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Evaluation of motion artifacts reduction software that compensate for respiratory movements in the craniocaudal direction during abdominal cone-beam computed tomography. Radiol Phys Technol 2023; 16:338-345. [PMID: 36881329 DOI: 10.1007/s12194-023-00707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
Abstract
We acquired cone-beam computed tomography (CBCT) images of a locally made contrast-enhanced hepatic artery phantom under various conditions, both with the phantom still, and while moving it from the cranial to the caudal position. All the motion CBCT images were processed with and without motion artifacts reduction software (MARS). We calculated some quantitative similarity indexes between the still CBCT images (no-motion) and the motion CBCT images both processed with MARS (MARS ON) and without MARS (MARS OFF). In addition, the vessel signal values under the same movement conditions of the MARS ON/OFF and no-motion were evaluated. All quantitative similarity indexes between MARS ON and no-motion were significantly higher than between MARS OFF and no-motion in all movement conditions (p < 0.01). The vessel signal values were higher in MARS ON than in MARS OFF (p < 0.01) and closer to no-motion in all movement conditions.
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Becker LS, Dewald CLA, von Falck C, Werncke T, Maschke SK, Kloeckner R, Wacker FK, Meyer BC, Hinrichs JB. Effectuality study of a 3D motion correction algorithm in C-arm CTs of severely impaired image quality during transarterial chemoembolization. Cancer Imaging 2022; 22:37. [PMID: 35908026 PMCID: PMC9338620 DOI: 10.1186/s40644-022-00473-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background To evaluate effectivity of a 3D-motion correction algorithm in C-Arm CTs (CACT) with limited image quality (IQ) during transarterial chemoembolization (TACE). Methods From 1/2015–5/2021, 644 CACTs were performed in patients during TACE. Of these, 27 CACTs in 26 patients (18 m, 8f; 69.7 years ± 10.7 SD) of limited IQ were included. Post-processing of the original raw-data sets (CACTOrg) included application of a 3D-motion correction algorithm and bone segmentation (CACTMC_no_bone). Four radiologists (R1-4) compared the images by choosing their preferred dataset and recommending repeat acquisition in case of severe IQ-impairment. R1,2 performed additional grading of intrahepatic vessel visualization, presence/extent of movement artifacts, and overall IQ. Results R1,2 demonstrated excellent interobserver agreement for overall IQ (ICC 0.79,p < 0.01) and the five-point vessel visualization scale before and after post-processing of the datasets (ICC 0.78,p < 0.01). Post-processing caused significant improvement, with overall IQ improving from 2.63 (CACTOrg) to 1.39 (CACTMC_no_bone;p < 0.01) and a decrease in the mean distance of identifiable, subcapsular vessels to the liver capsule by 4 mm (p < 0.01). This proved especially true for datasets with low parenchymal and high hepatic artery contrast. A good interobserver agreement (ICC = 0.73) was recorded concerning the presence of motion artifacts, with significantly less discernible motion after post-processing (CACTOrg:1.31 ± 1.67, CACTMC_no_bone:1.00 ± 1.34, p < 0.01). Of the 27 datasets, ≥ 23 CACTMC_no_bone were preferred, with identical datasets chosen by the readers to show benefit from the algorithm. Conclusion Application of a 3D-motion correction algorithm significantly improved IQ in diagnostically limited CACTs during TACE, with the potential to decrease repeat acquisitions.
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Affiliation(s)
- Lena S Becker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Cornelia L A Dewald
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christian von Falck
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Werncke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sabine K Maschke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Mainz, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Higashihara H, Osuga K, Onishi H, Nakamoto A, Tsuboyama T, Tomiyama N. The diagnostic value of dual-phase cone-beam CT during hepatic arteriography in transarterial chemoembolization for hepatocellular carcinoma. Medicine (Baltimore) 2021; 100:e24902. [PMID: 33761647 PMCID: PMC9281990 DOI: 10.1097/md.0000000000024902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 02/01/2021] [Indexed: 01/05/2023] Open
Abstract
To evaluate the diagnostic value of dual-phase cone beam CT during hepatic arteriography (CBCTHA) for hepatocellular carcinoma (HCC).Thirty seven patients with unresectable HCC underwent the dual-phase CBCTHA prior to transarterial chemoembolization (TACE). Three blinded observers independently reviewed and compared the first phase CBCTHA images alone and the dual phase CBCTHA images. Diagnostic accuracy was evaluated by the alternative free-response receiver operating characteristic method (Area under the curve: Az value). Sensitivities were analyzed with the paired t test. The analysis was performed for overall HCCs, HCCs up to 1 cm and those larger than 1 cm.For all HCCs and HCCs up to 1 cm, Az value and sensitivity showed no significant difference between the first-phase CBCTHA alone and the dual-phase CBCTHA (Az: 0.81 vs 0.88, P = .07, 0.79 and 0.85, P = .14, sensitivity: 0.61 and 0.73, P = .11, 0.41 and 0.52, P = .33, respectively). For HCCs larger than 1 cm, the mean Az value and sensitivity for the dual-phase CBCTHA were significantly higher than those for the first phase CBCTHA alone (Az: 0.96 vs 0.92, P = .008, sensitivity: 0.85 vs 0.75, P = .013, respectively).The diagnostic accuracy of the dual-phase CBCTHA was superior to that of the first phase CBCTHA alone in the diagnosis of HCC larger than 1 cm.
