Gonzalez-Aguirre Adrian J, Petre Elena N, Hsu Meier, Moskowitz Chaya S, Solomon Stephen B, Durack Jeremy C
Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Cardiovasc Intervent Radiol. 2018 Jun;41(6):898-904. doi: 10.1007/s00270-017-1875-y. Epub 2018 Jan 11.
The practice of positioning patients' arms above the head during catheter-injected hepatic arterial phase cone beam CT (A-CBCT) imaging has been inherited from standard CT imaging due to image quality concerns, but interrupts workflow and extends procedure time. We sought to assess A-CBCT image quality and artifacts with arms extended above the head versus down by the side.
We performed an IRB approved retrospective evaluation of reformatted and 3D-volume rendered images from 91 consecutive A-CBCTs (43 arms up, 48 arms down) acquired during hepatic tumor arterial embolization procedures. Two interventional radiologists reviewed all A-CBCT imaging and assigned vessel visualization scores (VVS) from 1 to 5, ranging from non-diagnostic to optimal visualization. Streak artifacts across axial images were rated from 1 to 3 based on resulting image quality (none to significant). Presence of respiratory or cardiac motion during acquisition, body mass index and radiation dose area product (DAP) were also recorded and analyzed. Univariate and multivariate analyses were used to assess the impact of arm position on VVS and imaging artifacts.
VVS were not significantly associated with arm position during A-CBCT imaging. One reader reported more streak artifacts across axial images in the arms down group (p = 0.005). DAP was not statistically different between the groups (23.9 Gy cm [6.1-73.4] arms up, 26.1 Gy cm [4.2-102.6] arms down, p = 0.54).
A-CBCT angiography performed with the arms above the head is not superior for clinically relevant hepatic vascular visualization compared to imaging performed with the arms by the patient's side.
由于对图像质量的担忧，在导管注射肝动脉期锥形束CT（A-CBCT）成像过程中将患者手臂置于头部上方的做法是从标准CT成像沿袭而来的，但这会中断工作流程并延长检查时间。我们试图评估手臂置于头部上方与置于身体两侧时A-CBCT的图像质量和伪影情况。
我们对在肝肿瘤动脉栓塞手术期间获取的91例连续A-CBCT（43例手臂上举，48例手臂下垂）的重组图像和三维容积再现图像进行了一项经机构审查委员会批准的回顾性评估。两名介入放射科医生审查了所有A-CBCT成像，并根据血管可视化程度从1到5分进行评分，1分为无法诊断，5分为最佳可视化。根据轴向图像的最终质量（无到显著）将条纹伪影评为1到3级。还记录并分析了采集过程中呼吸或心脏运动的情况、体重指数和辐射剂量面积乘积（DAP）。采用单因素和多因素分析来评估手臂位置对血管可视化评分和成像伪影的影响。
在A-CBCT成像过程中，血管可视化评分与手臂位置无显著相关性。一名读者报告说，手臂下垂组的轴向图像上条纹伪影更多（p = 0.005）。两组之间的DAP无统计学差异（手臂上举组为23.9 Gy·cm [6.1 - 73.4]，手臂下垂组为26.1 Gy·cm [4.2 - 102.6]，p = 0.54）。
与手臂置于患者身体两侧进行成像相比，手臂置于头部上方进行A-CBCT血管造影在临床相关的肝血管可视化方面并无优势。
