Three-dimensional rotational angiography is preferable to conventional two-dimensional techniques for uterine artery embolization

Abstract

ORIGINAL ARTICLE PURPOSE We aimed to investigate the potential benefits of three-dimensional rotational angiography (3DRA) compared to two-dimensional (2D) roadmapping to visualize the uterine artery (UA) origins during uterine artery embolization (UAE) procedures. MATERIALS AND METHODSSixty-three UAE cases performed under 3DRA guidance were reviewed retrospectively to determine if there was an optimal angiographic projection angle for identifying UA origin. Digital subtraction angiogram (DAS)-like images of the pelvic vessels were generated from the 3DRA scans at six different angles: left anterior oblique (LAO) 25°, 35°, 45°; and right anterior oblique (RAO) 25°, 35°, 45°. Two experienced interventional radiologists assessed if these angles could effectively serve as a roadmap to guide catheterization of the UA. Assessment was validated against original 3DRA scans to determine the percentage of true and false positives. RESULTSNo single projection angle was found that could consistently be utilized for UA catheterization. The projection angles used during 3D roadmapping for both the left and right UA showed two clusters with both a wide spread: RAO 20° to 50° and LAO 20° to 50°. More than 50% of the DSA-like images at RAO and LAO 45° appeared to be adequate for UA catheterization, but validation against the 3DRA revealed 28% of these images were suboptimal and deceptive, due to unappreciated overlapping vessels. CONCLUSIONNo standard projection angles can be recommended with 2D roadmapping to consistently visualize UA origin. The 3DRA can be as a useful tool for UAE to achieve reliable and consistent visibility of the UA origin.

Radiation Exposure During Uterine Artery Embolization: Effective Measures to Minimize Dose to the Patient

“…When angiographic runs are used in overlay technique, the radiologist should not only use a lower frame rate but also discontinue a run as soon as the artery origins have been adequately visualized. Rotational angiography of the female pelvis with generation of a 3D roadmap has been described but clearly leads to unnecessary dose escalation [28,33]. Naguib et al [26] made a useful proposal, namely that the origins of the uterine arteries should be assessed by MRA before the intervention to identify the optimal catheterization angle before UAE.…”

Value of Dyna CT in guiding embolization during transarterial uterine artery embolization of fibroids

“…In a previous study, Gupta et al ( 23 ) demonstrated that 3-D rotational angiography is preferable to 2-D techniques for UAE. When using 3-D angiography by Dyna CT in the transarterial embolization of fibroids, it was esteemed to overcome the limits of DSA anterior-posterior imaging.…”