Transcatheter 4-Dimensional versus 3-Dimensional Computed Tomography Angiography to Guide Selective Arterial...

To compare transcatheter 4-dimensional (4D) and 3-dimensional (3D) computed tomography (CT) angiography for guiding selective renal artery embolization (SRAE).

This retrospective, single-center study included 111 patients (114 clear cell renal cell carcinomas [RCCs]) who underwent SRAE before cryoablation (2018-2025). Based on available angio-CT systems, 69 patients (70 tumors) underwent 3D CT angiography (6-second single-phase helical scan), and 42 (44 tumors) underwent 4D CT angiography (4.55-second volumetric scan, 13 continuous phases; up to 5 intermittent if feasible). On 4D CT angiography, 4D maximum intensity projection replaced digital subtraction angiography (DSA) for renal artery mapping. Intraprocedural automated feeding artery detection (AFD) was performed; success was defined as identifying all reference-standard feeding arteries without false positives. Outcomes were evaluated using univariable and multivariable analyses.

Four-dimensional CT angiography patients were older (mean, 75.3 vs 68.4 years) and had lower estimated glomerular filtration rate (55 vs 65.6 mL/min/1.73 m², both P < .01). Compared with 3D CT angiography, 4D CT angiography reduced median DSA runs (2 vs 5) and contrast volume (29 vs 71.5 mL, both P < .001), with similar procedure duration and acceptable radiation doses. AFD success was higher (84.1% vs 15.7%, P < .001) with optimized phase selection. Four-dimensional CT angiography independently predicted fewer DSA runs (β = -3.229) and lower contrast volume (β = -44.745) and was associated with higher AFD success (odds ratio, 41.46) (all P < .001). Renal function was maintained in both cohorts.

Four-dimensional CT angiography showed higher AFD success and enabled time-resolved vascular mapping, with fewer DSA runs and lower contrast volume during preablation RCC embolization.