Intra-procedural bronchial artery embolization planning: the usefulness of cone-beam CT

Ulrich Grosse, Gerd Grözinger, Roland Syha, Dominik Ketelsen, Sasan Partovi, Konstantin Nikolaou, Rüdiger Hoffmann
Acta Radiologica 2019 March 21, : 284185119837931

BACKGROUND: Bronchial artery embolization (BAE) can be a challenging intervention due to variations of the vascular anatomy.

PURPOSE: To evaluate the utility of C-arm cone-beam computed tomography (CBCT) for BAE in patients with hemoptysis and indefinite bronchial artery (BA) anatomy on pre-interventional CT imaging.

MATERIAL AND METHODS: From November 2016 to July 2017, 17 patients (mean age = 64.3 ± 14.7 years) with hemoptysis underwent BAE including pre-interventional CT, aortography, and CBCT during the procedure. CBCT, angiography, and CT were independently evaluated by readers A and B (with one and three years of experience in interventional radiology) with regard to number and origin of detected BA, image quality, and diagnostic confidence for BA detection (using a Likert scale). Consensus reading by two experienced interventional radiologists served as gold standard (GS). Seventeen consecutive patients who underwent BAE before the installation of the CBCT in October 2016 served as control group. Spearman rank correlation and Wilcoxon signed-rank test were conducted.

RESULTS: Both readers showed a statistically significant increase in diagnostic confidence for CBCT compared to pre-procedural CT (A: P = 0.003; B: P = 0.03) and for CBCT compared to aortography (A+B: P < 0.001). Correlation coefficient between GS and CBCT regarding the number of detected BA was: r = 0.855 (A), r = 0.877 (B); GS and CT: r = 0.250 (A), r = 0.317 (B); GS and aortography: r = 0.290 (A); r = 0.429 (B). Time to BA catheterization was 32.6 ± 12.5 min (control group 38.5 ± 24.6 min; P = 0.72). Significantly less angiographic series were acquired until BA catheterization after CBCT (1.3 ± 0.7; control group: 3.6 ± 2.9; P = 0.003).

CONCLUSION: CBCT supports the assessment of the BA anatomy during BAE in patients with hemoptysis.

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