CO 2 -based C-arm computed tomography (CACT) of the pelvic arteries: feasibility and diagnostic performance in comparison to CO 2 -angiography in patients with peripheral arterial disease
Restricted accessResearch articleFirst published online 2020
CO 2 -based C-arm computed tomography (CACT) of the pelvic arteries: feasibility and diagnostic performance in comparison to CO 2 -angiography in patients with peripheral arterial disease
Patients with substantially impaired kidney function and peripheral arterial disease (PAD) underwent comparative CO2-based depiction of the pelvic arteries (PAs).
Purpose
To evaluate the feasibility and diagnostic performance of CO2-based C-arm computed tomography (CACT) and compare its depiction of PAs with CO2-digital subtraction angiography (DSA).
Material and Methods
Fifteen patients (10 men, mean age 70 ± 11 years) with PAD received CO2-DSA and CO2-CACT of the PAs, depicted from the aorta to femoral arteries. These were divided into nine segments (135 in total) and graded by two independent readers for image quality (IQ; 1 = sufficient, 2 = minimal impairments, 3 = insufficient, 4 = outside field of view) and subsequent stenosis grading (SG; grade 1: normal to grade 4: occlusion), under exclusion of all segments with insufficient IQ. Inter-observer and inter-modality agreement calculation and subsequent consensus reading were performed and correlated to a standard of reference (StOR), representing a modality consensus.
Results
Of 135 segments, 117 showed sufficient IQ, excluding 18 segments (10 CACT, 8 DSA). Inter-observer agreement for IQ and consecutive SG demonstrated good to excellent agreement: IQDSA: κ = 0.83, IQCACT: κ = 0.76; StenosisDSA: κ = 0.71, StenosisCACT: κ = 0.84. Inter-modality agreement for SG lay at κ = 0.76 and κ = 0.65, respectively. More stenoses could be detected by CACT, and analysis of pooled consensus values of SG in CACTcons versus StOR showed an excellent agreement (κ = 0.96) that proved considerably higher than the moderate agreement between consensus values in DSAcons versus StOR (κ = 0.43).
Conclusion
CO2-CACT proved feasible, and has the potential to optimize angiographic work-up of PAD in patients with contraindications for other contrast media.
DuaALeeCJ.Epidemiology of peripheral arterial disease and critical limb ischemia. Tech Vasc Interv Radiol2016;
19:91–95.
2.
StegemannETegtmeierCBimpong-ButaNY, et al.
Carbondioxide-aided angiography decreases contrast volume and preserves kidney function in peripheral vascular interventions. Angiology2016;
67:875–881.
3.
PalenaLMDiaz-SandovalLJCandeoA, et al.
Automated carbon dioxide angiography for the evaluation and endovascular treatment of diabetic patients with critical limb ischemia. J Endovasc Ther2016;
23:40–48.
4.
MalyarNFurstenbergTWellmannJ, et al.
Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease: a nationwide population-based analysis. Eur Heart J2013;
34:2706–2714.
5.
ArendtCTLeithnerDLengaL, et al.
Multi-observer comparison study between unenhanced quiescent-interval single-shot magnetic resonance angiography and invasive carbon dioxide angiography in patients with peripheral arterial disease and chronic renal insufficiency. Eur J Radiol2018;
108:140–146.
6.
GuptaADosekunAKKumarV.Carbon dioxide-angiography for patients with peripheral arterial disease at risk of contrast-induced nephropathy. World J Cardiol2020;
12:76–90.
7.
GhummanSSWeinermanJKhanA, et al.
Contrast induced-acute kidney injury following peripheral angiography with carbon dioxide versus iodinated contrast media: A meta-analysis and systematic review of current literature. Catheter Cardiovasc Interv2017;
90:437–448.
8.
McCulloughPAWolynRRocherLL, et al.
Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med1997;
103:368–375.
9.
RashidSTSalmanMMyintF, et al.
Prevention of contrast-induced nephropathy in vascular patients undergoing angiography: a randomized controlled trial of intravenous N-acetylcysteine. J Vasc Surg2004;
40:1136–1141.
10.
AspelinPStaculFThomsenHS, et al.
Effects of iodinated contrast media on blood and endothelium. Eur Radiol2006;
16:1041–1049.
HawkinsIFChoKJCaridiJG.Carbon dioxide in angiography to reduce the risk of contrast-induced nephropathy. Radiol Clin North Am2009;
47:813–825, v–vi.
13.
NadolskiGJStavropoulosSW.Contrast alternatives for iodinated contrast allergy and renal dysfunction: options and limitations. J Vasc Surg2013;
57:593–598.
14.
SharafuddinMJMarjanAE.Current status of carbon dioxide angiography. J Vasc Surg2017;
66:618–637.
15.
BackMRCaridiJGHawkinsIFJr, et al.
Angiography with carbon dioxide (CO2). Surg Clin North Am1998;
78:575–591.
16.
KesselDORobertsonIPatelJT, et al.
Carbon-dioxide-guided vascular interventions: technique and pitfalls. Cardiovasc Intervent Radiol2002;
25:476–483.
17.
KernsSRHawkinsIFJr.Carbon dioxide digital subtraction angiography: expanding applications and technical evolution. AJR Am J Roentgenol1995;
164:735–741.
