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

Abstract

ObjectiveTo 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 MethodsThe 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.ResultsIn 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.ConclusionFlightPlan 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.

Exploring software navigation tools for liver tumour angiography: a scoping review

“…A total of 12 studies were reported on feeder detection software 11–22 . This visualisation and guidance software utilises a CBCT dataset to distinguish and define all vessels from the imaging source to the tumour via contrast‐enhanced arteries, with the goal to avoid non‐target embolisation.…”

“…A total of 12 studies were reported on feeder detection software. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 This visualisation and guidance software utilises a CBCT dataset to distinguish and define all vessels from the imaging source to the tumour via contrast‐enhanced arteries, with the goal to avoid non‐target embolisation. When compared to conventional DSA the software demonstrated a significant improvement in accurately detecting feeding arteries by 43%.…”

Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal

“…Regarding the DTA studies, one reviewer experienced in DTA studies selected eligible articles according to criteria established elsewhere ( 9 ) with additional confirmation by another DTA expert in cases of ambiguity. Of the initial 124 candidate articles, 63 articles ( 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 ) were finally included. Regarding the studies that analyzed reliability, eligible articles were chosen by consensus after review by two of four independent reviewers experienced in the relevant methodology.…”

Hepatic Arterial Infusion of Chemotherapy for Advanced Hepatobiliary Cancers: State of the Art

“…Nowadays, this technique has been supplemented with a three-dimensional (3 D) cone beam CT (CBCT) that includes opacification of vessels by making the detection of segmental and subsegmental arteries supplying the target tumor easier [ 44 ]. In addition, several studies have been evaluating with favourable results, the role of automatic feeder detection (AFD) software in the analyzation and digital process of CBCT imaging for simplifying and shortening the procedures of hepatic arterial port-a-cath system implantation [ 44 , 45 , 46 , 47 , 48 ]. Possible causes of failure of port-a-cath placement must be considered in this preliminary phase to evaluate if the patient is a suitable candidate for HAI.…”