Comparison of the Number of Image Acquisitions and Procedural Time Required for Transarterial Chemoembolization of Hepatocellular Carcinoma with and without Tumor-Feeder Detection Software
Purpose. To compare the number of image acquisitions and procedural time required for transarterial chemoembolization (TACE) with and without tumor-feeder detection software in cases of hepatocellular carcinoma (HCC). Materials and Methods. We retrospectively reviewed 50 cases involving software-assisted TACE (September 2011–February 2013) and 84 cases involving TACE without software assistance (January 2010–August 2011). We compared the number of image acquisitions, the overall procedural time, and the therapeutic efficacy in both groups. Results. Angiography acquisition per session reduced from 6.6 times to 4.6 times with software assistance ( ). Total image acquisition significantly decreased from 10.4 times to 8.7 times with software usage ( ). The mean procedural time required for a single session with software-assisted TACE (103？min) was significantly lower than that for a session without software (116？min, ). For TACE with and without software usage, the complete (68% versus 63%, resp.) and objective (78% versus 80%, resp.) response rates did not differ significantly. Conclusion. In comparison with software-unassisted TACE, automated feeder-vessel detection software-assisted TACE for HCC involved fewer image acquisitions and could be completed faster while maintaining a comparable treatment response. 1. Introduction Two randomized trials have shown that transarterial chemoembolization (TACE) confers significant survival benefits [1, 2]. It has subsequently been accepted as a standard locoregional therapy for managing unresectable hepatocellular carcinoma (HCC). Detection of tumor feeders using intraprocedural imaging is indispensable for the technical success of this procedure. However, sequential angiographic acquisitions are usually necessary to accurately determine the feeder vessels in manual assessments using two-dimensional (2D) angiography. Additional angiographic runs at different angles are often required in patients with highly complex hepatic arterial vasculature. Such efforts are time-consuming and increase radiation exposure and contrast material use. A software program specifically designed to assist in planning selective liver tumor embolization (FlightPlan for Liver, GE Healthcare, Waukesha, WI, USA) was recently developed to detect and visualize potential tumor feeders from three-dimensional (3D) C-arm computed tomography (CT) data [3]. When catheter entry and a target tumor are chosen on the multiplanar reformatted (MPR) C-arm CT images, the software automatically predicts tumor feeders by showing a color-coded image on the
References
[1]
C.-M. Lo, H. Ngan, W.-K. Tso et al., “Randomized controlled trial of transarterial Lipiodol chemoembolization for unresectable hepatocellular carcinoma,” Hepatology, vol. 35, no. 5, pp. 1164–1171, 2002.
[2]
J. M. Llovet, M. I. Real, X. Monta？a et al., “Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial,” Lancet, vol. 359, no. 9319, pp. 1734–1739, 2002.
[3]
E. Pichon, G. Bekes, F. Deschamps, and S. B. Solomon, “Development and preliminary evaluation of software for planning selective liver embolizations from three-dimensional rotational fluoroscopy imaging,” International Journal of Computer Assisted Radiology and Surgery, vol. 3, no. 5, pp. 405–412, 2008.
[4]
R. Lencioni and J. M. Llovet, “Modified recist (mRECIST) assessment for hepatocellular carcinoma,” Seminars in Liver Disease, vol. 30, no. 1, pp. 52–60, 2010.
[5]
S. B. Solomon, R. Thornton, F. Deschamps, et al., “A treatment planning system for transcatheter hepatic therapies: pilot study,” Journal of Interventional Oncology, vol. 1, no. 1, pp. 12–18, 2008.
[6]
F. Deschamps, S. B. Solomon, R. H. Thornton et al., “Computed analysis of three-dimensional cone-beam computed tomography angiography for determination of tumor-feeding vessels during chemoembolization of liver tumor: a pilot study,” CardioVascular and Interventional Radiology, vol. 33, no. 6, pp. 1235–1242, 2010.
[7]
J. Iwazawa, S. Ohue, N. Hashimoto, O. Muramoto, and T. Mitani, “Clinical utility and limitations of tumor-feeder detection software for liver cancer embolization,” European Journal of Radiology, 2013.
[8]
S. Hirota, N. Nakao, S. Yamamoto et al., “Cone-beam CT with flat-panel-detector digital angiography system: early experience in abdominal interventional procedures,” CardioVascular and Interventional Radiology, vol. 29, no. 6, pp. 1034–1038, 2006.
[9]
S. Kakeda, Y. Korogi, Y. Hatakeyama et al., “The usefulness of three-dimensional angiography with a flat panel detector of direct conversion type in a transcatheter arterial chemoembolization procedure for hepatocellular carcinoma: initial experience,” CardioVascular and Interventional Radiology, vol. 31, no. 2, pp. 281–288, 2008.
[10]
J. Iwazawa, S. Ohue, T. Mitani et al., “Identifying feeding arteries during TACE of hepatic tumors: comparison of C-Arm CT and digital subtraction angiography,” American Journal of Roentgenology, vol. 192, no. 4, pp. 1057–1063, 2009.
[11]
S. Miyayama, M. Yamashiro, M. Okuda et al., “Usefulness of cone-beam computed tomography during ultraselective transcatheter arterial chemoembolization for small hepatocellular carcinomas that cannot be demonstrated on angiography,” CardioVascular and Interventional Radiology, vol. 32, no. 2, pp. 255–264, 2009.
[12]
J. Iwazawa, S. Ohue, N. Hashimoto, H. Abe, M. Hamuro, and T. Mitani, “Detection of hepatocellular carcinoma: comparison of angiographic C-arm CT and MDCT,” American Journal of Roentgenology, vol. 195, no. 4, pp. 882–887, 2010.
[13]
H. Higashihara, K. Osuga, H. Onishi et al., “Diagnostic accuracy of C-arm CT during selective transcatheter angiography for hepatocellular carcinoma: comparison with intravenous contrast-enhanced, biphasic, dynamic MDCT,” European Radiology, vol. 22, no. 4, pp. 879–872, 2012.
