title: Ultraselective transcatheter arterial chemoembolization for small hepatocellular carcinoma guided by automated tumor-feeders detection software: technical success and short-term tumor response.
abstract: OBJECTIVE
  To analyze the technical success and tumor response of ultraselective transcatheter arterial chemoembolization (TACE) for small hepatocellular carcinoma (HCC) using automated tumor-feeders detection (AFD) software.
  
  
  METHODS
  Prototype AFD software was prospectively applied to cone-beam computed tomography images acquired during TACE for 155 consecutive HCCs ≤50 mm in 81 patients. The detectability of tumor-feeding subsubsegmental arteries was analyzed. Technical success of TACE was classified into three grades according to 1-week CT; the tumor was embolized with a safety margin (5 mm wide for tumors <25 mm, and 10 mm wide for tumors ≥25 mm) (grade A), without a margin in parts (grade B), or the entire tumor was not embolized (grade C). Tumor response at 2-3 months after TACE was also evaluated in 71 patients using the modified Response Evaluation Criteria in Solid Tumors.
  
  
  RESULTS
  One-hundred and twenty-eight (82.6%) tumors were classed as grade A, 17 (11%) as grade B, and 10 (6.5%) as grade C. AFD software could identify 211 (85.4%) of 247 tumor-feeders but not 36 (14.6%). Eighteen (7.9%) were false positive. The tumor response of target lesions in each patient was complete response (CR) in 49 (69%) patients, partial response (PR) in 19 (26.8%), and stable disease (SD) in 3 (4.2%). The overall tumor response was CR in 39 (54.9%) patients, PR in 15 (21.2%), SD in 1 (1.4%), and progressive disease in 16 (22.5%).
  
  
  CONCLUSIONS
  AFD software has sufficient performance to identify tumor-feeders and contributes to the high technical success in ultraselective TACE.
authors.affiliation: Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui, 918-8503, Japan, s-miyayama@fukui.saiseikai.or.jp.
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyayama
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamashiro
authors.forename: Masaya
authors.initials: M
authors.lastname: Ikuno
authors.forename: Kennichiro
authors.initials: K
authors.lastname: Okumura
authors.forename: Miki
authors.initials: M
authors.lastname: Yoshida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012984:Software; D016896:Treatment Outcome