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Affiliation(s)
- Hiroki Higashihara
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita
| | - Keigo Osuga
- Department of Radiology, Osaka Medical College, 2-7 Daigakucho, Takatsuki, Osaka, Japan
| | - Hiromitsu Onishi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita
| | - Atsushi Nakamoto
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita
| | - Takahiro Tsuboyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita
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Becker LS, Gutberlet M, Maschke SK, Werncke T, Dewald CLA, von Falck C, Vogel A, Kloeckner R, Meyer BC, Wacker F, Hinrichs JB. Evaluation of a Motion Correction Algorithm for C-Arm Computed Tomography Acquired During Transarterial Chemoembolization. Cardiovasc Intervent Radiol 2020; 44:610-618. [PMID: 33280058 PMCID: PMC7987696 DOI: 10.1007/s00270-020-02729-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
Purpose The aim of this retrospective study was to evaluate the feasibility of a motion correction 3D reconstruction prototype technique for C-arm computed tomography (CACT). Material and Methods We included 65 consecutive CACTs acquired during transarterial chemoembolization of 54 patients (47 m,7f; 67 ± 11.3 years). All original raw datasets (CACTOrg) underwent reconstruction with and without volume punching of high-contrast objects using a 3D image reconstruction software to compensate for motion (CACTMC_bone;CACTMC_no bone). Subsequently, the effect on image quality (IQ) was evaluated using objective (image sharpness metric) and subjective criteria. Subjective criteria were defined by vessel geometry, overall IQ, delineation of tumor feeders, the presence of foreign material-induced artifacts and need for additional imaging, assessed by two independent readers on a 3-(vessel geometry and overall IQ) or 2-point scale, respectively. Friedman rank-sum test and post hoc analysis in form of pairwise Wilcoxon signed-rank test were computed and inter-observer agreement analyzed using kappa test. Results Objective IQ as defined by an image sharpness metric, increased from 273.5 ± 28 (CACTOrg) to 328.5 ± 55.1 (CACTMC_bone) and 331 ± 57.8 (CACTMC_no bone; all p < 0.0001). These results could largely be confirmed by the subjective analysis, which demonstrated predominantly good and moderate inter-observer agreement, with best agreement for CACTMC_no bone in all categories (e.g., vessel geometry: CACTOrg: κ = 0.51, CACTMC_bone: κ = 0.42, CACTMC_no bone: κ = 0.69). Conclusion The application of a motion correction algorithm was feasible for all data sets and led to an increase in both objective and subjective IQ parameters. Level of Evidence 3
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Affiliation(s)
- Lena S. Becker
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Marcel Gutberlet
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Sabine K. Maschke
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Thomas Werncke
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Cornelia L. A. Dewald
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Christian von Falck
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Mainz, Germany
| | - Bernhard C. Meyer
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jan B. Hinrichs
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Lucatelli P, Argirò R, Bascetta S, Saba L, Catalano C, Bezzi M, Levi Sandri GB. Single injection dual phase CBCT technique ameliorates results of trans-arterial chemoembolization for hepatocellular cancer. Transl Gastroenterol Hepatol 2017; 2:83. [PMID: 29167830 DOI: 10.21037/tgh.2017.10.03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 10/17/2017] [Indexed: 12/13/2022] Open
Abstract
Cone-beam CT (CBCT) application to the field of trans-arterial chemoembolization has been recently the focus of several researches. This imaging modality is performed with a rotation of the C-arm around the patient, without needs of patient repositioning. Datasets are immediately processed, obtaining volumetric CT-like images with the possibility of post-processing and reconstruction of images. Dual phase CBCT recently introduced in clinical practice consists in a first arterial acquisition followed by a delayed acquisition corresponding to a venous phase. The introduction of this feature has overcome the limit of single-phase acquisitions, allowing lesions characterization. Moreover these recent advantages have several intra-procedural implications. Detailed technical and acquisition parameters will be widely exposed in this review with particular attention to: catheter positioning, acquisition delay, injection parameters, patient positioning and contrast dilution. Comparison with standard of practice second line imaging [multidetector computer tomography (MDCT) and MDCT/arteriography] demonstrate the capability of detecting occult nodules providing some clinical implications thus potentially identifying a sub set of patients with aggressive disease behaviour. Other intra-procedural advantages of dual phase CBCT usage consist in a better tumor feeder visualization, reduction of proper DSA and fluoroscopic time, suggestion the presence of an extrahepatic parasitic feeder thus resulting in a more accurate treatment. Finally, the volumetrical intraprocedural evaluation of accumulation of embolic agent has proved to be correlate with treatment response if compared with MRI.
