title: The Value of 320-Row Multidetector CT Bronchial Arteriography in Recurrent Hemoptysis after Failed Transcatheter Arterial Embolization.
abstract: OBJECTIVE
  To retrospectively assess the value of computed tomographic (CT) bronchial arteriography (BA) with 320-row multidetector CT in the management of patients with recurrent hemoptysis immediately after bronchial artery embolization (BAE).
  
  
  METHODS
  Among 135 consecutive patients treated with BAE between April 2014 and March 2016, recurrent hemoptysis developed in 15, and 10 subsequently underwent multidetector CT. Vascular abnormalities and associated anatomy were evaluated to determine the potential cause of BAE failure, and the clinical impacts of CT BA were analyzed.
  
  
  RESULTS
  CT BA revealed an additional 22 abnormal vessels in the qualified 10 patients, and 8 patients were treated again within 24 hours after the first BAE based on multidetector CT findings. Of the 22 abnormal vessels, 16 were embolized, including 4 orthotopic arteries, 8 ectopic arteries, and 4 nonbronchial systemic arteries (NBSAs); the remaining 6 abnormal arteries were not embolized because of normal BA (n = 1), anatomic inaccessibility (n = 2), or cessation of hemoptysis with conservative therapy (n = 3). There were no further cases of recurrent hemoptysis after the second intervention, with a mean follow-up of 7.7 months ± 6.7. Overall, initial conventional BA missed 65% of potential bleeding arteries (22 of 34). After CT BA, 73% of the newly identified vessels (16 of 22) were embolized.
  
  
  CONCLUSIONS
  Multiple unrecognized abnormal ectopic bronchial arteries and NBSAs are the major causes of failure of initial BAE. Multidetector CT BA can precisely identify a large number of feeding vessels that are missed on conventional BA, allowing for repeat embolization with a high success rate.
authors.affiliation: Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Tian
authors.initials: T
authors.lastname: Zhao
authors.affiliation: Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Sini
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Changzhou, China.
authors.forename: Zhongzhi
authors.initials: Z
authors.lastname: Jia
authors.affiliation: Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Yunjun
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224. Electronic address: wang.weiping@mayo.edu.
authors.forename: Weiping
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Houzhang
authors.initials: H
authors.lastname: Sun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001981:Bronchial Arteries / Q000002:abnormalities / Q000000981:diagnostic imaging*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006469:Hemoptysis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure