Venous thrombosis following microwave ablation of hepatocellular carcinoma and liver metastases

Abstract

Purpose: To assess the feasibility and diagnostic performance of carbon dioxide enhanced C-Arm Computed Tomography (CO2-CACT) of the pelvic arteries in comparison to carbon dioxide enhanced Digital Subtraction Angiography (CO2-DSA) in patients after renal transplant or with renal failure. Materials: Ten patients (9 men, 70±7 years) with an estimated glomerular filtration rate (eGFR) o60ml/min/1.73m2 underwent CO2-DSA and CO2-CACT using a 4F catheter placed in the infrarenal aorta. CO2-DSA and CO2-CACT were acquired using 100ml CO2 per run via a syringe-based CO2 injection device (CO2-Angioset, Optimed, Ettlingen, Germany). Two interventional radiologists (R1; R2) independently assessed image quality and grade of stenosis (4-point-scale) for arterial segments (AS) from the infrarenal aorta to the common femoral arteries in both modalities. Inter-modality and inter-observer agreement was calculated (Cohen´s Kappa). Results: The mean baseline eGFR was 28±15o60ml/min/1.73m2. Six patients had a renal transplant. Overall, 90 arterial segments were evaluated. In case of CO2-CACT, 9 arterial segments in 5 patients were out of the field-of-view. A total of 81 AS were covered by both modalities. In CO2-DSA and CO2-CACT, 90% (91%) and 93% (93%) of AS were rated to be assessable for pathologic findings by R1 (R2), respectively. 96% (96%) of AS were assessable by at least one modality by R1 (R2). 70 AS were evaluated for pathologic findings. Eight patients had relevant pathologic findings in the pelvic or common femoral arteries. Agreement of AS stenosis grading in DSA and CACT was observed in 89% (86%) by R1 (R2). In 11% (R1) and 14% (R2), CACT detected additional findings (R1 6/70; R2 5/70) or ruled out stenoses suspected to be relevant on DSA (R1 2/70; R2 5/70). No adverse side effects occurred. Conclusions: CO2-enhanced CACT of the pelvic arteries is feasible and can supplement information to CO2-DSA in patient with renal insufficiencies.