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, University of Siena, Siena, Italy
| | - Renato Argirò
- Departement of Diagnostic and Interventional Radiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Stefano Bascetta
- Vascular and Interventional Radiology Unit, University of Siena, Siena, Italy
| | - Luca Saba
- Departement of Medical Imaging, Azienda Ospedaliera Universitaria of Cagliari, Polo Monserrato, Cagliari, Italy
| | - Carlo Catalano
- Vascular and Interventional Radiology Unit, Sapienza University of Rome, Rome, Italy
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Sapienza University of Rome, Rome, Italy
| | - Giovanni Battista Levi Sandri
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy.,Departement of Surgical Sciences, PhD in "Advanced Surgical Technology", Sapienza University of Rome, Rome, Italy
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Bae JS, Kim JH, Yu MH, Lee DH, Kim HC, Chung JW, Han JK. Diagnostic accuracy of gadoxetic acid-enhanced MR for small hypervascular hepatocellular carcinoma and the concordance rate of Liver Imaging Reporting and Data System (LI-RADS). PLoS One 2017; 12:e0178495. [PMID: 28558068 PMCID: PMC5448778 DOI: 10.1371/journal.pone.0178495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/14/2017] [Indexed: 01/08/2023] Open
Abstract
Background & aims To assess diagnostic accuracy of gadoxetic acid–enhanced MR for small hypervascular hepatocellular carcinoma (HCC) detected by C-arm CT and concordance rate of Liver Imaging Reporting and Data System (LI-RADS). Methods In this retrospective study, we recruited 4,544 patients suspected of having HCC underwent C-arm CT from November 2008 to May 2013. Among these patients, gadoxetic acid–enhanced MR was performed in 167 patients with HCC (n = 379; 257 > 1 cm, 122 ≤ 1 cm). HCC was confirmed by MR, CT, or follow-up images. Two radiologists graded likelihood of HCC and assessed MR features. Jackknife alternative free-response receiver operating characteristic (JAFROC) analysis was performed. All HCCs were evaluated concordance rate of LI-RADS. Results Mean JAFROC figure of merit for large (>1-cm) HCC was 0.948, while that for small HCC was 0.787 with fair agreement (κ = 0.409). Mean sensitivity and positive predictive value (PPV) were 91% and 90% for large HCC versus 63.0% and 79% for small HCC, respectively. Seventeen of 122 small HCCs (13.9%) were not visible on MR. Among 379 HCCs, 99 met LR-5, and 259 met LR-4. Common features for small HCC included arterial enhancement (81.9%), hepatobiliary phase hypointensity (80.3%), and delayed washout (72.9%). Conclusion Diagnostic accuracy of gadoxetic acid–enhanced MR imaging for small, hypervascular HCCs (Mean figure of merit = 0.787) was still low compared with large HCC (Mean figure of merit = 0.948). LR-5 and LR-4 covered 94% (358/379) of the HCCs.
