title: Three-dimensional rotational angiography is preferable to conventional two-dimensional techniques for uterine artery embolization.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Sixty-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.
  
  
  RESULTS
  No 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.
  
  
  CONCLUSIONS
  No 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.
authors.affiliation: Department of Interventional Radiology, Paoli Hospital, Paoli, PA, USA. guptaa@mlhs.org
authors.forename: Atul
authors.initials: A
authors.lastname: Gupta
authors.forename: Kirsten
authors.initials: K
authors.lastname: Zuurmond
authors.forename: Thijs
authors.initials: T
authors.lastname: Grünhagen
authors.forename: Geert
authors.initials: G
authors.lastname: Maleux
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods; D003287:Contrast Media; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007472:Iohexol / Q000031:analogs & derivatives; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055988:Uterine Artery / Q000000981:diagnostic imaging*; D055357:Uterine Artery Embolization / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide