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The efficacy of TACE; how can automated feeder software help? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This is a prospective study of 44 patients having 57 hepatocellular carcinoma (HCC) lesions indicated for transarterial chemoembolization (TACE) and a control group of 41 patients having 55 HCC lesions. TACE in the study group was performed on an angiography machine with an installed automated feeder detection (AFD) software (EmboGuide; Philips Healthcare, Best, The Netherlands) and in the control group was performed on a similar angiography machine (ALLURA XPER FD 20, Philips, Holland), but lacking the AFD software. The aim is to evaluate the clinical utilization of cone-beam CT (CBCT) and (AFD) software in accurate detection of (HCC) arterial feeders, the effect of (AFD) software utilization on the outcome of (TACE) and its utilization effect on fluoroscopy time and radiation dose to the patient during the (TACE) procedure.
Results
The highest percentage of agreement was between the number of arterial feeders detected by EmboGuide and the actual number of feeders detect during embolization reaching 91.2% with p value < 0.001. The residual non-intended non-embolized areas among the study group at 1-month follow-up were found in 2 out of 57 lesions compared to 9 out of 55 lesions in the control group. The average dose-area product (DAP) among the study group was less than that of the control group.
Conclusion
CBCT using AFD software provides more information about tumor feeders with consequent more efficient targeted embolization, higher success rate of TACE and less patient exposure to radiation.
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Kim HC, Miyayama S, Choi JW, Kim GM, Chung JW. Hepatocellular Carcinoma Supplied by the Inferior Phrenic Artery or Cystic Artery: Anatomic and Technical Considerations. Radiographics 2022; 43:e220076. [DOI: 10.1148/rg.220076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hyo-Cheol Kim
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (H.C.K., J.W. Choi, J.W. Chung); Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan (S.M.); and Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.M.K.)
| | - Shiro Miyayama
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (H.C.K., J.W. Choi, J.W. Chung); Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan (S.M.); and Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.M.K.)
| | - Jin Woo Choi
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (H.C.K., J.W. Choi, J.W. Chung); Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan (S.M.); and Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.M.K.)
| | - Gyoung Min Kim
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (H.C.K., J.W. Choi, J.W. Chung); Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan (S.M.); and Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.M.K.)
| | - Jin Wook Chung
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (H.C.K., J.W. Choi, J.W. Chung); Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan (S.M.); and Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.M.K.)
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Efficacy of Superselective Conventional Transarterial Chemoembolization Using Guidance Software for Hepatocellular Carcinoma within Three Lesions Smaller Than 3 cm. Cancers (Basel) 2021; 13:cancers13246370. [PMID: 34944990 PMCID: PMC8699350 DOI: 10.3390/cancers13246370] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/11/2021] [Accepted: 12/16/2021] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Although transarterial chemoebolization (TACE) is indicated for small hepatocellular carcinoma (HCC) as a second choice, TACE for small HCC is frequently difficult and less effective because of less hypervascularity and the presence of tumor portions receiving a dual blood supply. The aim of this study was to evaluate the efficacy of superselective cTACE under guidance software for patients with HCC within three lesions smaller than 3 cm. By using TACE guidance software, 81.2% of HCC lesions could be completely embolized and the cumulative local tumor progression rates in 303 tumors at 1, 3, 5, and 7 years were 17.8, 27.8, 32.0, and 36.0%, respectively. The 1-, 3-, 5-, and 7-year overall and recurrence-free survival rates in 175 patients were 97.1 and 68.7, 82.8 and 34.9, 64.8 and 20.2, and 45.3 and 17.3%, respectively. Our results indicate the efficacy of superselective cTACE using guidance software for HCC within three lesions smaller than 3 cm. Abstract The indication of transarterial chemoembolization (TACE) has advanced to hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage A when surgical resection (SR), thermal ablation, and bridging to transplantation are contraindicated; however, TACE for small HCC is frequently difficult and ineffective because of less hypervascularity and the presence of tumor portions receiving a dual blood supply. Here, we report outcomes of superselective conventional TACE (cTACE) for 259 patients with HCCs within three lesions smaller than 3 cm using guidance software. Automated tumor feeder detection (AFD) functionality was applied to identify tumor feeders on cone-beam computed tomography during hepatic arteriography (CBCTHA) data. When it failed, the feeder was identified by manual feeder detection functionality and/or selective angiography and CBCTHA. Regarding the technical success in 382 tumors (mean diameter, 17.2 ± 5.9 mm), 310 (81.2%) were completely embolized with a safety margin (5 mm wide for HCC ≤25 mm and 10 mm wide for HCC >25 mm). In 61 (16.0%), the entire tumor was embolized but the safety margin was not uniformly obtained. The entire tumor was not embolized in 11 (2.9%). Regarding the tumor response at 2–3 months after cTACE in 303 tumors excluding those treated with combined radiofrequency ablation (RFA) or SR and lost to follow-up, 287 (94.7%) were classified into complete response, seven (2.3%) into partial response, and nine (3.0%) into stable disease. The mean follow-up period was 44.9 ± 27.6 months (range, 1–109) and the cumulative local tumor progression rates at 1, 3, 5, and 7 years were 17.8, 27.8, 32.0, and 36.0%, respectively. The 1-, 3-, 5-, and 7-year overall and recurrence-free survival rates in 175 patients, excluding those with Child–Pugh C class, who died of other malignancies, or who underwent combined RFA or hepatic resection, were 97.1 and 68.7, 82.8 and 34.9, 64.8 and 20.2, and 45.3 and 17.3%, respectively. Our results indicate the efficacy of superselective cTACE using guidance software for HCC within three lesions smaller than 3 cm.
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Cui Z, Shukla PA, Habibollahi P, Park HS, Fischman A, Kolber MK. A systematic review of automated feeder detection software for locoregional treatment of hepatic tumors. Diagn Interv Imaging 2020; 101:439-449. [PMID: 32035822 DOI: 10.1016/j.diii.2020.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/07/2020] [Accepted: 01/16/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to perform a systematic review of current literature describing the efficacy and technical outcomes of transarterial liver therapies using automated feeder detection (AFD) software. MATERIALS AND METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A structured search was performed in the PubMed, SCOPUS, and Embase databases of patients undergoing locoregional therapy of liver tumors utilizing AFD software. Demographic data, procedure data (including radiometrics) and tumor response rate were recorded. Where available, performance of AFD was compared to conventional digital subtraction angiography (DSA) and cone-beam CT (CBCT) without AFD. RESULTS A total of 14 full-text manuscripts met inclusion criteria, comprising 1042 tumors in 604 patients (305 men, 156 women; mean age, 68.6±6.0 [SD] years), including 537 patients with hepatocellular carcinoma, 8 with metastases from neuroendocrine tumors, and 59 patients without reported etiology. Reported sensitivity of AFD ranged between 86% and 98.5%, compared to DSA alone (38% - 64%) or DSA in combination with CBCT (69% - 81%). Three studies reported tumor response by modified response evaluation criteria in solid tumors (mRECIST) guidelines, with complete response in the range of 60% - 69%. CONCLUSION AFD is a promising new technology for the identification of intrahepatic and extrahepatic tumor-feeding arteries and should be considered a useful adjunct to conventional DSA and CBCT in the treatment of liver tumors.
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Affiliation(s)
- Z Cui
- UT Southwestern Medical Center, 5323 Harry Hines Blvd., 75390-9003 Dallas, TX, USA
| | - P A Shukla
- Division of Interventional Radiology, Department of Radiology, Rutgers New Jersey Medical School, MSB F-506, 07103 Newark, NJ, USA
| | - P Habibollahi
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, 75390 Dallas, TX, USA
| | - H S Park
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, 75390 Dallas, TX, USA
| | - A Fischman
- Division of Vascular and Interventional Radiology, Department of Radiology, Icahn School of Medicine at Mount Sinai, 10029 New York, NY, USA
| | - M K Kolber
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, 75390 Dallas, TX, USA.
