Abstract
Ultra-low-dose CT fluoroscopy (ULD-CTF) is a recently developed technique that significantly increases the temporal resolution and decreases radiation exposure during CT fluoroscopy. 4D CT DSA is a method for performing time-resolved CTA and flow quantification in a 3D vascular volume. The purpose of this study was to determine the feasibility of using ULD-CTF and 4D CT DSA to perform vascular interventions in an in vivo porcine model. Under intermittent CT guidance, a 5Fr catheter was placed in the descending thoracic aorta of an ∼50kg female swine and a CTA of the abdomen was acquired. This CTA was motion corrected and combined with ongoing catheter reconstructions using ULD-CTF. Four CT projections per gantry rotation (gantry rotation time 0.5s) were used to reconstruct the catheter with 8 frames/sec. The reconstruction of a single time frame of the catheter was performed using two projection images separated by a 90-degree angle. To evaluate the accuracy of the intravascular device reconstruction, intermittent CT was performed as the catheter was guided through the aorta into the splenic artery. Traditional roadmap and endovascular views were created. Subsequently, the catheter was repositioned into the common hepatic artery. 4D CT DSA images were obtained and flow within the main hepatic arteries calculated. The localization error of the catheter tip on ULD-CTF was 2.70±0.73 mm compared to the conventional reconstruction. Reconstructing the catheter with only 4 projections per gantry rotation enables a relative radiation dose reduction of up to 250× compared with conventional reconstruction. Flow values in the hepatic arteries were: common hepatic (1.74ml/s), gastroduodenal (0.33ml/s), left hepatic (0.95ml/s), left medial (0.89ml/s), left lateral (0.42ml/s), right medial (0.96ml/s) and right lateral (0.84ml/s and 0.84ml/s) arteries. Flow conservation within the vascular volume was 86.44%. ULD-CTF and 4D CT DSA are feasible and, when combined, may enable quantitative CT-guided vascular diagnosis and interventions in the future.
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