Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Optimized Performance of FlightPlan during Chemoembolization for Hepatocellular Carcinoma: Importance of the Proportion of Segmented Tumor Area

  • Joo, Seung-Moon (Department of Radiology, Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Yong Pyo (Department of Radiology, Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Yum, Tae Jun (Department of Radiology, Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Eun, Na Lae (Department of Radiology, Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Dahye (Department of Radiology, Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Kwang-Hun (Department of Radiology, Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • Received : 2016.02.18
  • Accepted : 2016.05.27
  • Published : 2016.09.01
⟨ Previous Next ⟩

Abstract

Objective: To evaluate retrospectively the clinical effectiveness of FlightPlan for Liver (FPFL), an automated tumor-feeding artery detection software in cone-beam CT angiography (CBCTA), in identifying tumor-feeding arteries for the treatment of hepatocellular carcinoma (HCC) using three different segmentation sensitivities. Materials and Methods: The study included 50 patients with 80 HCC nodules who received transarterial chemoembolization. Standard digital subtracted angiography (DSA) and CBCTA were systematically performed and analyzed. Three settings of the FPFL software for vascular tree segmentation were tested for each tumor: the default, Group D; adjusting the proportion of segmented tumor area between 30 to 50%, Group L; and between 50 to 80%, Group H. Results: In total, 109 feeder vessels supplying 80 HCC nodules were identified. The negative predictive value of DSA, FPFL in groups D, L, and H was 56.8%, 87.7%, 94.2%, 98.5%, respectively. The accuracy of DSA, FPFL in groups D, L, and H was 62.6%, 86.8%, 93.4%, 95.6%, respectively. The sensitivity, negative predictive value (NPV), and accuracy of FPFL were higher in Group H than in Group D (p = 0.041, 0.034, 0.005). All three segmentation sensitivity groups showed higher specificity, positive predictive value, NPV, and accuracy of FPFL, as compared to DSA. Conclusion: FlightPlan for Liver is a valuable tool for increasing detection of HCC tumor feeding vessels, as compared to standard DSA analysis, particularly in small HCC. Manual adjustment of segmentation sensitivity improves the accuracy of FPFL.

