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Utility of CBCT and AVD for intraprocedural diagnosis and treatment of lower GI bleeding

Published:December 07, 2022DOI:https://doi.org/10.1016/j.clinimag.2022.11.016

      Highlights

      • CBCT is useful in the intraprocedural detection of LGIB when DSA is indeterminate.
      • Use of CBCT increases sensitivity and changed management by IR without significant changes in dose or evidence of off target embolization.
      • Use of CBCT to increase sensitivity for LGIB is thus safe, feasible and effective.
      • Use of AVD software can increase operator confidence when identifying feeding vessels for empiric treatment.

      Abstract

      Background

      Intraprocedural Cone Beam CT (CBCT) is assessed to examine if use improves diagnosis and embolization rates of acute lower GI bleed (LGIB) and if automatic vessel detection (AVD) software can identify feeding vessels (FV) for embolization.

      Methods

      Patients with inconclusive DSA findings had CBCT and retrospective analysis with AVD software (Innova 3100, GE Company, USA). Technical success was defined as the ability to detect a lower GIB site while clinical success was defined as successful embolization without evidence of rebleeding or death within 30 days. AVD technical success was defined by the ability to identify the FV on both CTA and CBCT upon independent review by 3 blinded IRs, who also assigned a degree of certainty on a 5-point Likert scale.

      Results

      74 patients in total were treated for lower GI bleed of which 34 had indeterminate DSA. Of those, 10 patients received DSA only, of which 1 was super selective. 24 patients with GIB on pre-procedural CTA and inconclusive DSA underwent CBCT. Use of CBCT identified 9 bleeds not seen on DSA and an additional source artery in 1 case representing a 42% change in intraprocedural management as all findings were embolized. When a bleed could not be identified on CBCT, but the FV could be identified on CTA, the same suspected FV could be selected on AVD 62% of the time with an average certainty of 4.0.

      Conclusion

      CBCT is useful in the intraprocedural detection of GIB when DSA is indeterminate. Furthermore, AVD software can feasibly be utilized to accurately identify FVs for empiric treatment when intraprocedural imaging is inconclusive.

      Level of evidence

      Level III, therapeutic study.

      Keywords

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