Quantitative 4D-Digital Subtraction Angiography to Assess Changes in Hepatic Arterial Flow during Transarterial Embolization: A Feasibility Study in a Swine Model

Meram, Ece; Harari, Colin; Shaughnessy, Gabe; Wagner, Martin; Brace, Christopher L.; Mistretta, Charles A.; Speidel, Michael A.; Laeseke, Paul F.

doi:10.1016/j.jvir.2019.01.018

Cited by 8 publications

(9 citation statements)

References 19 publications

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“…One, quantitative 4D transcatheter intra-arterial perfusion MRI, showed promise, however, lacks feasibility as it requires a complex and costly hybrid angiography/MR suite only available at selected institutions [18,19]. A recent study demonstrated the feasibility of using quantitative 4D-DSA to depict changes in hepatic arterial blood velocity during transarterial embolization in a swine model, but the method requires lengthy data acquisition times and greater amounts of iodinated contrast [20,21]. The 2D qDSA technique described here could be easily translated to intra-procedural clinical workflows given that it would only require modification to image acquisition parameters.…”

Section: Discussionmentioning

confidence: 99%

A Quantitative Digital Subtraction Angiography Technique for Characterizing Reduction in Hepatic Arterial Blood Flow During Transarterial Embolization

Periyasamy

Hoffman

Longhurst

et al. 2020

Cardiovasc Intervent Radiol

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Objective There is no standardized and objective method for determining the optimal treatment endpoint (sub-stasis) during transarterial embolization. The objective of this study was to demonstrate the feasibility of using a quantitative digital subtraction angiography (qDSA) technique to characterize intra-procedural changes in hepatic arterial blood flow velocity in response to transarterial embolization in an in vivo porcine model. Materials and Methods Eight domestic swine underwent bland transarterial embolizations to partial-and sub-stasis angiographic endpoints with intraprocedural DSA acquisitions. Embolized lobes were assessed on histopathology for ischemic damage and tissue embolic particle density. Analysis of target vessels used qDSA and a commercially available color-coded DSA (ccDSA) tool to calculate blood flow velocities and time-to-peak, respectively.Results Blood flow velocities calculated using qDSA showed a statistically significant difference (p \ 0.01) between partial-and sub-stasis endpoints, whereas time-topeak calculated using ccDSA did not show a significant difference. During the course of embolizations, the average correlation with volume of particles delivered was larger for qDSA (-0.86) than ccDSA (0.36). There was a statistically smaller mean squared error (p \ 0.01) and larger coefficient of determination (p \ 0.01) for qDSA compared to ccDSA. On pathology, the degree of embolization as calculated by qDSA had a moderate, positive correlation (p \ 0.01) with the tissue embolic particle density of ischemic regions within the embolized lobe. Conclusions qDSA was able to quantitatively discriminate angiographic embolization endpoints and, compared to a commercially available ccDSA method, improve intra-procedural characterization of blood flow changes. Additionally, the qDSA endpoints correlated with tissue-level changes. Keywords Hepatocellular carcinoma (HCC) Á Transarterial embolization (TAE) Á Transarterial chemoembolization (TACE) Á 2D digital subtraction angiography (DSA) Á Quantitative digital subtraction angiography (qDSA) Á Color-coded digital subtraction angiography (ccDSA) Á Time-attenuation curve (TAC) Á Time-to-peak (TTP)

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Section: Discussionmentioning

confidence: 99%

A Quantitative Digital Subtraction Angiography Technique for Characterizing Reduction in Hepatic Arterial Blood Flow During Transarterial Embolization

Periyasamy

Hoffman

Longhurst

et al. 2020

Cardiovasc Intervent Radiol

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“…The SBR is a proxy for the signal-to-noise ratio of the cardiac pulsatile waveform, and, as such, is a major determinant of flow quantification performance [7]. A higher SBR has been associated with a higher correlation seen between 4D-DSA and intravascular Doppler blood velocities [6]. Given that the objective of the study was to determine factors improving the quality of 4D-DSA reconstructions and flow quantitation, not to actually quantify hepatic arterial flow in a porcine model, SBR, not blood velocity, was the primary endpoint in the analysis.…”

Section: Assessment Of Optimal Acquisition Parametersmentioning

confidence: 99%

“…Quantitative 4D-DSA may provide a better understanding of in vivo flow dynamics during hepatic interventional procedures and facilitate the development of rather objective angiographic endpoints. For example, quantitative 4D-DSA was recently shown to be a feasible modality for quantifying hepatic blood flow and characterizing changes in flow during transarterial embolization [6]. However, the quality of the 4D-DSA reconstructions and resultant accuracy of the flow calculations was shown to be dependent on, and positively correlated with, the strength of the contrast pulsatility [7].…”