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Affiliation(s)
- Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
| | - Mi Hye Yu
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Werncke T, von Falck C, Luepke M, Stamm G, Wacker FK, Meyer BC. Collimation and Image Quality of C-Arm Computed Tomography: Potential of Radiation Dose Reduction While Maintaining Equal Image Quality. Invest Radiol 2016; 50:514-21. [PMID: 25867655 DOI: 10.1097/rli.0000000000000158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to assess the potential for radiation dose reduction in collimated C-arm computed tomography (CACT) while maintaining the image quality of the full field of view (FFOV) acquisition. MATERIAL AND METHODS A whole-body anthropomorphic phantom representing a 70-kg male was used in this study. The upper abdomen of the phantom was imaged using an angiographic system (Artis Zeego Q; Siemens Healthcare, Germany) with either the standard detector radiation dose level (RDL; D100, 360 nGy) or 14 experimental reduced RDLs ranging from 95% (D95, 342 nGy) to 30% D100 (D30, 108 nGy). Either the FFOV (craniocaudal coverage, 18 cm) or a collimated field of view (CFOV; craniocaudal coverage, 6 cm) was applied. The organ dose was measured using thermoluminescence detector dosimetry, and the mean effective dose was computed according to the recommendations by the International Commission on Radiological Protection Publication 103. To compare the CFOV and the FFOV data sets, image quality was assessed in terms of high- and low-contrast resolution by calculating the modulation transfer function using the wire method as well as the image noise, signal-to-noise ratio, and contrast-to-noise ratio using a low-contrast insert placed in the upper abdomen (Δ50 HU). RESULTS Collimated imaging (CFOV) covering 33% of the FFOV led to an increase in the x-ray tube output of 152% for CFOV (D100; FFOV, 95.5 mGy; CFOV, 147.7 mGy) to maintain the detector dose. The mean effective dose of D100 was 6.0 mSv (male) and 6.2 mSv (female) for the FFOV and 3.7 mSv (male) and 4.1 mSv (female) for the CFOV. High-contrast resolution was comparable for all acquisition protocols (mean 10% modulation transfer function ± 95% confidence interval; FFOV, 8.8 ± 0.1 line pairs/cm; CFOV, 8.8 ± 0.1 line pairs/cm). Low-contrast resolution was superior for the CFOV compared with that for the FFOV for each RDL (D100; image noise: FFOV, 34 ± 2 HU; CFOV, 22 ± 1 HU; contrast-to-noise ratio: FFOV, 1.3 ± 0.2; CFOV, 1.8 ± 0.3). Low-contrast resolution of the standard (D100) FFOV acquisition was achieved for the CFOV at 84% D100 of the FFOV and 54% D100 of the CFOV. Therefore, collimation up to 33% of the FFOV combined with the lower detector dose allows overall reduction of a patient's radiation exposure to 33% × 84% = 28% compared with FFOV acquisition. In the upper abdomen, this results in a nearly 50% reduction of the mean effective radiation dose (male, 2.0 mSv; female, 2.2 mSv) without loss of image quality compared with the standard FFOV acquisition. CONCLUSIONS Craniocaudal collimation in CACT should be used whenever possible to increase the image quality and reduce the patient's overall radiation exposure. Therefore, new smart acquisition protocols are required for collimated CACT to improve the trade-off between radiation exposure and image quality requirements considering the collimation used.
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Affiliation(s)
- Thomas Werncke
- From the *Institute of Diagnostic and Interventional Radiology, Hannover Medical School; and †University of Veterinary Medicine, Hannover Institute for General Radiology and Medical Physics, Hannover, Germany
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Wang Z, Hansis E, Chen R, Duran R, Chapiro J, Sheu YR, Kobeiter H, Grass M, Geschwind JF, Lin M. Automatic bone removal for 3D TACE planning with C-arm CBCT: Evaluation of technical feasibility. MINIM INVASIV THER 2016; 25:162-70. [PMID: 26923140 DOI: 10.3109/13645706.2015.1129970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate the technical feasibility of automatically removing the ribs and spine from C-arm cone-beam computed tomography (CBCT) images acquired during transcatheter arterial chemoembolization (TACE). MATERIAL AND METHODS Fifty-eight patients (45.8 ± 5.0 years) with unresectable hepatocellular carcinoma (HCC) underwent transcatheter arterial chemoembolization and had intraprocedural CBCT imaging. Automatic bone removal was performed using model-based segmentation of the ventral cavity. Two interventional radiologists independently evaluated the performance of bone removal, remaining soft tissue retention, and general usability (where both the bone is appropriately removed while retaining soft tissue) for 3D TACE planning on a four-level (complete/excellent, adequate/good, incomplete/questionable, insufficient/bad) score. The proportion of inter-reader agreement was calculated. RESULTS For ribs and spine removal, 98.3-100% and 100% of cases showed complete or adequate performance, respectively. In 96.6% of the cases, soft tissue was at least adequately retained. 91.3-93.1% of the cases demonstrated good or excellent general usability for TACE planning. Satisfactory inter-reader agreement proportion was achieved in ribs (93.1%) and spine removal (89.7%), soft tissue retention (84.5%), and general usability for TACE planning (72.4%). CONCLUSION Intraprocedural automatic bone removal on CBCT images is technically feasible and offers good removal of ribs and spine while preserving soft tissue. Its clinical value needs further assessment.
