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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical ImagingAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Management of acute lower gastrointestinal bleeding.Tech Vasc Interv Radiol. 2017; 20: 258-262
- Endovascular therapy of gastrointestinal bleeding.Rofo. 2019; 191: 1073-1082
- AGA clinical practice update on endoscopic therapies for non-variceal upper gastrointestinal bleeding: expert review.Gastroenterology. 2020; 159: 1120-1128
- Empiric cone-beam CT-guided embolization in acute lower gastrointestinal bleeding.Eur Radiol. 2020; 314 (2020): 2161-2172
- Clinical variables associated with positive angiographic localization of lower gastrointestinal bleeding.ANZ J Surg. 2005; 75: 953-957
- Outcome of acute nonvariceal gastrointestinal haemorrhage after nontherapeutic arteriography compared with embolization.Eur Radiol. 2003; 13: 2604-2614
- Empiric transcatheter embolization for acute arterial upper gastrointestinal bleeding: a meta-analysis.AJR Am J Roentgenol. 2021; 216: 880-893
- Superselective microcoil embolization of colonic hemorrhage.Am J Roentgenol. 2001; 177: 829-836
- C-arm cone-beam CT: general principles and technical considerations for use in interventional radiology.J Vasc Interv Radiol. 2008; 19: 814-820
- A systematic review of automated feeder detection software for locoregional treatment of hepatic tumors.Diagn Interv Imaging. 2020; 101: 439-449
- R: a language and environment for statistical computing.R Foundation for Statistical Computing, 2021
- Cone beam computed tomography improves the detection of injured vessels and involved vascular territories in patients with bleeding of uncertain origin.Br J Radiol. 2018; (Epub ahead of print): 91https://doi.org/10.1259/BJR.20170562
- Usefulness of cone-beam computed tomography and automatic vessel detection software in emergency transarterial embolization.Cardiovasc Interv Radiol. 2015; 394 (2015): 530-537
- Feasibility of using vessel-detection software for the endovascular treatment of visceral arterial bleeding.Diagn Interv Radiol. 2014; 20: 160-163
Article info
Publication history
Published online: December 07, 2022
Accepted:
November 28,
2022
Received in revised form:
November 9,
2022
Received:
August 14,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
