Ierardi Anna Maria, Pesapane Filippo, Rivolta Nicola, Fumarola Enrico Maria, Angileri Salvatore Alessio, Piacentino Filippo, Carrafiello Gianpaolo
1 Department of Diagnostic and Interventional Radiology, University of Milan, San Paolo Hospital, Milan, Italy.
2 Vascular Surgery Department, University of Insubria, Varese, Italy.
Acta Radiol. 2018 Jun;59(6):681-687. doi: 10.1177/0284185117729184. Epub 2017 Aug 31.
Background Dual-phase cone beam computed tomography (DP-CBCT) and automatic vessel detection (AVD) software are helpful tools for detecting arteries before planned endovascular interventions. Purpose To evaluate the usefulness of DP-CBCT and AVD software in guiding the trans-arterial embolization (TAE) of challenging T2 lumbar endoleaks (T2-L-EL). Material and Methods Ten patients with T2-L-EL were included in this study. The accuracy of DP-CBCT and the AVD software was defined by the ability to detect the endoleak and arterial feeding vessel, respectively. Technical success was defined as the correct positioning of the microcatheter using AVD software and the successful embolization of the endoleak. Clinical success was defined as the absence of recurrent endoleaks during follow-up and the stability of the sac diameter for persistent endoleaks. The total volume of iodinated contrast medium, overall procedure time, mean procedural radiation dose, and mean fluoroscopy time were recorded. Results The EL was detected by DP-CBCT in all patients. The AVD software identified the feeding arterial branch in all cases. In one patient, the nidus of the endoleak was not reached due to the small caliber of the feeding artery, even though the software had clearly identified the vessel route. The mean contrast volume was 109 mL, the mean overall procedural time was 74.3 min. The mean procedural radiation dose was 140.97 Gy cm, and the mean fluoroscopy time was 29.8 min. Conclusion The use of DP-CBCT and the AVD software is feasible and may facilitate successful embolization in challenging occult T2-L-EL with complex vasculature.
背景 双期锥形束计算机断层扫描（DP-CBCT）和自动血管检测（AVD）软件是在计划进行血管内介入治疗前检测动脉的有用工具。目的 评估DP-CBCT和AVD软件在指导具有挑战性的T2型腰椎内漏（T2-L-EL）经动脉栓塞术（TAE）中的作用。材料与方法 本研究纳入了10例T2-L-EL患者。DP-CBCT和AVD软件的准确性分别通过检测内漏和动脉供血血管的能力来定义。技术成功定义为使用AVD软件将微导管正确定位并成功栓塞内漏。临床成功定义为随访期间无复发性内漏且持续性内漏的囊袋直径稳定。记录碘化造影剂的总体积、总手术时间、平均手术辐射剂量和平均透视时间。结果 所有患者的内漏均通过DP-CBCT检测到。AVD软件在所有病例中均识别出供血动脉分支。在1例患者中，尽管软件已清晰识别血管路径，但由于供血动脉管径小，内漏病灶未到达。平均造影剂体积为109 mL，平均总手术时间为74.3分钟。平均手术辐射剂量为140.97 Gy·cm，平均透视时间为29.8分钟。结论 使用DP-CBCT和AVD软件是可行的，并且可能有助于在具有复杂血管系统的具有挑战性的隐匿性T2-L-EL中成功进行栓塞。
