A Quantitative Digital Subtraction Angiography Technique for Characterizing Reduction in Hepatic Arterial Blood Flow Dur
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LABORATORY INVESTIGATION
EMBOLISATION (ARTERIAL)
A Quantitative Digital Subtraction Angiography Technique for Characterizing Reduction in Hepatic Arterial Blood Flow During Transarterial Embolization Sarvesh Periyasamy1,4 • Carson A. Hoffman2 • Colin Longhurst3 • Georgia C. Schefelker4 • Orhan S. Ozkan4 • Michael A. Speidel2 • Paul F. Laeseke4
Received: 6 May 2020 / Accepted: 27 August 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
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.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00270-020-02640-0) contains supplementary material, which is available to authorized users. & Sarvesh Periyasamy [email protected] 1
Department of Biomedical Engineering, University of Wisconsin – Madison, 1310-C WIMR, 1111 Highland Avenue, Madison, WI 53705, USA
2
Department of Medical Physics, University of Wisconsin – Madison, Madison, WI, USA
3
4
Department of Biostatistics and Medical Informatics, University of Wisconsin – Madison, Madison, WI, USA Department of Radiology, University of Wisconsin – Madison, Madison, WI, USA
Results Blood flow velocities calculated using qDSA showed a statistically significant difference (p \ 0.01) between partial- and sub-stasis endpoints, whereas time-topeak 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-le
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