18.
AlbrichHGmeinwieserJMankeC, et al.
[Transfemoral pelvic vein angiography with CO2: experiences with pressure- and volume-controlled injections]. Rofo1999;
170:384–390.
19.
FontaineRKimMKienyR.[Surgical treatment of peripheral circulation disorders].Helv Chir Acta1954;
21:499–533.
20.
HuberPRLeimbachMELewisWL, et al.
CO(2) angiography. Catheter Cardiovasc Interv2002;
55:398–403.
21.
KundelHLPolanskyM.Measurement of observer agreement. Radiology2003;
228:303–308.
22.
KorogiYHiraiTTakahashiM.Intravascular ultrasound imaging of peripheral arteries as an adjunct to balloon angioplasty and atherectomy. Cardiovasc Intervent Radiol1996;
19:1–9.
23.
HeidrichJNguyenJFlorescuC, et al.
Carbon dioxide CT angiography during endovascular treatment of bilateral common iliac disease with angio-CT utilisation. J Med Imaging Radiat Oncol2018;
62:798–802.
24.
HitchnerEZayedMVaruV, et al.
A prospective evaluation of using IVUS during percutaneous superficial femoral artery interventions. Ann Vasc Surg2015;
29:28–33.
25.
HuiFKTongFCDionJE.The use of gadolinium chelates as an alternative radiographic contrast agent for use with flat panel detector angiography. J Neurointerv Surg2011;
3:95–97.
26.
SpinosaDJHagspielKDAngleJF, et al.
Gadolinium-based contrast agents in angiography and interventional radiology: uses and techniques. J Vasc Interv Radiol2000;
11:985–990.
27.
FujiharaMKawasakiDShintaniY, et al.
Endovascular therapy by CO2 angiography to prevent contrast-induced nephropathy in patients with chronic kidney disease: a prospective multicenter trial of CO2 angiography registry. Catheter Cardiovasc Interv2015;
85:870–877.
28.
BarrettBJKatzbergRWThomsenHS, et al.
Contrast-induced nephropathy in patients with chronic kidney disease undergoing computed tomography: a double-blind comparison of iodixanol and iopamidol. Invest Radiol2006;
41:815–821.
29.
Leidig-BrucknerG.[Iodinated contrast medium in patients with thyroid disorders]. Radiologe2019;
59:413–424.
30.
RheeCMBhanIAlexanderEK, et al.
Association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism. Arch Intern Med2012;
172:153–159.
31.
TokueHMoritaH.Imaging findings of pseudo-occlusion of common iliac artery: pitfall of time-resolved contrast-enhanced magnetic resonance angiography. Cureus2020;
12:e7252.
32.
SpuentrupERuebbenAMahnkenA, et al.
Artifact-free coronary magnetic resonance angiography and coronary vessel wall imaging in the presence of a new, metallic, coronary magnetic resonance imaging stent. Circulation2005;
111:1019–1026.
HawkinsIFJr.CaridiJGKernsSR.Plastic bag delivery system for hand injection of carbon dioxide. AJR Am J Roentgenol1995;
165:1487–1489.
35.
YoungMMohanJ.Carbon dioxide angiography.
Treasure Island, FL:
StatPearls, 2020.
36.
MaesRMLewinJSDuerkJL, et al.
Combined use of the intravascular blood-pool agent, gadomer, and carbon dioxide: a novel type of double-contrast magnetic resonance angiography (MRA). J Magn Reson Imaging2005;
21:645–649.
37.
Wacker FK, Maes RM, Jesberger JA, et al. MR imaging-guided vascular procedures using CO2 as a contrast agent. AJR Am J Roentgenol 2003; 181: 485–489. 2003/07/24. DOI: 10.2214/ajr.181.2.1810485.
38.
Hinrichs JB, Marquardt S, von Falck C, et al. Comparison of C-arm Computed Tomography and Digital Subtraction Angiography in Patients with Chronic Thromboembolic Pulmonary Hypertension. Cardiovasc Intervent Radiol 2016; 39: 53–63. 2015/04/02. DOI: 10.1007/s00270-015-1090-7.
39.
Maschke SK, Hinrichs JB, Renne J, et al. C-Arm computed tomography (CACT)-guided balloon pulmonary angioplasty (BPA): Evaluation of patient safety and peri- and post-procedural complications. Eur Radiol 2019; 29: 1276–1284. 2018/09/14. DOI: 10.1007/s00330-018-5694-6.
40.
TacherVBhagatNRaoPV, et al.
Image quality improvements in C-Arm CT (CACT) for liver oncology applications: preliminary study in rabbits. Minim Invasive Ther Allied Technol2013;
22:297–303.
41.
Olsson KM, Wiedenroth CB, Kamp JC, et al. Balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension: the initial German experience. Eur Respir J 2017; 49 2017/06/10. DOI: 10.1183/13993003.02409-2016.
42.
Dioguardi BurgioMBenseghirTRocheV, et al.
Clinical impact of a new cone beam CT angiography respiratory motion artifact reduction algorithm during hepatic intra-arterial interventions. Eur Radiol2020;
30:163–174.
