Dynamic 4D-CT Angiography for Guiding Transarterial Chemoembolization: Impact on the Reduction of Contrast Material, Operator Radiation Exposure, Catheter Consumption, and Diagnostic Confidence

Albrecht, Moritz H.; Vogl, Thomas J.; Wichmann, Julian L.; Martin, Simon S.; Scholtz, Jan-Erik; Fischer, Sebastian; Hammerstingl, Renate; Harth, Marc; Nour-Eldin, Nour-Eldin A.; Thalhammer, A.; Zangos, Stephan; Bauer, Ralf W.

doi:10.1055/a-0595-7964

Cited by 9 publications

(8 citation statements)

References 25 publications

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“…Contrast-enhanced multi-slice CT allows for rapid assessment of vascular malformations with precise evaluation of the feeding and draining vessels, though the major disadvantage of this modality is the significant dose of ionizing radiation [ 36 ], which is particularly relevant in children [ 37 ]. Accordingly, CT is not recommended as a routine diagnostic modality but should be reserved for certain cases, where MRI is either not possible or expected to not provide enough information for proper treatment planning [ 13 ], which may allow to reduce procedure time and radiation dose during DSA [ 38 ]. This is ideally performed by time-resolved CTA and CT venography (4D CT imaging) over a wide z -axis coverage combined with low tube voltage settings [ 39 ].…”

Section: Current Imaging Conceptsmentioning

confidence: 99%

Imaging of peripheral vascular malformations — current concepts and future perspectives

et al. 2021

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Vascular Malformations belong to the spectrum of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic vasculature. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) is of major importance to guide proper treatment. Imaging plays a crucial role to classify vascular malformations according to their dominant vessel type, anatomical extension, and flow pattern. Several imaging concepts including color-coded Duplex ultrasound/contrast-enhanced ultrasound (CDUS/CEUS), 4D computed tomography angiography (CTA), magnetic resonance imaging (MRI) including dynamic contrast-enhanced MR-angiography (DCE-MRA), and conventional arterial and venous angiography are established in the current clinical routine. Besides the very heterogenous phenotypes of vascular malformations, molecular and genetic profiling has recently offered an advanced understanding of the pathogenesis and progression of these lesions. As distinct molecular subtypes may be suitable for targeted therapies, capturing certain patterns by means of molecular imaging could enhance non-invasive diagnostics of vascular malformations. This review provides an overview of subtype-specific imaging and established imaging modalities, as well as future perspectives of novel functional and molecular imaging approaches. We highlight recent pioneering imaging studies including thermography, positron emission tomography (PET), and multispectral optoacoustic tomography (MSOT), which have successfully targeted specific biomarkers of vascular malformations.

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Section: Current Imaging Conceptsmentioning

confidence: 99%

Imaging of peripheral vascular malformations — current concepts and future perspectives

et al. 2021

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“…In highly complex and extensive fast-flow AVMs, 4D CT imaging should be reserved for intervention planning, when arterial inflow vessels to the nidus of the AVM and venous outflow have to be identified for transarterial, transvenous and percutaneous access to the lesion during one embolization procedure [29]. Intervention time and associated radiation exposure during DSA can be reduced and the selection of catheter devices facilitated, when axial perfusion images and postprocessed reformatted CT images in 4D or 3D view in dynamic volume rendering technique display the rich arteriovenous shunting in fast-flow vascular anomalies well [30].…”