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Lucatelli P, De Rubeis G, Basilico F, Ginanni Corradini L, Corona M, Bezzi M, Catalano C. Sequential dual-phase cone-beam CT is able to intra-procedurally predict the one-month treatment outcome of multi-focal HCC, in course of degradable starch microsphere TACE. Radiol Med 2019; 124:1212-1219. [PMID: 31473930 DOI: 10.1007/s11547-019-01076-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/23/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the prognostic value of sequential dual-phase CBCT (DP-CBCT) imaging performed during degradable starch microsphere TACE (DSM-TACE) session in predicting the HCC's response to treatment, evaluate with modify response evaluation criteria in solid tumours (mRECIST) at 1-month multi-detector CT (MDCT) follow-up. MATERIALS AND METHODS Between January and May 2018, 24 patients (68.5 ± 8.5 year [45-85]) with HCC lesions (n = 96 [average 4/patient]) were prospectively enrolled. Imaging assessment included: pre-procedural MDCT, intra-procedural DP-CBCT performed before first and second DSM-TACEs and 1-month follow-up MDCT. Lesions' attenuation/pseudo-attenuation was defined as average value measured on ROIs (HU for MDCT; arbitrary unit called HU* for CBCT). Lesions' attenuation modification was correlated with the post-procedural mRECIST criteria at 1-month MDCT. RESULTS Eighty-two DSM-TACEs were performed. Lesion's attenuation values were: pre-procedural MDCT arterial phase (AP) 107.00 HU (CI 95% 100.00-115.49), venous phase (VP) 85.00 HU (CI 95% 81.13-91.74); and lesion's pseudo-attenuation were: first CBCT-AP 305.00 HU* (CI 95% 259.77-354.04), CBCT-VP 155.00 HU* (CI 95% 135.00-163.34). For second CBCT were: -AP 210.00 HU* (CI 95% 179.47-228.58), -VP 141.00 HU* (CI 95% 125.47-158.11); and for post-procedural MDCT were: -AP 95.00 HU (CI 95% 81.35-102.00), -VP 83.00 HU (CI 95% 78.00-88.00). ROC curve analysis showed that a higher difference pseudo-attenuation between first and second DP-CBCTs is related to treatment response. The optimal cut-off value of the difference between first and second CBCT-APs to predict complete response, objective response (complete + partial response) and overall disease control (objective response + stable disease) were > 206 HU* (sensitivity 80.0%, specificity 81.7%), > 72 HU* (sensitivity 79.5%, specificity 83.0%) and > - 7 HU* (sensitivity 91.6%, specificity 65.4%), respectively. CONCLUSIONS DP-CBCT can predict intra-procedurally, by assessing lesion pseudo-attenuation modification, the DSM-TACE 1-month treatment outcome.
