Carrafiello Gianpaolo, Ierardi Anna Maria, Duka Ejona, Radaelli Alessandro, Floridi Chiara, Bacuzzi Alessandro, de Bucourt Maximilian, De Marchi Giuseppe
Department of Radiology, Interventional Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy.
Philips Healthcare, Best, The Netherlands.
Cardiovasc Intervent Radiol. 2016 Apr;39(4):530-7. doi: 10.1007/s00270-015-1213-1. Epub 2015 Oct 20.
This study was designed to evaluate the utility of dual phase cone beam computed tomography (DP-CBCT) and automatic vessel detection (AVD) software to guide transarterial embolization (TAE) of angiographically challenging arterial bleedings in emergency settings.
Twenty patients with an arterial bleeding at computed tomography angiography and an inconclusive identification of the bleeding vessel at the initial 2D angiographic series were included. Accuracy of DP-CBCT and AVD software were defined as the ability to detect the bleeding site and the culprit arterial bleeder, respectively. Technical success was defined as the correct positioning of the microcatheter using AVD software. Clinical success was defined as the successful embolization. Total volume of iodinated contrast medium and overall procedure time were registered.
The bleeding site was not detected by initial angiogram in 20% of cases, while impossibility to identify the bleeding vessel was the reason for inclusion in the remaining cases. The bleeding site was detected by DP-CBCT in 19 of 20 (95%) patients; in one case CBCT-CT fusion was required. AVD software identified the culprit arterial branch in 18 of 20 (90%) cases. In two cases, vessel tracking required manual marking of the candidate arterial bleeder. Technical success was 95%. Successful embolization was achieved in all patients. Mean contrast volume injected for each patient was 77.5 ml, and mean overall procedural time was 50 min.
C-arm CBCT and AVD software during TAE of angiographically challenging arterial bleedings is feasible and may facilitate successful embolization. Staff training in CBCT imaging and software manipulation is necessary.
本研究旨在评估双期锥形束计算机断层扫描（DP-CBCT）和自动血管检测（AVD）软件在紧急情况下指导对血管造影具有挑战性的动脉出血进行经动脉栓塞（TAE）的效用。
纳入20例在计算机断层扫描血管造影时出现动脉出血且在初始二维血管造影系列中无法明确出血血管的患者。DP-CBCT和AVD软件的准确性分别定义为检测出血部位和出血责任动脉的能力。技术成功定义为使用AVD软件正确定位微导管。临床成功定义为栓塞成功。记录碘化造影剂的总体积和整个操作时间。
20%的病例中初始血管造影未检测到出血部位，而其余病例纳入的原因是无法识别出血血管。20例患者中有19例（95%）通过DP-CBCT检测到出血部位；1例需要CBCT-CT融合。AVD软件在20例病例中的18例（90%）中识别出出血责任动脉分支。2例中，血管追踪需要手动标记候选出血动脉。技术成功率为95%。所有患者均成功栓塞。每位患者注入的平均造影剂体积为77.5 ml，平均总操作时间为50分钟。
在对血管造影具有挑战性的动脉出血进行TAE期间，C形臂CBCT和AVD软件是可行的，可能有助于成功栓塞。有必要对工作人员进行CBCT成像和软件操作培训。