Keywords

Acknowledgement

Grant : BK21플러스

Supported by : 연세대학교

References

  1. Korean Liver Cancer Study Group (KLCSG); National Cancer Center, Korea (NCC). 2014 Korean Liver Cancer Study Group-National Cancer Center Korea practice guideline for the management of hepatocellular carcinoma. Korean J Radiol 2015;16:465-522 https://doi.org/10.3348/kjr.2015.16.3.465
  2. Liu YS, Ou MC, Tsai YS, Lin XZ, Wang CK, Tsai HM, et al. Transarterial chemoembolization using gelatin sponges or microspheres plus lipiodol-doxorubicin versus doxorubicin-loaded beads for the treatment of hepatocellular carcinoma. Korean J Radiol 2015;16:125-132 https://doi.org/10.3348/kjr.2015.16.1.125
  3. Han K, Kim JH, Yoon HM, Kim EJ, Gwon DI, Ko GY, et al. Transcatheter arterial chemoembolization for infiltrative hepatocellular carcinoma: clinical safety and efficacy and factors influencing patient survival. Korean J Radiol 2014;15:464-471 https://doi.org/10.3348/kjr.2014.15.4.464
  4. Miyayama S, Matsui O, Yamashiro M, Ryu Y, Kaito K, Ozaki K, et al. Ultraselective transcatheter arterial chemoembolization with a 2-f tip microcatheter for small hepatocellular carcinomas: relationship between local tumor recurrence and visualization of the portal vein with iodized oil. J Vasc Interv Radiol 2007;18:365-376 https://doi.org/10.1016/j.jvir.2006.12.004
  5. Golfieri R, Cappelli A, Cucchetti A, Piscaglia F, Carpenzano M, Peri E, et al. Efficacy of selective transarterial chemoembolization in inducing tumor necrosis in small (<5 cm) hepatocellular carcinomas. Hepatology 2011;53:1580-1589 https://doi.org/10.1002/hep.24246
  6. Wallace MJ, Murthy R, Kamat PP, Moore T, Rao SH, Ensor J, et al. Impact of C-arm CT on hepatic arterial interventions for hepatic malignancies. J Vasc Interv Radiol 2007;18:1500-1507 https://doi.org/10.1016/j.jvir.2007.07.021
  7. Kim HC. Role of C-arm cone-beam CT in chemoembolization for hepatocellular carcinoma. Korean J Radiol 2015;16:114-124 https://doi.org/10.3348/kjr.2015.16.1.114
  8. Iwazawa J, Ohue S, Mitani T, Abe H, Hashimoto N, Hamuro M, et al. Identifying feeding arteries during TACE of hepatic tumors: comparison of C-arm CT and digital subtraction angiography. AJR Am J Roentgenol 2009;192:1057-1063 https://doi.org/10.2214/AJR.08.1285
  9. Deschamps F, Solomon SB, Thornton RH, Rao P, Hakime A, Kuoch V, 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. Cardiovasc Intervent Radiol 2010;33:1235-1242 https://doi.org/10.1007/s00270-010-9846-6
  10. Iwazawa J, Ohue S, Hashimoto N, Mitani T. Accuracy of software-assisted detection of tumour feeders in transcatheter hepatic chemoembolization using three target definition protocols. Clin Radiol 2014;69:145-150 https://doi.org/10.1016/j.crad.2013.09.005
  11. Iwazawa J, Ohue S, Hashimoto N, Muramoto O, Mitani T. Survival after C-arm CT-assisted chemoembolization of unresectable hepatocellular carcinoma. Eur J Radiol 2012;81:3985-3992 https://doi.org/10.1016/j.ejrad.2012.08.012
  12. Pichon E, Bekes G, Deschamps F, Solomon SB. Development and preliminary evaluation of software for planning selective liver embolizations from three-dimensional rotational fluoroscopy imaging. Int J CARS 2008;3:405-412 https://doi.org/10.1007/s11548-008-0242-5
  13. Kakeda S, Korogi Y, Ohnari N, Moriya J, Oda N, Nishino K, et al. Usefulness of cone-beam volume CT with flat panel detectors in conjunction with catheter angiography for transcatheter arterial embolization. J Vasc Interv Radiol 2007;18:1508-1516 https://doi.org/10.1016/j.jvir.2007.08.003
  14. Virmani S, Ryu RK, Sato KT, Lewandowski RJ, Kulik L, Mulcahy MF, et al. Effect of C-arm angiographic CT on transcatheter arterial chemoembolization of liver tumors. J Vasc Interv Radiol 2007;18:1305-1309 https://doi.org/10.1016/j.jvir.2007.07.006
  15. Miyayama S, Yamashiro M, Okuda M, Yoshie Y, Sugimori N, Igarashi S, et al. Usefulness of cone-beam computed tomography during ultraselective transcatheter arterial chemoembolization for small hepatocellular carcinomas that cannot be demonstrated on angiography. Cardiovasc Intervent Radiol 2009;32:255-264 https://doi.org/10.1007/s00270-008-9468-4
  16. Iwazawa J, Ohue S, Hashimoto N, Mitani T. Comparison of the number of image acquisitions and procedural time required for transarterial chemoembolization of hepatocellular carcinoma with and without tumor-feeder detection software. Radiol Res Pract 2013;2013:580839
  17. Lee IJ, Chung JW, Yin YH, Kim HC, Kim YI, Jae HJ, et al. Cone-beam computed tomography (CBCT) hepatic arteriography in chemoembolization for hepatocellular carcinoma: performance depicting tumors and tumor feeders. Cardiovasc Intervent Radiol 2015;38:1218-1230 https://doi.org/10.1007/s00270-015-1055-x

Cited by

  1. Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal vol.18, pp.6, 2017, https://doi.org/10.3348/kjr.2017.18.6.888
  2. Hepatic Arterial Infusion of Chemotherapy for Advanced Hepatobiliary Cancers: State of the Art vol.13, pp.12, 2016, https://doi.org/10.3390/cancers13123091