Section: Introductionmentioning

confidence: 99%

Optimization of quantitative time-resolved 3D (4D) digital subtraction angiography in a porcine liver model

et al. 2020

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Background: Time-resolved three-dimensional digital subtraction angiography (4D-DSA) can be used to quantify blood velocity. Contrast pulsatility, a major discriminant on 4D-DSA, is yet to be optimized. We investigated the effects of different imaging and injection parameters on sideband ratio (SBR), a measure of contrast pulsatile strength, within the hepatic vasculature of an in vivo porcine model. Methods: Fifty-nine hepatic 4D-DSA procedures were performed in three female domestic swine (mean weight 54 kg). Contrast injections were performed in the common hepatic artery with different combinations of imaging duration (6 s or 12 s), injection rates (from 1.0 to 2.5 mL/s), contrast concentration (50% or 100%), and catheter size (4 Fr or 5 Fr). Reflux was recorded. SBR and vessel cross-sectional areas were calculated in 289 arterial segments. Multiple linear mixed-effects models were estimated to determine the effects of parameters on SBR and cross-sectional vessel area. Results: Twelve-second acquisitions yielded a SBR higher than 6 s (p < 0.001). No significant differences in SBR were seen between different catheter sizes (p = 0.063) or contrast concentration (p = 0.907). For higher injection rates (2.5 mL/s), SBR was lower (p = 0.007) and cross-sectional area was higher (p < 0.001). Reflux of contrast does not significantly affect SBR (p = 0.087). Conclusions: The strength of contrast pulsatility used for flow quantitation with 4D-DSA can be increased by adjusting injection rates and using longer acquisition times. Reduction of contrast concentration to 50% is feasible and reflux of contrast does not significantly hinder contrast pulsatility.

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“…Specifically, hepatic arterial interventions (e.g., transarterial embolization) are a routinely performed image-guided intervention and are the subject of many active investigations in image guidance. 24 Therefore, realistic CHPs are important for the development and evaluation of hepatic blood flow quantification algorithms [25][26][27][28][29][30][31] and the synthesis of realistic interventional hepatic angiograms for machine learning (ML) applications (e.g., vessel segmentation for treatment planning and tumor feeding artery identification). This would require the simulation of motion and contrast dynamics as well as randomizable anatomy to provide sufficient data variability for the training of ML algorithms.…”

Section: Introductionmentioning

confidence: 99%

In silico simulation of hepatic arteries: An open‐source algorithm for efficient synthetic data generation

et al. 2023

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BackgroundIn silico testing of novel image reconstruction and quantitative algorithms designed for interventional imaging requires realistic high‐resolution modeling of arterial trees with contrast dynamics. Furthermore, data synthesis for training of deep learning algorithms requires that an arterial tree generation algorithm be computationally efficient and sufficiently random.PurposeThe purpose of this paper is to provide a method for anatomically and physiologically motivated, computationally efficient, random hepatic arterial tree generation.MethodsThe vessel generation algorithm uses a constrained constructive optimization approach with a volume minimization‐based cost function. The optimization is constrained by the Couinaud liver classification system to assure a main feeding artery to each Couinaud segment. An intersection check is included to guarantee non‐intersecting vasculature and cubic polynomial fits are used to optimize bifurcation angles and to generate smoothly curved segments. Furthermore, an approach to simulate contrast dynamics and respiratory and cardiac motion is also presented.Results: The proposed algorithm can generate a synthetic hepatic arterial tree with 40 000 branches in 11 s. The high‐resolution arterial trees have realistic morphological features such as branching angles (MAD with Murray's law ), radii (median Murray deviation ), and smoothly curved, non‐intersecting vessels. Furthermore, the algorithm assures a main feeding artery to each Couinaud segment and is random (variability = 0.98 ± 0.01).ConclusionsThis method facilitates the generation of large datasets of high‐resolution, unique hepatic angiograms for the training of deep learning algorithms and initial testing of novel 3D reconstruction and quantitative algorithms designed for interventional imaging.

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Quantitative 4D-Digital Subtraction Angiography to Assess Changes in Hepatic Arterial Flow during Transarterial Embolization: A Feasibility Study in a Swine Model

Cited by 8 publications

References 19 publications

A Quantitative Digital Subtraction Angiography Technique for Characterizing Reduction in Hepatic Arterial Blood Flow During Transarterial Embolization

A Quantitative Digital Subtraction Angiography Technique for Characterizing Reduction in Hepatic Arterial Blood Flow During Transarterial Embolization

Optimization of quantitative time-resolved 3D (4D) digital subtraction angiography in a porcine liver model

In silico simulation of hepatic arteries: An open‐source algorithm for efficient synthetic data generation

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