title: Clinical utility and limitations of tumor-feeder detection software for liver cancer embolization.
abstract: OBJECTIVE
  To evaluate the clinical utility and limitations of a computer software program for detecting tumor feeders of hepatocellular carcinoma (HCC) during transarterial chemoembolization (TACE).
  
  
  METHODS
  Forty-six patients with 59 HCC nodules underwent nonselective digital subtraction angiography (DSA) and C-arm computed tomography (CT) in the same hepatic artery. C-arm CT data sets were analyzed using the software to identify potential tumor feeders during each TACE session. For DSA analysis, 3 radiologists were independently assigned to identify tumor feeders using the DSA images in a separate session. The sensitivity of the 2 techniques in detecting tumor feeders was compared, with TACE findings as the reference standard. Factors affecting the failure of the software to detect tumor feeders were assessed by univariate and multivariate analyses.
  
  
  RESULTS
  We detected 65 tumor feeders supplying 59 HCC nodules during TACE sessions. The sensitivity of the software to detect tumor feeders was significantly higher than that of the manual assessment using DSA (87.7% vs. 71.8%, P<0.001). Multivariate analysis showed that a tumor feeder diameter of <1.0mm (hazard ratio [HR], 56.3; P=0.003) and lipiodol accumulation adjacent to the tumor (HR, 11.4; P=0.044) were the significant predictors for failure to detect tumor feeders.
  
  
  CONCLUSIONS
  The software analysis was superior to manual assessment with DSA in detecting tumor feeders during TACE for HCC. However, the capability of the software to detect tumor feeders was limited by vessel caliber and by prior lipiodol accumulation to the tumor.
authors.affiliation: Department of Radiology, Nissay Hospital, 6-3-8 Itachibori, Nishiku, Osaka 550-0012, Japan. iwazawa.jin@nissay-hp.or.jp
authors.forename: Jin
authors.initials: J
authors.lastname: Iwazawa
authors.forename: Shoichi
authors.initials: S
authors.lastname: Ohue
authors.forename: Naoko
authors.initials: N
authors.lastname: Hashimoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Muramoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Mitani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D004360:Drug Therapy, Computer-Assisted / Q000379:methods; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage*; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015641:Radiography, Interventional / Q000379:methods; D012984:Software; D016896:Treatment Outcome; D047368:Tumor Burden / Q000187:drug effects
chemical_list: D000970:Antineoplastic Agents; D006490:Hemostatics
keywords: Chemoembolization; Cone-beam computed tomography; Hepatocellular carcinoma; Software; Treatment planning