Added Value of Selective Intra-arterial Cone-Beam CT Angiography in the Management of Visceral Artery Aneurysms

Abstract

Purpose: The aim of this study is to evaluate the value of selective intra-arterial cone-beam computed tomography angiography (CBCTA) relative to conventional computed tomography angiography (CTA) in understanding visceral artery aneurysm (VAA) morphology, and its impact on treatment planning. Materials and Methods: Between January 2017 and August 2021, all patients who had a diagnosis of VAA and underwent intraoperative CBCTA imaging were retrospectively reviewed. Impact on treatment decisions, optimal C-arm angulations derived from CBCTA, and additional radiation exposure were reported. Two blinded independent reviewers qualitatively reviewed CBCTA and conventional CTA images. A 5-point Likert scale (1=poor image quality, 5=excellent image quality) was used to assess the overall image quality of each modality. Number of vessels arising from the aneurysm sac was counted. Results: A total of 16 patients had a diagnosis of VAA during the study period, of whom 10 patients had intraoperative CBCTA and conventional CTA available for review. Out of 10 patients, 7 underwent successful endovascular treatment, 2 were deemed not amenable for endovascular embolization based on intraoperative CBCTA findings, and 1 had resolved pseudoaneurysm. Total fluoroscopy time and radiation dose (dose area product [DAP] and skin dose) for all procedures were 27.7 ± 19.9 minutes, 28 362 (±18 651) µGy*m2, and 1879 (±1734) mGy, respectively. Radiation exposure from CBCTA (DAP and skin dose) was 5703 (±3967) µGy*m2 and 223.6 (±141.3) mGy, respectively. In patients who underwent endovascular treatment, the proportional DAP from CBCTA was 18.3% (±15.3%) of the total procedural radiation dose. Qualitative rating of overall image quality of CBCTA images was superior to CTA images (mean score: 4.55 vs 3, p<0.001). More branch vessels arising from the VAA were identified by all reviewers in CBCTA as compared with conventional CTA (median, min-max: 3, 0–4 vs 2,1–3 vessels). Conclusion: Intraoperative CBCTA after selective intra-arterial contrast injection, with better spatial resolution, provided better delineation of visceral aneurysm morphology as compared with conventional, intravenous CTA and enabled optimal treatment planning at a reasonable additional radiation exposure. Clinical Impact Visceral artery aneurysms (VAA) are often diagnosed incidentally by conventional computed tomographic angiography (CTA). Endovascular treatment typically requires selective angiographies at multiple projections to better understand aneurysm morphology, location, and efferent branch vessels. Intra-arterial cone-beam CT angiography (CBCTA) for VAA has the advantage of selective contrast opacification, better spatial resolution, and three-dimensional/multi-planar visualization of aneurysm morphology. In addition, CBCTA enables identification of optimal C-arm working projection for subsequent endovascular treatment. The aim of this study is to evaluate the value of intraoperative CBCTA relative to conventional CTA in understanding visceral artery aneurysm morphology and its impact on treatment planning.

Evaluation of Radiation Exposure and Influential Factors in Cone-Beam Computed Tomography (CBCT) of the Head and Abdomen during Interventional Procedures

“…Piron et al [ 25 ] investigated radiation exposure via abdominal CBCT during transarterial chemoembolization (TACE) and reported a DAP of 59.397 (46.290–66.401) Gy⋅cm 2 for a single rotation. Similarly, Berczeli et al [ 3 ] conducted CBCT imaging for visceral aneurysms and found DAP and skin dose values of 57.03 ± 39.67 Gy⋅cm 2 and 223.6 ± 141.3 mGy, respectively.…”

“…Cone-beam computed tomography (CBCT) is a valuable three-dimensional (3D) volumetric imaging technique widely utilized in neuroradiology and interventional oncology [ 1 , 2 ]. It offers significant advantages in terms of visualizing complex anatomical structures, guiding percutaneous punctures and catheterizations, verifying intracranial stent placement in real time, and promptly monitoring intracranial hemorrhages or infractions [ 3 , 4 , 5 , 6 , 7 , 8 ]. However, a notable drawback of this technique is the additional degree of radiation exposure, especially when multiple CBCT scans are performed [ 9 , 10 , 11 ].…”

“…While previous studies have explored the role of CBCT in interventional procedures [ 3 , 6 , 10 ], there has been limited research specifically focusing on the radiation dose associated with CBCT image acquisition. Some studies have employed phantoms to estimate the dose of CBCT, but the corresponding results have shown significant variations due to the different methodologies used for estimating the effective dose (ED) [ 12 , 13 , 14 , 15 , 16 , 17 ].…”