Assessment of automated cone-beam CT vessel identification software during transarterial hepatic embolisation: radiation dose, contrast medium volume, processing time, and operator perspectives compared to digital subtraction angiography. Issue 12 (December 2018) - Durack, J.C.
Abstract : Aim: To evaluate arterial cone-beam computed tomography (A-CBCT) automated analysis software for identification of vessels supplying tumours during transarterial hepatic embolisation (TAE). Materials and methods: This study was approved by the institutional review board, with waiver of consent. Consecutive TAE procedures using arterial mapping software (AMS), and performed between February 2014 and August 2014, were reviewed. Hepatic arteries were imaged using digital subtraction angiography (DSA) as well as A-CBCT processed with AMS. Interventional radiologists reported 1 potential embolisation target vessels computed using AMS versus DSA alone, 2 modification of the embolisation plan based on AMS, and 3 operator confidence related to technical success. Imaging set-up, processing time, radiation dose, and contrast media volume were recorded. Results: Thirty of 34 consecutive procedures were evaluated retrospectively. At least one additional embolisation target vessel was identified using AMS in 13 procedures (43%, 95% confidence interval [CI]: 26–61%) and embolisation plan modified in 11 (37%, 95% CI: 19–54%). Radiologists reported AMS increased operator confidence and reduced the number of DSA acquisitions in 25 (83%, 95% CI: 70–97%) and 15 cases (50%, 95% CI: 32–68%), respectively. The average A-CBCT acquisition and processing time was 4 minutes 53 seconds and 3 minutes 45 seconds, respectively. A-CBCT contributed to 11% of the radiation dose and 18% of the contrast media volume. Conclusion: Physicians report increased tumour supplying vessel detection and intraprocedural confidence using AMS during TAE without substantial impact on radiation dose, contrast media volume, and procedure time. Highlights: Cone-beam computed tomographic arterial mapping improves operator confidence. Arterial mapping software facilitates identification of tumor supplying vessels. Cone-beam imaging and arterial mapping software reduce the need for angiography.