Angiography-Based C-Arm CT for the Assessment of Extrahepatic Shunting before Radioembolization

 

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Zusammenfassung

Ziel: Beurteilung der Genauigkeit der Rotationsangiografie für die Detektion extrahepatischer Shunts vor Radioembolisation. Material und Methoden: 30 Patienten (Durchschnittsalter 64 ± 12 Jahre) mit hypervaskularisierten Lebertumoren wurden angiografiert; es wurden alle arteriellen gastrointestinalen Kollateralen des hepatischen Gefäßsystems coilembolisiert und die Mikrokatheterpositionen für die spätere SIRT festgelegt. Aus diesen 48 Positionen wurde eine Angiografie und Rotationsangiografie (XperCT®, Philips Healthcare) durchgeführt. Danach erhielten alle Patienten eine 99mTc-MAA-SPECT/CT. Die SPECT/CT diente als Referenzstandard zur Ermittlung der Genauigkeit der hepatischen Angiografie und der Rotationsangiografie für die Detektion extrahepatischer Shunts. Ergebnisse: Die SPECT/CT wies bei 5 Patienten extrahepatische Shunts nach (17 %). Bzgl. der Detektion extrahepatischer Shunts war die hepatische Angiografie bei 22 (73 %) Patienten richtig negativ, bei 5 (17 %) falsch negativ und bei 3 Patienten (10 %) unklar. Die Rotationsangiografie war richtig positiv bei 3 (10 %), richtig negativ bei 24 (80 %), falsch positiv bei 1 (3 %) und falsch negativ bei 2 Patienten (7 %). Die Spezifität und der NPV der Angiografie betrug 88 % bzw. 81 % die Sensitivität, Spezifität, der PPV, der NPV und die Genauigkeit der Rotationsangiografie betrugen 60 %, 96 %, 75 %, 92 % und 90 %. Schlussfolgerung: Die Rotationsangiografie bietet zusätzliche Informationen zur Angiografie bei der Detektion extrahepatischer Shunts vor SIRT. Aufgrund der genaueren Detektion extrahepatischer Shunts kann der Einsatz der Rotationsangiografie den Arbeitsablauf vor einer SIRT durch die Vermeidung unnötiger Reangiografien optimieren.

Abstract

Purpose: To retrospectively assess the accuracy of angiography-based C-arm CT for the detection of extrahepatic shunting before SIRT. Materials and Methods: 30 patients (mean age: 64 ± 12 years) with hypervascularized hepatic tumors underwent hepatic angiography, coil embolization of gastrointestinal collaterals and 99mTc-macroaggregated albumin (MAA) SPECT/CT before SIRT. Before MAA injection via a microcatheter from the intended treatment position, an angiography and angiography-based C-arm CT (XperCT™, Philips Healthcare) were acquired. Angiographies and XperCT™ were performed from 48 microcatheter positions followed by MAA injections and MAA-SPECT/CT. MAA-SPECT/CT served as the reference standard for determining the accuracy of hepatic arteriography and C-arm CT for the detection of extrahepatic shunting. Results: MAA-SPECT/CT revealed extrahepatic shunting in 5 patients (17 %). Hepatic arteriography yielded a true negative in 22 (73 %), a false negative in 5 (17 %), and an unclear result in 3 patients (10 %). C-arm CT yielded a true positive in 3 (10 %), true negative in 24 (80 %), false positive in 1 (3 %), and false negative in 2 patients (7 %). The specificity and the NPV of hepatic arteriography for the detection of extrahepatic shunting were 88 % and 81 %, respectively. For C-arm CT the sensitivity, specificity, PPV, NPV, and accuracy for the detection of extrahepatic shunting were 60 %, 96 %, 75 %, 92 %, and 90 %, respectively. Conclusion: C-arm CT offers additional information to angiography when assessing SIRT patients for extrahepatic shunting. More accurate detection of extrahepatic shunting may optimize the workflow in SIRT preparations by avoiding unnecessary repeat angiographies.

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Dr. Till Alexander Heusner

Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinik Essen

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