Prospective concordance of multidetector CT angiography and digital subtraction angiography in assessing bronchial artery morphology for hemoptysis embolization outcomes

Hemoptysis, often life-threatening in its massive form, is predominantly caused by bronchial artery pathology. Bronchial artery embolization (BAE) is the established first-line intervention, yet the relationship between bronchial artery morphology and embolization outcomes remains insufficiently defined. This prospective pilot study aimed to assess the association between bronchial artery anatomical features and short-term outcomes following BAE, and to evaluate concordance between computed tomography (CT) angiography and digital subtraction angiography (DSA) in detecting hypertrophy and tortuosity. Twenty-eight patients with hemoptysis requiring BAE were prospectively enrolled in a cohort study. Baseline multidetector CT angiography characterized bronchial artery origin, diameter, hypertrophy, tortuosity, and systemic collaterals. All patients underwent DSA-guided BAE. Treatment success was defined as cessation of hemoptysis within 48 hours, with recurrence assessed at 30 days. Inter-modality agreement was measured using Cohen's kappa. Immediate success was achieved in 92.9% of cases, with recurrence observed in 14.3% at 30 days. No statistically significant associations were found between artery morphology and outcomes. Descriptive trends suggested higher recurrence in patients with systemic collaterals and smaller left bronchial artery diameters (<2 mm). Moderate agreement was observed between CT and DSA for hypertrophy detection (Kappa = 0.563 for right bronchial artery, 0.500 for left), while substantial agreement was found for tortuosity (Kappa = 0.710 and 0.774, respectively). CT angiography demonstrated moderate concordance with DSA for hypertrophy detection (Kappa = 0.563 for right bronchial artery, 0.500 for left), while substantial agreement was found for tortuosity (Kappa = 0.710 and 0.774, respectively). Bronchial artery morphology was not significantly predictive of short-term BAE outcomes, though systemic collaterals and small vessel diameters may contribute to recurrence risk. While moderate agreement limits CTA as a sole tool, it aids in identifying targets efficiently. Larger, multicenter studies are warranted to refine risk stratification and optimize hemoptysis management.