Cone beam computed tomography improves the detection of injured vessels and involved vascular territories in patients with bleeding of uncertain origin

Abstract

The purpose ofthis preliminary retrospective study was to analyse if cone beam CT (CBCT) is able to identify more bleeding sites and correspondingfeeding arteriesin patients with haemorrhage of uncertain origin. In 18vascular territories (16 patients), pre-interventional CTangiography (CTA) and selective angiograms resulted in discordant informationregarding the suspected bleeding site and hence received CBCT. Image data ofCTA and selective angiograms in comparison to CBCT were independently reviewedby two interventional radiologists.Image quality, diagnostic confidence, numberof bleeding sites and involved vascular territories were investigated.Additionally,thecorrelation between number of bleeding sites and involved vascular territories witha clinical gold-standard(super-selective angiographic findings and definitive clinicaloutcomes) was analysed. Overall, subjective image quality did not significantly differ between investigatedimaging modalities. However, CBCT significantly improved diagnostic confidence inboth readers in detecting bleeding vessel(s) (p=0.0024/0.0005; Reader 1/Reader2).High correlation coefficients regarding the number of bleeding sites(r=0.9163/0.7692) in contrast to the number of involved vascular territories(r=0.2888/0.0105) were observed for CTA in comparison to clinical gold-standard.In this context, CBCT demonstrated a very strong correlation for bothparameters,the number of bleeding vessels (r=0.9720/0.9721) and the number involvedvascular territories (r=0.9441/0.9441). In complexcases of suspected haemorrhage, CBCT images can aid the interventionalist in detectingbleeding sites as well as narrowing down the number of involved vascularterritories and thereby identifying feeding arteries of the bleeding source. Advances in knowledge: (1)CBCT showed no improvement in image quality. However, in complex bleeding cases CBCT information might aid in treatment planning.(2)CBCT improves visualization of bleeding vessels and involved feeding arteries.(3)Particularly, less experienced interventionalists might benefit from the three-dimensional information gathered by CBCT.