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Gianluca De Rubeis
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Fabrizio Basilico
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Luca Ginanni Corradini
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Mario Corona
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Carlo Catalano
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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Assessment of automated cone-beam CT vessel identification software during transarterial hepatic embolisation: radiation dose, contrast medium volume, processing time, and operator perspectives compared to digital subtraction angiography. Clin Radiol 2018; 73:1057.e1-1057.e6. [PMID: 30220595 DOI: 10.1016/j.crad.2018.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/10/2018] [Indexed: 11/21/2022]
Abstract
AIM To evaluate arterial cone-beam computed tomography (A-CBCT) automated analysis software for identification of vessels supplying tumours during transarterial hepatic embolisation (TAE). MATERIALS AND METHODS This study was approved by the institutional review board, with waiver of consent. Consecutive TAE procedures using arterial mapping software (AMS), and performed between February 2014 and August 2014, were reviewed. Hepatic arteries were imaged using digital subtraction angiography (DSA) as well as A-CBCT processed with AMS. Interventional radiologists reported1 potential embolisation target vessels computed using AMS versus DSA alone,2 modification of the embolisation plan based on AMS, and3 operator confidence related to technical success. Imaging set-up, processing time, radiation dose, and contrast media volume were recorded. RESULTS Thirty of 34 consecutive procedures were evaluated retrospectively. At least one additional embolisation target vessel was identified using AMS in 13 procedures (43%, 95% confidence interval [CI]: 26-61%) and embolisation plan modified in 11 (37%, 95% CI: 19-54%). Radiologists reported AMS increased operator confidence and reduced the number of DSA acquisitions in 25 (83%, 95% CI: 70-97%) and 15 cases (50%, 95% CI: 32-68%), respectively. The average A-CBCT acquisition and processing time was 4 minutes 53 seconds and 3 minutes 45 seconds, respectively. A-CBCT contributed to 11% of the radiation dose and 18% of the contrast media volume. CONCLUSION Physicians report increased tumour supplying vessel detection and intraprocedural confidence using AMS during TAE without substantial impact on radiation dose, contrast media volume, and procedure time.
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Tanahashi Y, Kondo H, Yamamoto M, Osawa M, Yokoyama T, Sugawara T, Kawada H, Goshima S, Matsuo M, Furui S, Oba H. Efficacy of Automated Supplying Artery Tracking Software Using Multidetector-Row Computed Tomography Images for Emergent Transcatheter Arterial Embolization. Cardiovasc Intervent Radiol 2018; 41:1786-1793. [PMID: 29992347 DOI: 10.1007/s00270-018-2027-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess the reliability of a prototype automated supplying artery tracking software (ASATS) using multidetector-row CT (MDCT) images in emergent TAE. MATERIALS AND METHODS Consecutive 53 patients underwent 57 sessions of emergent TAE during 7 months. Twenty-one cases were excluded due to a lack of CT data (n = 12) or negative angiographic findings (n = 9). Remaining 34 sessions of TAE and MDCT images in 32 patients (mean age 62.9 years; age range 37-92 years) were enrolled. ASATS was retrospectively conducted for the identification of supplying arteries which were confirmed with angiography (automated method). Manual modification was added as needed (semi-automated method). Two observers independently reviewed the MDCT images to detect supplying arteries (manual method). Detectability of supplying artery and time to analysis were compared among the automated, semi-automated, and manual methods by both observers. RESULTS A total of 64 bleeding sites were demonstrated on angiography. The detectability was 28 (43.8%) for automated method, 53 (82.8%) for semi-automated method, 55 (85.9%) for observer 1, and 58 (90.6%) for observer 2. Detectability of semi-automated method was significantly better than of automated method (P = 0.000) and comparable with manual method by both observers (P = 0.193 and 0.081). Average time to analysis was 185.4 s for automated method, 297.2 s for semi-automated method, 186.2 s for observer 1, and 243.7 s for observer 2. CONCLUSION ASATS has a sufficient ability to identify supplying arteries of bleeding by adding manual modification as needed and can be used for emergent TAE. LEVEL OF EVIDENCE Level 4, Case Control Study.
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Affiliation(s)
- Yukichi Tanahashi
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroshi Kondo
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan.
