Sarvesh Periyasamy1,2, Carson A Hoffman3, Colin Longhurst4, Georgia C Schefelker5, Orhan S Ozkan5, Michael A Speidel3, Paul F Laeseke5. 1. Department of Biomedical Engineering, University of Wisconsin - Madison, 1310-C WIMR, 1111 Highland Avenue, Madison, WI, 53705, USA. periyasamy@wisc.edu. 2. Department of Radiology, University of Wisconsin - Madison, Madison, WI, USA. periyasamy@wisc.edu. 3. Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA. 4. Department of Biostatistics and Medical Informatics, University of Wisconsin - Madison, Madison, WI, USA. 5. Department of Radiology, University of Wisconsin - Madison, Madison, WI, USA.
Abstract
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.
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.
Entities:
Keywords:
2D digital subtraction angiography (DSA); Color-coded digital subtraction angiography (ccDSA); Hepatocellular carcinoma (HCC); Quantitative digital subtraction angiography (qDSA); Time-to-peak (TTP); Time–attenuation curve (TAC); Transarterial chemoembolization (TACE); Transarterial embolization (TAE)
Authors: Carson Hoffman; Sarvesh Periyasamy; Colin Longhurst; Rafael Medero; Alejandro Roldan-Alzate; Michael A Speidel; Paul F Laeseke Journal: CVIR Endovasc Date: 2021-01-07