ml, respectively, with average t½ of 4.6 h and 12.4 h following administration of DEBIRI. Best overall response during the study showed disease control in 9 patients (2 patients with partial response and 7 with stable disease, overall response rate of 18%). Our study shows that transarterial chemoembolisation with irinotecan-loaded DC beads (DEBIRI) is safe, technically feasible and effective with a good PK profile.

[Radiological diagnosis and intervention of cholangiocarcinomas (CC)]. / Radiologische Diagnostik und Intervention von Cholangiokarzinomen (CC).

To present current data on diagnosis, indication and different therapy options in patients with cholangiocarcinoma (CC) based on an analysis of the current literature and clinical experience. The diagnostic routine includes laboratory investigations with parameters of cholestasis and also serum tumor markers CA19 - 9 and CEA. After ultrasound for clarifying a tumor and/or dilated bile ducts, contrast-enhanced magnetic resonance imaging (MRI) should be performed with magnetic resonance cholangiography (MRCP). The accuracy (positive predictive value) for diagnosing a CC is 37-84% (depending on the location) for ultrasound, 79-94% for computed tomography (CT), and 95% for MRI and MRCP. An endoscopic retrograde cholangiography (ERCP) can then be planned, especially if biliary drainage or cytological or histological specimen sampling is intended. A curative approach can be achieved by surgical resection, rarely by liver transplantation. However, many patients are not eligible for surgery. In addition to systemic chemotherapy, locoregional therapies such as transarterial chemoembolization (TACE), hepatic arterial infusion (HAI)--also known as chemoperfusion--, drug eluting beads-therapy (DEB) as well as thermoablative procedures, such as laser-induced thermotherapy (LITT), microwave ablation (MWA) and radiofrequency ablation (RFA) can be provided with a palliative intention.

Role of uterine artery Doppler in the management of uterine leiomyoma by arterial embolization.

OBJECTIVES: To study Doppler changes in the uterine artery immediately following and 3 months after uterine artery embolization (UAE) and to test the feasibility of using uterine artery Doppler as a predictor of the predominant side of arterial supply to leiomyomas, amount of embolizing material needed and leiomyoma tumor volume at follow-up. METHODS: The study included 38 patients undergoing UAE for leiomyomas. Uterine artery Doppler was performed transabdominally before, within 6 hours after and 3 months after UAE to determine the peak systolic (PSV) and end-diastolic (EDV) velocities and resistance index (RI). Leiomyoma volume was measured using contrast-enhanced magnetic resonance imaging (MRI) before and 3 months after UAE. The predominant side of arterial supply to the leiomyoma was determined on digital subtraction angiography using the uterine artery diameter and tumor blush after contrast injection. For correlations with leiomyoma volume, the average PSV, EDV and RI of both sides was used, while for prediction of the predominant side of supply and for correlation with the amount of embolizing material needed, separate measurements from each side were used. RESULTS: Relative to the pre-embolization value, the uterine artery PSV and EDV were significantly reduced (P < 0.05) immediately following UAE, while the RI was significantly elevated (P < 0.05). For prediction of the predominant side of supply, the lowest RI showed the highest accuracy (81.6%). There was no significant correlation between the pre-embolization PSV, EDV or RI and the amount of embolizing material utilized. Immediately post-embolization EDV and RI values were statistically significantly correlated with the 3-month follow-up leiomyoma volume, with RI showing the strongest correlation (P = 0.0400 and 0.0002, rho = 0.34 and - 0.58, respectively). The leiomyoma volume was predicted to have reduced by 38-61% after 3 months if the immediate post-embolization average RI value was between 0.82 and 0.88. CONCLUSION: Pre-interventional Doppler assessment can be used to predict the predominant side of supply to leiomyomas but not the amount of embolizing material needed. Immediate post-interventional Doppler assessment can predict the leiomyoma volume after UAE.

[Chemoperfusion and embolization in the treatment of liver metastases]. / Chemoperfusion und -embolisation von Lebermetastasen.

Presentation of techniques and procedures for regional chemotherapy in the treatment of unresectable liver metastases from different primary tumors as a modality of interdisciplinary therapy management. Such transarterial therapy methods include hepatic arterial infusion (HAI), transarterial chemoembolization (TACE), chemoembolization with cytostatic-loaded microspheres (DEBs), transarterial embolization (TAE) and selective internal radiation therapy (SIRT). Regional chemotherapy procedures in the treatment of liver metastases represent a minimally invasive treatment option that can be successfully combined with surgical resection and/or radiofrequency (RFA), laser-induced thermotherapy (LITT), microwave ablation (MWA). These procedures allow optimization of the local control rate with strictly intrahepatic processes and lead to increased survival rates without any quality of life restriction.