1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen , Tuebingen , Germany.
2 Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University , Cleveland, OH , USA.
Br J Radiol. 2018 Jul;91(1088):20170562. doi: 10.1259/bjr.20170562. Epub 2018 Jun 12.
The purpose of this preliminary retrospective study was to analyse if cone beam CT (CBCT) is able to identify more bleeding sites and corresponding feeding arteries in patients with haemorrhage of uncertain origin.
In 18 vascular territories (16 patients), pre-interventional CT angiography (CTA) and selective angiograms resulted in discordant information regarding the suspected bleeding site and hence received CBCT. Image data of CTA and selective angiograms in comparison to CBCT were independently reviewed by two interventional radiologists. Image quality, diagnostic confidence, number of bleeding sites and involved vascular territories were investigated. Additionally, the correlation between number of bleeding sites and involved vascular territories with a clinical gold-standard (super-selective angiographic findings and definitive clinical outcomes) was analysed.
Overall, subjective image quality did not significantly differ between investigated imaging modalities. However, CBCT significantly improved diagnostic confidence in both readers in detecting bleeding vessel (s) (p = 0.0024/0.0005; Reader 1/Reader2). High correlation coefficients regarding the number of bleeding sites (r = 0.9163/0.7692) in contrast to the number of involved vascular territories (r = 0.2888/0.0105) were observed for CTA in comparison to clinical gold-standard. In this context, CBCT demonstrated a very strong correlation for both parameters, the number of bleeding vessels (r = 0.9720/0.9721) and the number involved vascular territories (r = 0.9441/0.9441).
In complex cases of suspected haemorrhage, CBCT images can aid the interventionalist in detecting bleeding sites as well as narrowing down the number of involved vascular territories and thereby identifying feeding arteries of the bleeding source. Advances in knowledge: (1) CBCT showed no improvement in image quality. However, in complex bleeding cases CBCT information might aid in treatment planning. (2) CBCT improves visualization of bleeding vessels and involved feeding arteries. (3) Particularly, less experienced interventionalists might benefit from the three-dimensional information gathered by CBCT.
本初步回顾性研究的目的是分析锥形束 CT（CBCT）是否能够识别更多出血部位和相应的供血动脉在不明原因出血的患者。
在 18 个血管区域（16 名患者）中，术前 CT 血管造影（CTA）和选择性血管造影术对可疑出血部位的信息不一致，因此接受了 CBCT。由两名介入放射科医生独立对 CTA 和选择性血管造影的图像数据与 CBCT 进行了回顾。调查了图像质量、诊断信心、出血部位数量和受累血管区域。此外，还分析了出血部位和受累血管区域数量与临床金标准（超选择性血管造影发现和明确的临床结果）之间的相关性。
总体而言，各研究影像学方法的主观图像质量无显著差异。然而，CBCT 显著提高了两位读者在检测出血血管方面的诊断信心（p=0.0024/0.0005；读者 1/读者 2）。与涉及的血管区域（r=0.2888/0.0105）相比，CTA 与临床金标准相比，出血部位（r=0.9163/0.7692）的数量具有较高的相关系数。在这种情况下，CBCT 对两个参数（出血血管数量（r=0.9720/0.9721）和受累血管区域数量（r=0.9441/0.9441））都显示出很强的相关性。
在可疑出血的复杂病例中，CBCT 图像可以帮助介入放射科医生检测出血部位，并缩小受累血管区域的数量，从而确定出血源的供血动脉。知识的进步：（1）CBCT 并未改善图像质量。然而，在复杂的出血病例中，CBCT 信息可能有助于治疗计划。（2）CBCT 改善了出血血管和受累供血动脉的可视化。（3）特别是，经验较少的介入放射科医生可能会受益于 CBCT 收集的三维信息。