| | - Masayoshi Yamamoto
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Marie Osawa
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Taro Yokoyama
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Toshimasa Sugawara
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Hiroshi Kawada
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Satoshi Goshima
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Shigeru Furui
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Hiroshi Oba
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan
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Chiaradia M, Izamis ML, Radaelli A, Prevoo W, Maleux G, Schlachter T, Mayer J, Luciani A, Kobeiter H, Tacher V. Sensitivity and Reproducibility of Automated Feeding Artery Detection Software during Transarterial Chemoembolization of Hepatocellular Carcinoma. J Vasc Interv Radiol 2018; 29:425-431. [PMID: 29402612 DOI: 10.1016/j.jvir.2017.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To evaluate the performance of automated feeder detection (AFD) software (EmboGuide; Philips Healthcare, Best, The Netherlands) on hepatocellular carcinoma (HCC) tumors during transarterial chemoembolization. MATERIALS AND METHODS Forty-four first-time transarterial chemoembolization patients (37 men; mean age, 62 ± 11 years) were enrolled between May 2012 and July 2013. A total of 86 HCC lesions were treated (2.0 ± 1.4 lesions per patient; 27.6 ± 15.9 mm maximum diameter). One hundred forty-seven feeding arteries were found with digital subtraction angiography (DSA), cone-beam computed tomography (CT), and AFD software with the option of manual adjustment (MA). Three independent interventional radiologists analyzed the cone-beam CT images retrospectively with and without AFD and MA. Compared with the number of treated vessels, the number of true positives, false positives, false negatives, sensitivity, and interreader agreement were determined using clustered binary data analysis. RESULTS Cone-beam CT enabled detection of 100 ± 3.5 feeding arteries (70% sensitivity) with 68.6% agreement among readers. AFD software significantly improved detection to 127±0.6 feeding arteries (86% sensitivity, P = .008) with 99.7% reader agreement and reduced the number of false negatives from an average of 47 ± 3.5 to 20 ± 0.6 (P = .008). MA of the AFD results produced similar feeding artery detection rates (127 ± 5.1, 86% sensitivity, P = .8), with lower interreader agreement (91.6%) and slightly fewer false positives (16 ± 0.0 to 14 ± 2.5, P = .4). CONCLUSIONS AFD software significantly improved feeding artery detection rates during transarterial chemoembolization of HCC lesions with better user reproducibility compared with cone-beam CT alone. In conjunction with DSA, AFD enables maximum feeding artery detection in this setting.
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Affiliation(s)
- Mélanie Chiaradia
- Department of Radiology and Medical Imaging, Henri Mondor University Hospital, 51 Avenue du maréchal de Lattre de Tassigny, 94010 Creteil, France
| | | | | | - Warner Prevoo
- Department of Radiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; The Netherlands Katholieke Universiteit, Amsterdam, The Netherlands
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Todd Schlachter
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Julie Mayer
- Department of Radiology and Medical Imaging, Henri Mondor University Hospital, 51 Avenue du maréchal de Lattre de Tassigny, 94010 Creteil, France
| | - Alain Luciani
- Department of Radiology and Medical Imaging, Henri Mondor University Hospital, 51 Avenue du maréchal de Lattre de Tassigny, 94010 Creteil, France; Medical School, Université Paris Est Créteil, Créteil, France; Unité INSERM U 955, Equipe 18, Créteil, France
| | - Hicham Kobeiter
- Department of Radiology and Medical Imaging, Henri Mondor University Hospital, 51 Avenue du maréchal de Lattre de Tassigny, 94010 Creteil, France; Medical School, Université Paris Est Créteil, Créteil, France
| | - Vania Tacher
- Department of Radiology and Medical Imaging, Henri Mondor University Hospital, 51 Avenue du maréchal de Lattre de Tassigny, 94010 Creteil, France; Medical School, Université Paris Est Créteil, Créteil, France; Unité INSERM U 955, Equipe 18, Créteil, France.