Section: Computed Tomographymentioning

confidence: 99%

Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging

Sadick

Overhoff

Baeßler

et al. 2019

Fortschr Röntgenstr

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Background Peripheral vascular anomalies represent a rare disease with an underlying congenital mesenchymal and angiogenetic disorder. Vascular anomalies are subdivided into vascular tumors and vascular malformations. Both entities include characteristic features and flow dynamics. Symptoms can occur in infancy and adulthood. Vascular anomalies may be accompanied by characteristic clinical findings which facilitate disease classification. The role of periinterventional imaging is to confirm the clinically suspected diagnosis, taking into account the extent and location of the vascular anomaly for the purpose of treatment planning. Method In accordance with the International Society for the Study of Vascular Anomalies (ISSVA), vascular anomalies are mainly categorized as slow-flow and fast-flow lesions. Based on the diagnosis and flow dynamics of the vascular anomaly, the recommended periinterventional imaging is described, ranging from ultrasonography and plain radiography to dedicated ultrafast CT and MRI protocols, percutaneous phlebography and transcatheter angiography. Each vascular anomaly requires dedicated imaging. Differentiation between slow-flow and fast-flow vascular anomalies facilitates selection of the appropriate imaging modality or a combination of diagnostic tools. Results Slow-flow congenital vascular anomalies mainly include venous and lymphatic or combined malformations. Ultrasound and MRI and especially MR-venography are essential for periinterventional imaging. Arteriovenous malformations are fast-flow vascular anomalies. They should be imaged with dedicated MR protocols, especially when extensive. CT with 4D perfusion imaging as well as time-resolved 3D MR-A allow multiplanar perfusion-based assessment of the multiple arterial inflow and venous drainage vessels of arterio-venous malformations. These imaging tools should be subject to intervention planning, as they can reduce procedure time significantly. Fast-flow vascular tumors like hemangiomas should be worked up with ultrasound, including color-coded duplex sonography, MRI and transcatheter angiography in case of a therapeutic approach. In combined malformation syndromes, radiological imaging has to be adapted according to the dominant underlying vessels and their flow dynamics. Conclusion Guide to evaluation of flow dynamics in peripheral vascular anomalies, involving vascular malformations and vascular tumors with the intention to facilitate selection of periinterventional imaging modalities and diagnostic and therapeutic approach to vascular anomalies. Key Points: Citation Format

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“…Few studies have been discussing the usage of dynamic road mapping in coronary interventions especially in more than single coronary artery disease, yet some studies done on computed tomography of the peripheral vasculature or peripheral angiography have shown similar results (6)(7)(8). The studies done on coronary interventions have also detected significant reduction in contrast volume used and the amount of radiation for which medical personnel and patients are exposed.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Coronary Roadmap for Contrast, and Radiation Time Reduction during Coronary Intervention (DRM-COR)

Maher¹,

Zarif²,

El‐Gamal³

et al. 2022

AJHMN

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Purpose: The regularly used contrast media in the angiography procedures and interventions are known to carry certain risks to the patient. This includes allergy, nephrotoxicity, and pulmonary edema. Additionally, radiation exposure is associated with high bone marrow depression, infertility, and other hazards. The purpose of the study was to compare the Dynamic Roadmap technology to the regular contrast used in coronary intervention regarding radiation exposure, fluoroscopy time, and incidence of Contrast Induced Nephropathy. Methodology: Observational prospective cohort with 2 arms where 40 patients were randomly divided into 2 arms a case and control groups. The case group had DRM technology used in their procedures where the control group received the standard contrast used in the National Heart Institute. Findings: Findings showed no statistically significant difference between the 2 groups in age, sex, and risk profile including status of Hypertension, Diabetes Mellitus, Smoking and history of Ischemic Heart Disease. There was no difference in echocardiographic findings of both groups. There was significant difference in creatinine level at the 5th day of intervention and volume of contrast used and fluoroscopy time. DRM reduced contrast volume, reduced radiation exposure despite not reducing fluoroscopy or procedure time. This resulted in reduction of elevation in serum creatinine levels with similar success rates. Recommendations: Using the least possible contrast volume and radiation doses should always be target of the operator. Dynamic roadmap technology is recommended in all coronary interventions specially those at high risk of CIN with CKD.

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Dynamic 4D-CT Angiography for Guiding Transarterial Chemoembolization: Impact on the Reduction of Contrast Material, Operator Radiation Exposure, Catheter Consumption, and Diagnostic Confidence

Cited by 9 publications

References 25 publications

Imaging of peripheral vascular malformations — current concepts and future perspectives

Imaging of peripheral vascular malformations — current concepts and future perspectives

Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging

Dynamic Coronary Roadmap for Contrast, and Radiation Time Reduction during Coronary Intervention (DRM-COR)

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