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

Area of Science:

• Interventional Radiology
• Medical Imaging
• Oncology

Background:

• Selective renal artery embolization (SRAE) is a key treatment for renal cell carcinoma (RCC).
• Accurate pre-procedural imaging is crucial for guiding SRAE and optimizing outcomes.
• Traditional imaging methods may have limitations in visualizing complex renal vasculature.

Purpose of the Study:

• To compare the efficacy of four-dimensional computed tomography angiography (4D-CTA) versus three-dimensional computed tomography angiography (3D-CTA) in guiding SRAE for RCC.
• To evaluate the impact of 4D-CTA on procedural efficiency, including digital subtraction angiography (DSA) runs and contrast volume.
• To assess the success rate of automated feeder detection (AFD) using 4D-CTA.

Main Methods:

• A retrospective study of 111 patients (114 RCCs) undergoing SRAE before cryoablation.
• Patients were divided into two groups: 3D-CTA (n=69) and 4D-CTA (n=42).
• 4D-CTA utilized a volumetric scan with multiple phases and maximum intensity projection for renal artery mapping, aiming for higher AFD success.

Main Results:

• 4D-CTA group had higher AFD success rates (84.1% vs 15.7%) and independently predicted fewer DSA runs and lower contrast volume.
• Median DSA runs were reduced from 5 to 2, and contrast volume decreased from 71.5 mL to 29 mL with 4D-CTA (P < .001).
• Procedure duration and radiation doses were similar, and renal function was maintained in both cohorts.

Conclusions:

• 4D-CTA offers superior automated feeder detection compared to 3D-CTA for pre-ablation RCC embolization.
• The use of 4D-CTA significantly reduces the need for DSA runs and contrast agent administration.
• 4D-CTA enables time-resolved vascular mapping, improving guidance for SRAE and potentially enhancing patient safety.