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Lucatelli P, Argirò R, Bascetta S, Saba L, Catalano C, Bezzi M, Levi Sandri GB. Single injection dual phase CBCT technique ameliorates results of trans-arterial chemoembolization for hepatocellular cancer. Transl Gastroenterol Hepatol 2017; 2:83. [PMID: 29167830 DOI: 10.21037/tgh.2017.10.03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 10/17/2017] [Indexed: 12/13/2022] Open
Abstract
Cone-beam CT (CBCT) application to the field of trans-arterial chemoembolization has been recently the focus of several researches. This imaging modality is performed with a rotation of the C-arm around the patient, without needs of patient repositioning. Datasets are immediately processed, obtaining volumetric CT-like images with the possibility of post-processing and reconstruction of images. Dual phase CBCT recently introduced in clinical practice consists in a first arterial acquisition followed by a delayed acquisition corresponding to a venous phase. The introduction of this feature has overcome the limit of single-phase acquisitions, allowing lesions characterization. Moreover these recent advantages have several intra-procedural implications. Detailed technical and acquisition parameters will be widely exposed in this review with particular attention to: catheter positioning, acquisition delay, injection parameters, patient positioning and contrast dilution. Comparison with standard of practice second line imaging [multidetector computer tomography (MDCT) and MDCT/arteriography] demonstrate the capability of detecting occult nodules providing some clinical implications thus potentially identifying a sub set of patients with aggressive disease behaviour. Other intra-procedural advantages of dual phase CBCT usage consist in a better tumor feeder visualization, reduction of proper DSA and fluoroscopic time, suggestion the presence of an extrahepatic parasitic feeder thus resulting in a more accurate treatment. Finally, the volumetrical intraprocedural evaluation of accumulation of embolic agent has proved to be correlate with treatment response if compared with MRI.
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, University of Siena, Siena, Italy
| | - Renato Argirò
- Departement of Diagnostic and Interventional Radiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Stefano Bascetta
- Vascular and Interventional Radiology Unit, University of Siena, Siena, Italy
| | - Luca Saba
- Departement of Medical Imaging, Azienda Ospedaliera Universitaria of Cagliari, Polo Monserrato, Cagliari, Italy
| | - Carlo Catalano
- Vascular and Interventional Radiology Unit, Sapienza University of Rome, Rome, Italy
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Sapienza University of Rome, Rome, Italy
| | - Giovanni Battista Levi Sandri
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy.,Departement of Surgical Sciences, PhD in "Advanced Surgical Technology", Sapienza University of Rome, Rome, Italy
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The Role of Cone-Beam CT in Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: A Systematic Review and Meta-analysis. J Vasc Interv Radiol 2017; 28:334-341. [PMID: 28109724 DOI: 10.1016/j.jvir.2016.11.037] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/04/2016] [Accepted: 11/16/2016] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To review available evidence for use of cone-beam CT during transcatheter arterial chemoembolization in hepatocellular carcinoma (HCC) for detection of tumor and feeding arteries. MATERIALS AND METHODS Literature searches were conducted from inception to May 15, 2016, in PubMed (MEDLINE), Scopus, and Cochrane Central Register of Controlled Trials. Searches included "cone beam," "CBCT," "C-arm," "CACT," "cone-beam CT," "volumetric CT," "volume computed tomography," "volume CT," AND "liver," "hepatic*," "hepatoc*." Studies that involved adults with HCC specifically and treated with transcatheter arterial chemoembolization that used cone-beam CT were included. RESULTS Inclusion criteria were met by 18 studies. Pooled sensitivity of cone-beam CT for detecting tumor was 90% (95% confidence interval [CI], 82%-95%), whereas pooled sensitivity of digital subtraction angiography (DSA) for tumor detection was 67% (95% CI, 51%-80%). Pooled sensitivity of cone-beam CT for detecting tumor feeding arteries was 93% (95% CI, 91%-95%), whereas pooled sensitivity of DSA was 55% (95% CI, 36%-74%). CONCLUSIONS Cone-beam CT can significantly increase detection of tumors and tumor feeding arteries during transcatheter arterial chemoembolization. Cone-beam CT should be considered as an adjunct tool to DSA during transcatheter arterial chemoembolization treatments of HCC.
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Takao Y. 7. Inspection of Hepatocellular Carcinoma 5: Angiography. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:627-35. [PMID: 27440707 DOI: 10.6009/jjrt.2016_jsrt_72.7.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yoshinori Takao
- Osaka City University Hospital Central department of Radiology
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