Possible use of digital variance angiography in uterine fibroid embolization: a retrospective observational study

Digital variance angiography (DVA), a recently developed image processing technology, provides a higher contrast-to-noise ratio (CNR) and better image quality during lower limb interventions than digital subtraction angiography (DSA). Our aim was to investigate whether the quality reserve of DVA can also be observed in uterine fibroid embolization (UFE).

In this retrospective observational study, the CNR and image quality of DSA and DVA images from 56 patients (mean ± standard deviation age: 44.2 ± 5.3 years) who underwent UFE at our institution were assessed. For the visual evaluation of the same image pairs, the visibility of large vessels, small vessels, tissue blush, and background noise was compared by three experienced readers using a four-grade Likert scale. Data were analyzed using the Wilcoxon signed-rank test or the one-sample Wilcoxon test.

DVA provided significantly higher CNR than DSA (the median CNR_DVA/CNR_DSA was 1.96). In the visual comparison of DVA and DSA images, Likert scores did not significantly differ from zero (equal quality level) in any evaluated categories. The median (interquartile range) values were 0.00 (1.00) for large vessels, -0.33 (1.33) for small vessels, 0.00 (0.67) for tissue blush, and 0.00 (0.75) for background noise.

Although the visual image quality of DSA and DVA was identical, DVA provided a twofold CNR in UFE, indicating a significant quality advantage for this technology.

The observed quality reserve may allow for dose management (reduction of applied radiation dose and/or contrast media), enhancing the safety of UFE for both patients and personnel.