The utility of using TACE-assisted software with CBCT in colonic diverticular bleeding without extravascular leakage.

The utility of three-dimensional (3D) imaging with cone-beam computed tomography (CBCT) during interventional radiology (IVR) in colonic diverticular bleeding was compared to that of contrast-enhanced computed tomography (CECT). Additionally, to identify the responsible vessels in the absence of extravascular leakage using digital subtraction angiography, we examined the detection rate using software conventionally applied to transcatheter arterial chemoembolization (TACE). The 3D images obtained by CECT before IVR did not clearly show the destroyed vessels, whereas the 3D images obtained by CBCT during IVR clearly depicted the peripheral vessels. The TACE-assisted software identified the responsible vessels with a high probability, even in cases without extravascular leakage. CBCT could delineate vascular positions more accurately than CECT. Moreover, 80% of the responsible vessels could be delineated using the software; however, caution should be exercised as results may differ depending on the positioning of the region of interest.

Transcatheter Arterial Embolization Using Cone-beam Computed Tomography during Angiography and Automated Vessel Detection Software for Obscure Colonic Diverticular Hemorrhage after Unsuccessful Endoscopic Clipping: A Report of Two Cases.

We report the usefulness of cone-beam computed tomography angiography (CBCTA) and automated vessel detection (AVD) software in transcatheter arterial embolization in two cases of obscure ascending colonic diverticular hemorrhage after unsuccessful endoscopic clipping. Arteriography of the superior mesenteric artery demonstrated no active bleeding. Considering the positional relationship of the clips, we could narrow the responsible vessel down to two candidates but could not definitively identify the responsible vessel. We performed CBCTA at the marginal artery of the right colic artery, and the responsible branch was identified using AVD. The responsible vessel could be embolized, and hemostasis was achieved with no ischemic complications. CBCTA and AVD software for colonic diverticular hemorrhage after endoscopic clipping were useful for identifying the responsible vessel and in performing selective embolization.