3:09 PM Abstract No. 182 Comparison of cone-beam CT versus computed tomography intraarterial angiography for intraprocedural TACE planning

Abstract

To compare imaging characteristics of intraarterial cone-beam computed-tomography angiography (CBCTA) versus computed tomography angiography (IACTA) for transarterial chemoembolization (TACE) planning. This single-institution retrospective study included 144 patients submitted to 181 TACE sessions under conscious sedation (CBCTA, n = 111; IACTA, n = 70) from January 2015 to July 2017. CBCTA was performed using a single plane angiography system equipped with a 30×40 cm flat detector (Syngo 6s DR DynaCT, Artis Zee, Siemens, Germany). IACTA was performed using a hybrid Angio-CT system equipped with a 128-slice sliding gantry CT (MIYABI Angio CT, Siemens, Germany). Similar intraarterial contrast injection protocols were utilized for both modalities. Multi-planar reformatted CBCTA- and IACTA-images (5-10 mm MPR MIP Thick) were independently reviewed by two readers in a dedicated workstation and classified using a binary (yes vs no) system (breathing motion artifact, and field of view [FOV] coverage of entire liver) or a 3-/4-level ordinal grading system (tumor conspicuity, tumor arterial feeder conspicuity, streaking artifacts, overall vessels conspicuity, and overall image quality). CBCTA and IACTA groups were compared using a F-test and score test. There were no significant differences in patient demographic and tumor characteristics between the IACTA and CBCTA groups. IACTA was significantly superior to CBCTA in respect to better tumor conspicuity (P < 0.01), tumor arterial feeder conspicuity (P = 0.02), less frequent incidence of streaking artifact (P < 0.01), FOV coverage of entire liver (CBTCTA: 22%; IACTA: 84%; P < 0.01), overall vessel conspicuity (P < 0.05), and overall image quality (P < 0.001). CBCTA trended to have more frequent image degradation due to breathing motion during acquisition (CBCTA: 10%; IACTA: 1.4%; P = 0.057). IACTA provides more reliable and consistent imaging information when compared to CBCTA for liver soft-tissue and vessel analysis for intraprocedural TACE planning. Further studies are required to explore the diagnostic utility and radiation dose of IACTA in the context of TACE planning in a hybrid CT angio suite.