A Quantitative Digital Subtraction Angiography Technique for Characterizing Reduction in Hepatic Arterial Blood Flow During Transarterial Embolization

Objective There is no standardized and objective method for determining the optimal treatment endpoint (sub-stasis) during transarterial embolization. The objective of this study was to demonstrate the feasibility of using a quantitative digital subtraction angiography (qDSA) technique to characteri...

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Published in:	Cardiovascular and interventional radiology Vol. 44; no. 2; pp. 310 - 317
Main Authors:	Periyasamy, Sarvesh, Hoffman, Carson A., Longhurst, Colin, Schefelker, Georgia C., Ozkan, Orhan S., Speidel, Michael A., Laeseke, Paul F.
Format:	Journal Article
Language:	English
Published:	New York Springer US 01-02-2021 Springer Nature B.V
Subjects:	Angiography Angiography, Digital Subtraction - methods Animals Blood flow Blood Flow Velocity - physiology Cardiology Chemoembolization Correlation Embolisation (arterial) Embolization Embolization, Therapeutic - methods Evaluation Studies as Topic Feasibility Studies Flow velocity Hepatic Artery - diagnostic imaging Hepatic Artery - physiopathology Histopathology Imaging In vivo methods and tests Ischemia Laboratory Investigation Liver Liver cancer Livestock Medical imaging Medicine Medicine & Public Health Nuclear Medicine Particle density (concentration) Radiology Statistical analysis Swine Tissue analysis Tissues Ultrasound Time-to-peak (TTP) Transarterial chemoembolization (TACE) 2D digital subtraction angiography (DSA) Hepatocellular carcinoma (HCC) Quantitative digital subtraction angiography (qDSA) Time–attenuation curve (TAC) Transarterial embolization (TAE) Color-coded digital subtraction angiography (ccDSA)
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Summary:	Objective There is no standardized and objective method for determining the optimal treatment endpoint (sub-stasis) during transarterial embolization. The objective of this study was to demonstrate the feasibility of using a quantitative digital subtraction angiography (qDSA) technique to characterize intra-procedural changes in hepatic arterial blood flow velocity in response to transarterial embolization in an in vivo porcine model. Materials and Methods Eight domestic swine underwent bland transarterial embolizations to partial- and sub-stasis angiographic endpoints with intraprocedural DSA acquisitions. Embolized lobes were assessed on histopathology for ischemic damage and tissue embolic particle density. Analysis of target vessels used qDSA and a commercially available color-coded DSA (ccDSA) tool to calculate blood flow velocities and time-to-peak, respectively. Results Blood flow velocities calculated using qDSA showed a statistically significant difference ( p < 0.01) between partial- and sub-stasis endpoints, whereas time-to-peak calculated using ccDSA did not show a significant difference. During the course of embolizations, the average correlation with volume of particles delivered was larger for qDSA (− 0.86) than ccDSA (0.36). There was a statistically smaller mean squared error ( p < 0.01) and larger coefficient of determination ( p < 0.01) for qDSA compared to ccDSA. On pathology, the degree of embolization as calculated by qDSA had a moderate, positive correlation ( p < 0.01) with the tissue embolic particle density of ischemic regions within the embolized lobe. Conclusions qDSA was able to quantitatively discriminate angiographic embolization endpoints and, compared to a commercially available ccDSA method, improve intra-procedural characterization of blood flow changes. Additionally, the qDSA endpoints correlated with tissue-level changes.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	0174-1551 1432-086X
DOI:	10.1007/s00270-020-02640-0