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Affiliation(s)
- Zhijun Wang
- a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA ;,b Interventional Radiology Department , Chinese PLA General Hospital , Beijing , China
| | | | - Rongxin Chen
- a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA
| | - Rafael Duran
- a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA
| | - Julius Chapiro
- a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA
| | - Yun Robert Sheu
- a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA
| | - Hicham Kobeiter
- d Service d'Imagerie Médicale, Unité de Radiologie interventionnelle et thérapeutique Vasculaire et Oncologique, Université Paris-Est Créteil, Assistance Publique-Hôpitaux de Paris, Centre Hospitalo-Universitaire Henri Mondor , France
| | | | - Jean-François Geschwind
- e Yale University School of Medicine, Department of Radiology and Biomedical Imaging , New Haven , CT , USA
| | - MingDe Lin
- e Yale University School of Medicine, Department of Radiology and Biomedical Imaging , New Haven , CT , USA ;,f U/S Imaging and Interventions (UII), Philips Research North America , Cambridge , MA , USA
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Comparison of C-arm Computed Tomography and Digital Subtraction Angiography in Patients with Chronic Thromboembolic Pulmonary Hypertension. Cardiovasc Intervent Radiol 2015; 39:53-63. [PMID: 25828726 DOI: 10.1007/s00270-015-1090-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the feasibility and diagnostic performance of contrast-enhanced, C-arm computed tomography (CACT) of the pulmonary arteries compared to digital subtraction angiography (DSA) in patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH). MATERIALS Fifty-two patients with CTEPH underwent ECG-gated DSA and contrast-enhanced CACT. Two readers (R1, R2) independently evaluated pulmonary artery segments and their sub-segmental branching using DSA and CACT for optimal image quality. Afterwards, the diagnostic findings, i.e., intraluminal filling defects, stenosis, and occlusion, were compared. Inter-modality and inter-observer agreement was calculated, and subsequently consensus reading was done and correlated to a reference standard representing the overall consensus of both modalities. Fisher's exact test and Cohen's Kappa were applied. RESULTS A total of 1352 pulmonary segments were evaluated, of which 1255 (92.8 %) on DSA and 1256 (92.9 %) on CACT were rated to be fully diagnostic. The main causes of the non-diagnostic image quality were motion artifacts on CACT (R1:37, R2:78) and insufficient contrast enhancement on DSA (R1:59, R2:38). Inter-observer agreement was good for DSA (κ = 0.74) and CACT (κ = 0.75), while inter-modality agreement was moderate (R1: κ = 0.46, R2: κ = 0.47). Compared to the reference standard, the inter-modality agreement for CACT was excellent (κ = 0.96), whereas it was inferior for DSA (κ = 0.61) due to the higher number of abnormal consensus findings read as normal on DSA. CONCLUSION CACT of the pulmonary arteries is feasible and provides additional information to DSA. CACT has the potential to improve the diagnostic work-up of patients with CTEPH and may be particularly useful prior to surgical or interventional treatment.
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Lee IJ, Chung JW, Yin YH, Kim HC, Kim YI, Jae HJ, Park JH. Cone-Beam Computed Tomography (CBCT) Hepatic Arteriography in Chemoembolization for Hepatocellular Carcinoma: Performance Depicting Tumors and Tumor Feeders. Cardiovasc Intervent Radiol 2015; 38:1218-30. [DOI: 10.1007/s00270-015-1055-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 01/08/2015] [Indexed: 12/14/2022]
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Kim HC. Role of C-arm cone-beam CT in chemoembolization for hepatocellular carcinoma. Korean J Radiol 2015; 16:114-24. [PMID: 25598679 PMCID: PMC4296258 DOI: 10.3348/kjr.2015.16.1.114] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 10/09/2014] [Indexed: 11/22/2022] Open
Abstract
With the advent of C-arm cone-beam computed tomography (CBCT), minimally-invasive procedures in the angiography suite made a new leap beyond the limitations of 2-dimensional (D) angiography alone. C-arm CBCT can help interventional radiologists in several ways with the treatment of hepatocellular carcinoma (HCC); visualization of small tumors and tumor-feeding arteries, identification of occult lesion and 3D configuration of tortuous hepatic arteries, assurance of completeness of chemoembolization, suggestion of presence of extrahepatic collateral arteries supplying HCCs, and prevention of nontarget embolization. With more improvements in the technology, C-arm CBCT may be essential in all kinds of interventional procedures in the near future.
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Affiliation(s)
- Hyo-Cheol Kim
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
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Lee IJ, Chung JW, Yin YH, Kim HC, Kim YI, Jae HJ, Park JH. Cone-Beam CT Hepatic Arteriography in Chemoembolization for Hepatocellular Carcinoma: Angiographic Image Quality and Its Determining Factors. J Vasc Interv Radiol 2014; 25:1369-79; quiz 1379-.e1. [DOI: 10.1016/j.jvir.2014.04.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 04/04/2014] [Accepted: 04/05/2014] [Indexed: 12/18/2022] Open
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Floridi C, Radaelli A, Abi-Jaoudeh N, Grass M, Lin M, Chiaradia M, Geschwind JF, Kobeiter H, Squillaci E, Maleux G, Giovagnoni A, Brunese L, Wood B, Carrafiello G, Rotondo A. C-arm cone-beam computed tomography in interventional oncology: technical aspects and clinical applications. Radiol Med 2014; 119:521-32. [PMID: 25012472 DOI: 10.1007/s11547-014-0429-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 06/16/2014] [Indexed: 12/12/2022]
Abstract
C-arm cone-beam computed tomography (CBCT) is a new imaging technology integrated in modern angiographic systems. Due to its ability to obtain cross-sectional imaging and the possibility to use dedicated planning and navigation software, it provides an informed platform for interventional oncology procedures. In this paper, we highlight the technical aspects and clinical applications of CBCT imaging and navigation in the most common loco-regional oncological treatments.
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Affiliation(s)
- Chiara Floridi
- Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy,
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Yu MH, Kim JH, Yoon JH, Kim HC, Chung JW, Han JK, Choi BI. Small (≤1-cm) Hepatocellular Carcinoma: Diagnostic Performance and Imaging Features at Gadoxetic Acid–enhanced MR Imaging. Radiology 2014; 271:748-60. [DOI: 10.1148/radiol.14131996] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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van den Hoven AF, Smits MLJ, de Keizer B, van Leeuwen MS, van den Bosch MAAJ, Lam MGEH. Identifying aberrant hepatic arteries prior to intra-arterial radioembolization. Cardiovasc Intervent Radiol 2014; 37:1482-93. [PMID: 24469409 DOI: 10.1007/s00270-014-0845-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Failing to identify aberrant hepatic arteries before radioembolization (RE) may compromise its treatment efficacy due to inadequate biodistribution of radioactive microspheres. The purpose of this study was to evaluate how often aberrant hepatic arteries were identified correctly in clinical practice, with computed tomography (CT), and during angiography in patients with liver tumors who received a workup for RE. METHODS The presence and vascularization pattern of aberrant (i.e., accessory and replaced) hepatic arteries was assessed on triphasic liver CT in 110 patients. Subsequently, radiological reports on CT and angiographic procedures were reviewed to determine whether aberrant hepatic arteries were identified correctly in clinical practice. The intrahepatic biodistribution of (99m)Tc-MAA and radioactive microspheres was assessed on SPECT/CT and PET/CT in all patients with unidentified aberrant hepatic arteries. RESULTS Thirty-seven of 110 patients (34%) had aberrant hepatic arteries. In 18 of 37 (49%) patients, the aberrant hepatic arteries were correctly identified on CT and in 32 of 37 (86%) during angiography. Aberrant right hepatic arteries were identified more frequently than aberrant left hepatic arteries on CT (54 vs. 44%) and during angiography (100 vs. 69%, p = 0.007). In five patients (14%), an aberrant left hepatic artery remained unidentified, resulting in a lack of (99m)Tc-MAA and (90)Y activity in the segmental territory of the unidentified aberrant hepatic arteries. CONCLUSIONS Aberrant left hepatic arteries were the most common unidentified aberrant hepatic arteries, resulting in incomplete radiation coverage. We formulated a practical approach to identify aberrant hepatic arteries correctly before RE.
