Due to the high risk of vascular and nerve damage during surgery, precise pre-operative evaluation of carotid body tumor (CBT) is important. We aim to apply intra-operative contrast-enhanced cone-beam CT (CBCT) with multi-volume technique in CBT evaluation, where the tumor, patent carotid arteries, and skull are demonstrated in three different colors, and to compare this novel technique with traditional computed tomography angiography (CTA). Seven CBT patients scheduled for traditional surgical removal were enrolled in this study between October 2013 and March 2016. For each patient, two CBCT scans were performed on the carotid region both pre- and post-operatively, with contrast injected into the common carotid artery directly. CT-like cross-sectional slices were then reconstructed with a dedicated workstation, and a novel multi-volume technique was further applied for advanced image post-processing. For all seven patients, the anatomic relationship between tumor and surrounding vessels was clearly demonstrated by reconstructed CBCT images with multiple fused volumes. Carotid was either completely or partially incarcerated by tumors. Interestingly, two sets of draining vein systems of CBT were found feeding into the internal jugular vein and the anterior vertebral venous plexus, respectively, which have not been revealed in pre-operative CTA. Post-operative CBCT confirmed the thorough removal of the tumor with an intact preservation of the internal carotid artery. CBCT with multi-volume technique outperforms CTA in discovering fine structures and revealing tumor–vessel relationship for CBT. This emerging imaging technique would offer more accurate diagnosis of CBT and assist in the decision of surgical plan.
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This study was funded by the Natural Science Foundation of China (81270390 and 81025001) and 973 Program, also known as National Basic Research Program (2012CB517802).
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
Authors have declared that no competing interests exist.
L Cui and G Gu contributed equally to this work.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary Fig. 1. Post-processing of the pre-procedual DSA of Patient 4 with syngo iFlow software on the workstation. (a) iFlow image generated from a single DSA series. Color of each individual pixel was coded by the time (time-to-peak, by second) when the pixel arrives its maximum intensity. (b) Quantitative information of two selected regions of interest (ROI). “ROI reference” was set at the common carotid artery, and “ROI 2” was set at the tumor parenchyma. (c) Time-intensity curve showed that contrast perfusion in the tumor tissue lasted from the third second to eleventh second, starting from the third second, according to which the X-ray delay time between two CBCT scans was set. (TIFF 5113 kb)
Supplementary Fig. 2. CBCT of (a) Patient 1, (b) Patient 2, and (c) Patient 3, reconstructed with dual-volume mode, where the bone and vessels were demonstrated in grey and red, respectively; and CBCT of (d) Patient 7 reconstructed with multi-volume mode, where the tumor, carotid arteries, and the skull were demonstrated in pink, blue, and grey, respectively. (TIFF 6504 kb)
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Cui, L., Gu, G., Ye, L. et al. An evaluation on novel application of cone-beam CT imaging with multi-volume technique in carotid body tumor. Eur Arch Otorhinolaryngol 274, 1713–1720 (2017). https://doi.org/10.1007/s00405-016-4405-7
- Cone-beam CT
- Carotid body tumor
- Dual-volume technique