C-Arm Cone Beam CT for Intraprocedural Image Fusion and 3D Guidance in Portal Vein Embolization (PVE)
- Charité, Humboldt-University Medical School, Department of Radiology (Germany)
- Yale School of Medicine, Department of Radiology and Biomedical Imaging (United States)
- Charité, Humboldt-University Medical School, Department of Surgery (Germany)
PurposePortal vein embolization (PVE) is applied in patients with extended oncologic liver disease to induce hyperplasia of the future liver remnant and make resection feasible. Ultrasound (US) guidance is the gold standard for percutaneous portal vein access. This study evaluated feasibility and safety of C-arm cone beam computed tomography (CBCT) for needle guidance.Materials and MethodsIn 10 patients, puncture was performed under 3D needle guidance in a CBCT data set. Contrast-enhanced (CE) CBCT was generated (n = 7), or native CBCT was registered to pre-examination CE-CT via image fusion (n = 3). Technical success, number of punctures, puncture time (time between CBCT acquisition and successful portal vein access), dose parameters and safety were evaluated. For comparison, 10 patients with PVE under US guidance were analyzed retrospectively. Study and control group were matched for age, BMI, INR, platelets, portal vein anatomy.ResultsAll interventions were technically successful without intervention-related complications. In the study group, the mean number of puncture attempts was 3.1 ± 2.5. Mean puncture time was 12 min (±10). Mean total dose area product (DAP) was 288 Gy cm{sup 2} (±154). The mean relative share of CBCT-related radiation exposure was 6% (±3). Intervention times and DAP were slightly higher compared to the control group without reaching significance.ConclusionCBCT-guided PVE is feasible and safe. The relative dose of CBCT is low compared to the overall dose of the intervention. This technique may be a promising approach for difficult anatomic situations that limit the use of US for needle guidance.
- OSTI ID:
- 22756196
- Journal Information:
- Cardiovascular and Interventional Radiology, Vol. 41, Issue 3; Other Information: Copyright (c) 2018 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Article Copyright (c) 2017 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA); ISSN 0174-1551
- Country of Publication:
- United States
- Language:
- English
Similar Records
Three-dimensional Image Fusion Guidance for Transjugular Intrahepatic Portosystemic Shunt Placement
Image Registration of Cone-Beam Computer Tomography and Preprocedural Computer Tomography Aids in Localization of Adrenal Veins and Decreasing Radiation Dose in Adrenal Vein Sampling