title: Angiography-based C-arm CT for the assessment of extrahepatic shunting before radioembolization.
abstract: OBJECTIVE
  To retrospectively assess the accuracy of angiography-based C-arm CT for the detection of extrahepatic shunting before SIRT.
  
  
  METHODS
  30 patients (mean age: 64+/-12 years) with hypervascularized hepatic tumors underwent hepatic angiography, coil embolization of gastrointestinal collaterals and 99mTc-macroaggregated albumin (MAA) SPECT/CT before SIRT. Before MAA injection via a microcatheter from the intended treatment position, an angiography and angiography-based C-arm CT (XperCT, Philips Healthcare) were acquired. Angiographies and XperCT were performed from 48 microcatheter positions followed by MAA injections and MAA-SPECT/CT. MAA-SPECT/CT served as the reference standard for determining the accuracy of hepatic arteriography and C-arm CT for the detection of extrahepatic shunting.
  
  
  RESULTS
  MAA-SPECT/CT revealed extrahepatic shunting in 5 patients (17%). Hepatic arteriography yielded a true negative in 22 (73%), a false negative in 5 (17%), and an unclear result in 3 patients (10%). C-arm CT yielded a true positive in 3 (10%), true negative in 24 (80%), false positive in 1 (3%), and false negative in 2 patients (7%). The specificity and the NPV of hepatic arteriography for the detection of extrahepatic shunting were 88% and 81%, respectively. For C-arm CT the sensitivity, specificity, PPV, NPV, and accuracy for the detection of extrahepatic shunting were 60%, 96%, 75%, 92%, and 90%, respectively.
  
  
  CONCLUSIONS
  C-arm CT offers additional information to angiography when assessing SIRT patients for extrahepatic shunting. More accurate detection of extrahepatic shunting may optimize the workflow in SIRT preparations by avoiding unnecessary repeat angiographies.
authors.affiliation: Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinik Essen, Essen. till.heusner@uni-due.de
authors.forename: T A
authors.initials: TA
authors.lastname: Heusner
authors.forename: M E
authors.initials: ME
authors.lastname: Hamami
authors.forename: J
authors.initials: J
authors.lastname: Ertle
authors.forename: S
authors.initials: S
authors.lastname: Hahn
authors.forename: T
authors.initials: T
authors.lastname: Poeppel
authors.forename: P
authors.initials: P
authors.lastname: Hilgard
authors.forename: A
authors.initials: A
authors.lastname: Bockisch
authors.forename: M
authors.initials: M
authors.lastname: Forsting
authors.forename: G
authors.initials: G
authors.lastname: Antoch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000295:instrumentation*; D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000532:radiotherapy*; D003097:Collateral Circulation / Q000502:physiology; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D005260:Female; D041981:Gastrointestinal Tract / Q000098:blood supply; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008102:Liver Circulation / Q000502:physiology; D008113:Liver Neoplasms / Q000098:blood supply* / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D012039:Regional Blood Flow / Q000502:physiology; D012680:Sensitivity and Specificity; D013668:Technetium Tc 99m Aggregated Albumin; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes