Fusion Imaging to Guide Thoracic Endovascular Aortic Repair (TEVAR): A Randomized Comparison of Two Methods, 2D/3D Versus 3D/3D Image Fusion

P.-A. Barral , M. A. Demasi-Jacquier , L. Bal , V. Omnes , A. Bartoli (1, 2) , P. Piquet , A. Jacquier (1, 2) , M. Gaudry

1 Department of Radiology, Assistance Publique des Hôpitaux de Marseille
2 CRMBM - Centre de résonance magnétique biologique et médicale

PURPOSE: To compare the accuracy of two-dimensional (2D) versus three-dimensional (3D) image fusion for thoracic endovascular aortic repair (TEVAR) image guidance. MATERIALS AND METHODS: Between December 2016 and March 2018, all eligible patients who underwent TEVAR were prospectively included in a single-center study. Image fusion methods (2D/3D or 3D/3D) were randomly assigned to guide each TEVAR and compared in terms of accuracy, dose area product (DAP), volume of contrast medium injected, fluoroscopy time and procedure time. RESULTS: Thirty-two patients were prospectively included; 18 underwent 2D/3D and 14 underwent 3D/3D TEVAR. The 3D/3D method allowed more accurate positioning of the aortic mask on top of the fluoroscopic images (proximal landing zone error vector: 1.7\,±\,3.3~mm) than was achieved by the 2D/3D method (6.1\,±\,6.1~mm; p\,=\,0.03). The 3D/3D image fusion method was associated with significantly lower DAP than the 2D/3D method (50.5\,±\,30.1~Gy~cm2 for 3D/3D vs. 99.5\,±\,79.1~Gy~cm2 for 2D/3D; p\,=\,0.03). The volume of contrast medium injected was significantly lower for the 3D/3D method than for the 2D/3D method (50.6\,±\,22.9~ml vs. 98.4\,±\,47.9~ml; p\,=\,0.002). CONCLUSION: Higher image fusion accuracy and lower contrast volume and irradiation dose were observed for 3D/3D image fusion than for 2D/3D during TEVAR. LEVEL OF EVIDENCE: II, Randomized trial.

Mots clés: Aged; Aorta; Thoracic; Aortic Aneurysm; bad affiliation; cvs; Endovascular procedures; Endovascular Procedures; Female; Fluoroscopy; Humans; Imaging; Three-Dimensional; Male; Multimodal imaging; Multimodal Imaging; Prospective Studies; Radiation Dosage; Radiation protection; Radiography; Interventional; Reproducibility of Results; Treatment Outcome

Domaines: Imagerie; Imagerie médicale; Cardiologie et système cardiovasculaire

P.-A. Barral, M. A. Demasi-Jacquier, L. Bal, V. Omnes, A. Bartoli, et al.. Fusion Imaging to Guide Thoracic Endovascular Aortic Repair (TEVAR): A Randomized Comparison of Two Methods, 2D/3D Versus 3D/3D Image Fusion. CardioVascular and Interventional Radiology, 2019, 42 (11), pp.1522--1529. ⟨10.1007/s00270-019-02303-9⟩. ⟨hal-03591705⟩