Usefulness of Cone-Beam Computed Tomography and Automatic Vessel Detection Software in Emergency Transarterial Embolization.
BACKGROUND
This study was designed to evaluate the utility of dual phase cone beam computed tomography (DP-CBCT) and automatic vessel detection (AVD) software to guide transarterial embolization (TAE) of angiographically challenging arterial bleedings in emergency settings.


METHODS
Twenty patients with an arterial bleeding at computed tomography angiography and an inconclusive identification of the bleeding vessel at the initial 2D angiographic series were included. Accuracy of DP-CBCT and AVD software were defined as the ability to detect the bleeding site and the culprit arterial bleeder, respectively. Technical success was defined as the correct positioning of the microcatheter using AVD software. Clinical success was defined as the successful embolization. Total volume of iodinated contrast medium and overall procedure time were registered.


RESULTS
The bleeding site was not detected by initial angiogram in 20% of cases, while impossibility to identify the bleeding vessel was the reason for inclusion in the remaining cases. The bleeding site was detected by DP-CBCT in 19 of 20 (95%) patients; in one case CBCT-CT fusion was required. AVD software identified the culprit arterial branch in 18 of 20 (90%) cases. In two cases, vessel tracking required manual marking of the candidate arterial bleeder. Technical success was 95%. Successful embolization was achieved in all patients. Mean contrast volume injected for each patient was 77.5 ml, and mean overall procedural time was 50 min.


CONCLUSIONS
C-arm CBCT and AVD software during TAE of angiographically challenging arterial bleedings is feasible and may facilitate successful embolization. Staff training in CBCT imaging and software manipulation is necessary.
Department of Radiology, Interventional Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy. gcarraf@gmail.com.
Gianpaolo
G
Carrafiello
Department of Radiology, Interventional Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy. amierardi@yahoo.it.
Anna Maria
AM
Ierardi
Department of Radiology, Interventional Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy. ejonaduka@hotmail.com.
Ejona
E
Duka
Philips Healthcare, Best, The Netherlands. alessandro.radaelli@philips.com.
Alessandro
A
Radaelli
Department of Radiology, Interventional Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy. chiara.floridi@gmail.com.
Chiara
C
Floridi
Anaesthesia and Palliative Care, University of Insubria, Varese, Italy. alessandro.bacuzzi@ospedale.varese.it.
Alessandro
A
Bacuzzi
Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany. maximilian.de-bucourt@charite.de.
Maximilian
M
de Bucourt
Department of Radiology, Interventional Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy. giuseppedemarchi@email.it.
Giuseppe
G
De Marchi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001158:Arteries / Q000000981:diagnostic imaging*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012984:Software
Arterial intervention; Clinical practice; Imaging