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Affiliation(s)
- Andor F van den Hoven
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands,
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Role of C-Arm CT for Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma: Diagnostic Performance and Predictive Value for Therapeutic Response Compared With Gadoxetic Acid–Enhanced MRI. AJR Am J Roentgenol 2013; 201:675-83. [DOI: 10.2214/ajr.12.10445] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Image fusion of preprocedural CTA with real-time fluoroscopy to guide proper hepatic artery catheterization during transarterial chemoembolization of hepatocellular carcinoma: a feasibility study. Cardiovasc Intervent Radiol 2012; 36:526-30. [PMID: 23070106 DOI: 10.1007/s00270-012-0495-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 09/07/2012] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess feasibility of proper hepatic artery catheterization using a 3D model obtained from preprocedural computed tomographic angiography (CTA), fused with real-time fluoroscopy, during transarterial chemoembolization of hepatocellular carcinoma. METHODS Twenty consecutive cirrhotic patients with hepatocellular carcinoma undergoing transarterial chemoembolization were prospectively enrolled onto the study. The early arterial phase axial images of the preprocedural CTA were postprocessed on an independent workstation connected to the angiographic system (Innova 4100; GE Healthcare, Milwaukee, WI), obtaining a 3D volume rendering image (VR) that included abdominal aorta, splanchnic arteries, and first and second lumbar vertebrae. The VR image was manually registered to the real-time X-ray fluoroscopy, with the lumbar spine used as the reference. The VR image was then used as guidance to selectively catheterize the proper hepatic artery. The procedure was considered successful when performed with no need for intraarterial contrast injections or angiographic acquisitions. RESULTS The procedure was successful in 19 (95 %) of 20 patients. In one patient, celiac trunk angiography was required for the presence of a significant ostial stenosis that was underestimated at computed tomography. Time for image reconstruction and registration was <10 min in all cases. CONCLUSION The use of preprocedural CTA model with fluoroscopy enables confident and direct catheterization of the proper hepatic artery with no need for preliminary celiac trunk angiography, thus reducing radiation exposure and contrast media administration.
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Berman DP, Khan DM, Gutierrez Y, Zahn EM. The use of three-dimensional rotational angiography to assess the pulmonary circulation following cavo-pulmonary connection in patients with single ventricle. Catheter Cardiovasc Interv 2012; 80:922-30. [DOI: 10.1002/ccd.23461] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 10/31/2011] [Indexed: 11/06/2022]
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Higashihara H, Osuga K, Onishi H, Nakamoto A, Tsuboyama T, Maeda N, Hori M, Kim T, Tomiyama N. Diagnostic accuracy of C-arm CT during selective transcatheter angiography for hepatocellular carcinoma: comparison with intravenous contrast-enhanced, biphasic, dynamic MDCT. Eur Radiol 2011; 22:872-9. [PMID: 22120061 DOI: 10.1007/s00330-011-2324-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 09/05/2011] [Accepted: 09/20/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE This study was aimed to compare the accuracy, sensitivity, and positive predictive value of C-arm CT (CACT) during selective transcatheter angiography with those of multidetector CT (MDCT) in the detection of hepatocellular carcinoma (HCC). MATERIAL AND METHODS In this prospective study, 30 patients (mean age, 73 years) with unresectable HCC were examined with CACT before chemoembolisation. Images of a combination of CACT during arterial portography (CACTAP) and dual-phase CACT during hepatic arteriography (CACTHA) was obtained and images of intravenous contrast-enhanced, biphasic, dynamic, MDCT was also obtained beforehand. Three blinded observers independently reviewed CACT and MDCT. Diagnostic accuracy was evaluated by the alternative free-response receiver operating characteristic (AFROC) method. Sensitivities and positive predictive values (PPV) were analyzed with the paired t-test. RESULTS In the mean area under the AFROC curve (Az), there was no significant difference between MDCT and CACT (MDCT, mean Az value, 0.83; CACT, 0.85, respectively) (P = 0.32). There was also no significant difference between the two techniques in sensitivity (MDCT, mean 0.65; CACT, 0.60) and PPV (MDCT, mean 0.98; CACT, 0.97) (P = 0.40, P = 0.68, respectively). CONCLUSION The diagnostic accuracy of CACT was equivalent to that of biphasic CT in the diagnosis of HCC. KEY POINTS C-arm CT helps detection of hepatocellular carcinoma (HCC) during interventional (TACE) treatment. C-arm CT for HCC seemed just as accurate as biphasic CT. TACE can be performed with greater confidence using C-arm CT.
