Diagnostic and interventional radiology (Ankara, Turkey) vol:19 issue:5 pages:418-22
PURPOSE: To investigate the potential benefits of using 3D Rotational Angiography (3DRA) compared to 2D roadmapping to visualize the uterine artery (UA) origins during Uterine Artery Embolization (UAE) procedures. MATERIALS AND METHODS: Sixty three cases of UAE performed under 3D rotational angiography (3DRA) guidance were reviewed retrospectively to determine if there was an optimal angiographic projection angle for identifying the origins of UAs. DSA-like images of the pelvic vessels were generated from the 3DRA scans at six different angles (left anterior oblique (LAO)25,35,45, right anterior oblique (RAO)25,35,45). Two experienced interventional radiologists assessed whether any of these angles could effectively serve as a roadmap to guide catheterization of the UA. This assessment was validated against the original 3DRA scans to determine the percentage of true and false positives. RESULTS: No single projection angle was found that can consistently be utilized for UA catheterization. The projection angles used during 3D roadmap for both the left and the right UA showed two clusters with both a wide spread: RAO20-RAO50 and LAO20-LAO50. More than 50% of the DSA-like images at RAO45 and LAO45 appeared to be adequate for UA catheterization, but when validated against the 3DRA, 28% of these images were actually suboptimal and deceptive, due to unappreciated overlapping vessels. Thus physicians would be relying on a wrong angle. CONCLUSION: No standard projection angles can be recommended with 2D roadmapping to consistently visualize the origin of the UAs. 3DRA can be considered as a useful tool for UAE to achieve reliable and consistent visibility of the UA origin.