Clinical Outcome and Utility of Cone-Beam Computed Tomography Imaging for Transcatheter Arterial Embolization in Patients with Malignant Intractable Hematuria

초록

Background: We assess the clinical outcomes and utility of cone-beam computed tomography (CBCT) during transcatheter arterial embolization (TAE) in patients with malignant intractable hematuria, related to lower urinary tract malignancy.Methods: A total of 22 consecutive patients (20 males and 2 females; age 71.8 ± 9.6 years) underwent CBCT during TAE for malignant intractable hematuria from May 2023 to August 2024. CBCT was performed on both internal iliac arteries for selective imaging. Contrast-enhanced three-dimensional (3D) images were acquired during breath-hold for embolization planning, with automated feeder detection aiding vessel visualization. Follow-up CT was performed 2–3 months after TAE, and regular visits monitored hematuria recurrence and treatment effects.Results: In all, 27 TAE procedures were performed in 22 patients, including those with bladder and prostate cancers. Technical success was achieved with all procedures. Clinical improvement in hematuria was observed in 86.4% of patients within 2 days. Five patients required re-intervention, and all improved. Significant changes were noted in hemoglobin, heart rate, transfusion, and tumor size, with 85.7% showing tumor reduction on follow-up imaging. CBCT provided valuable information in 52.1% cases, leading to treatment plan adjustments, particularly in identifying additional feeders and enabling superselective embolization. No major complications were reported.Conclusion: TAE is a safe and effective treatment for malignant intractable hematuria, leading to significant clinical improvement. CBCT further enhances TAE by providing crucial imaging that optimizes the embolization process.

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