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Affiliation(s)
- Hiroki Higashihara
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Glatz AC, Zhu X, Gillespie MJ, Hanna BD, Rome JJ. Use of angiographic CT imaging in the cardiac catheterization laboratory for congenital heart disease. JACC Cardiovasc Imaging 2011; 3:1149-57. [PMID: 21071003 DOI: 10.1016/j.jcmg.2010.09.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 08/26/2010] [Accepted: 09/16/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to retrospectively evaluate our initial experience using angiographic computed tomography (ACT) in a pediatric cardiac catheterization laboratory. BACKGROUND ACT provides cross-sectional CT images from a rotational angiography run using a C-arm mounted flat-panel detector in the interventional suite. A 3-dimensional (3D) angiographic image can be created from the CT volume set and used in real time during the procedure. To our knowledge, its use has never previously been described for congenital heart disease. METHODS 3D reconstructions were created and we retrospectively reviewed cases during our first year of ACT use. Images obtained were independently evaluated to determine their diagnostic utility. Radiation dose reduction protocols were defined using phantom testing and radiation dose calculation. RESULTS ACT was used during 41 cardiac catheterizations in patients at a median age of 5.1 years (range: 0.4 to 58.8 years) for evaluation of: right ventricular outflow tract (RVOT)/central pulmonary arteries (PAs) in 20; cavopulmonary connection (CPC) in 11; pulmonary veins in 5; distal PAs in 4; and other locations in 5. Four subjects had 2 anatomic areas studied by ACT. The mean contrast volume for ACT was 1.2 ± 0.4 ml/kg. Diagnostic-quality imaging was obtained in 71% of cases: 13/20 RVOT/central PAs; 9/11 CPC; 4/5 pulmonary veins; 2/4 distal PAs; and 4/5 others. In 12 cases, ACT contributed to clinical outcomes beyond standard angiography. Radiation dose reduction protocols allowed ACT to be comparable in exposure to a standard biplane cineangiogram. CONCLUSIONS Diagnostic-quality imaging can be obtained using ACT in 71% of cases without a significant increase in contrast or radiation exposure. In certain cases, ACT provides additional anatomic detail and may aid complex catheter manipulations. Future work is needed to continue to define applications of this new technology.
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Affiliation(s)
- Andrew C Glatz
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
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Sunderkötter C, Eickelmann M, Köhler M, Schmittel A, Wacker FK. Remission of extensive intrahepatic metastasis by C-arm computed tomography guided chemoembolization in uveal melanoma. J Dtsch Dermatol Ges 2009; 8:525-8. [PMID: 19922465 DOI: 10.1111/j.1610-0387.2009.07295.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As soon as uveal melanoma has metastasized to the liver, response rates to systemic chemotherapy are low. It can be improved by development of special locoregional procedures. A 24-year-old woman suffered from inoperable hepatic metastases which grew to life-endangering size despite both systemic chemotherapy with gemcitabine/treosulfan and conventional intrahepatic chemoembolization with fotemustine and starch particles. We subsequently performed two angiographic C-arm CT-guided, superselective chemoembolizations of the hepatic arteries feeding the tumor, using cisplatin, starch microspheres and ethiodized oil. Following this treatment, no vital tumor tissue was detectable by MRI. This remission lasted for more than 6 months and the patient's quality of life was good. A subsequent local relapse could not be treated with chemoembolization because of thrombosis of the portal vein due to tumor compression. And the patient died 20 months after first detection of metastases. However, the selective angiographic C-arm CT-guided chemoembolization resulted in prolongation of life with good quality despite the advanced stage of the disease.
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Affiliation(s)
- Cord Sunderkötter
- Clinic for Dermatology, University Hospital of Münster, Münster, Germany
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Becker HC, Meissner O, Waggershauser T. C-Bogen-CT-unterstützte 3D-Navigation perkutaner Interventionen. Radiologe 2009; 49:852-5. [DOI: 10.1007/s00117-009-1866-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wacker FK, Meissner OA, Meyer BC. [C-arm CT for planning and guidance of extrahepatic embolizations]. Radiologe 2009; 49:842-7. [PMID: 19697003 DOI: 10.1007/s00117-009-1864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Interventional radiological vascular embolizations are complex procedures that require exact imaging of the target region to facilitate safe and effective treatment. The purpose of this paper is to present the technique and feasibility of flat detector C-arm computed tomography (C-arm CT) for control and guidance of extrahepatic abdominal embolization procedures. C-arm CT images can provide important information on both vascular and cross-sectional anatomy of the target region, help in determining therapy endpoints and provide follow-up during and immediately after the abdominal interventions.The cases presented demonstrate that C-arm CT images are beneficial for abdominal embolization procedures and facilitate precise treatment.
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Affiliation(s)
- F K Wacker
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Johns Hopkins Outpatient Center, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287-0851, USA.
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