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Balloon pulmonary angioplasty: applicability of C-Arm CT for procedure guidance

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Abstract

Purpose

To investigate the feasibility of and compare two C-Arm CT (CACT) guidance methods during balloon pulmonary angioplasty (BPA).

Material and methods

Forty-two BPAs [27 CTEPH patients (nine males, 70 ± 14y)] targeting 143 pulmonary arteries were included. Twenty-two BPAs were guided by contrast-enhanced CACT acquired immediately before BPA (G3D). In another 20 BPAs (G2D), two orthogonal fluoroscopy images of the chest where acquired to compute a registration of a previously acquired CACT. Volume rendering-based graphic representations (VRT guidance) were generated indicating the origin and course of the vessels. Based on VRT guidance, the intervention was planned. Procedure durations and radiation exposure data were compared between the two groups (Wilcoxon test).

Results

The overall intervention time was approximately 2 h in both groups (p = 0.31). BPA was successfully performed in G3D 91 % and G2D 94 %. No significant difference was found concerning the mean dose area product (DAP) related to fluoroscopy (p = 0.38), while DAP related to DSA was slightly higher in G3D (p = 0.048). Overall, DAP was significantly higher in G3D (p = 0.002).

Conclusions

The use of CACT for procedure guidance in patients undergoing BPA is feasible and accurate. Image fusion of a pre-acquired CACT can be used to decrease radiation exposure due to multiple BPA sessions.

Key Points

• BPA guidance by CACT overlay is feasible and safe.

• 2D3D image fusion for BPA guidance is accurate.

• Image fusion can reduce patient radiation dose due to repeated BPA sessions.

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Acknowledgments

The scientific guarantor of this publication is Bernhard Meyer. The authors of this manuscript declare relationships with the following companies: Siemens Healthcare (Bernhard Meyer, Frank Wacker; outside the submitted work); Bayer (Marius Hoeper; outside the submitted work). The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the Institutional Review Board. None study subjects or cohorts have been previously reported. Methodology: retrospective, experimental, intra-individual comparison, performed at one institution.

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Authors and Affiliations

  1. Department for Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany

    Jan B. Hinrichs, Julius Renne, Frank K. Wacker & Bernhard C. Meyer

  2. Clinic for Pneumology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany

    Marius M. Hoeper & Karen M. Olsson

  3. Hannover Medical School, Institute for Diagnostic and Interventional Radiology, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Jan B. Hinrichs

Authors
  1. Jan B. Hinrichs
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  2. Julius Renne
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  3. Marius M. Hoeper
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  4. Karen M. Olsson
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  5. Frank K. Wacker
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  6. Bernhard C. Meyer
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Corresponding author

Correspondence to Jan B. Hinrichs.

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Disclosures in detail

Jan Hinrichs: nothing to disclose

Julius Renne: nothing to disclose

Marius Hoeper: Fees from Actelion, personal fees from Bayer, personal fees from GSK, personal fees from Pfizer, outside the submitted work.

Karen Olsson: nothing to disclose

Frank Wacker: Grants from Siemens Healthcare, grants from DFG, Rebirth-Cluster of Excellence, grants from BMBF, German Centre for Lung Research (DZL), grants from Promedicus Ltd., outside the submitted work

Bernhard Meyer: Grants from Siemens Healthcare during the conduct of the study, outside the submitted work; grants from Promedicus Ltd., outside the submitted work.

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Hinrichs, J.B., Renne, J., Hoeper, M.M. et al. Balloon pulmonary angioplasty: applicability of C-Arm CT for procedure guidance. Eur Radiol 26, 4064–4071 (2016). https://doi.org/10.1007/s00330-016-4280-z

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  • DOI: https://doi.org/10.1007/s00330-016-4280-z

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