Performance of cone-beam computed tomography (CBCT) renal arteriography for renal tumor embolization

Objectives: To evaluate tumor feeders, image quality, and performance of cone-beam computed tomography (CBCT) renal arteriography for renal tumor embolization. Methods: Fifty-four patients with renal tumors were included in this study. The performance of CBCT renal arteriography was classified into three groups: group A, all tumor feeders could be confirmed solely based on the CBCT maximum intensity projection (MIP); group B, all feeders were detected in CBCT MIP, but there were some possible feeders which needed to be confirmed with selective digital subtraction angiography (DSA); and group C, tumor feeders were not detected in CBCT MIP, hence, the feeder was detected based on selective DSA. Tumor size, location, and enhancement on pre-procedure CT and tumor identification, overall image quality, breathing motion and opacification of the renal collecting system on CBCT MIP were also evaluated. Results: There were 32 (59.2%) patients in group A, 15 (27.8%) patients in group B, and 7 (13.0%) patients in group C. Significant determining factors for performance of CBCT renal arteriography were age, tumor identification, overall image quality, and breathing motion (all p < 0.05). In six out of seven cases in group C, overall image quality deteriorated due to breathing motion (significant blurring of renal artery branches with difficulty in identifying the interlobar artery level). Conclusion: In most cases, CBCT renal arteriography was sufficient to detect tumor feeders for renal tumor embolization. However, additional selective DSA is required when the overall image quality deteriorates owing to the patient's motion.