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Purpose: To evaluate the outcomes of conventional transarterial chemoembolization using guidance software for hepatocellular carcinoma (HCC) patients., Materials and Methods: One hundred two patients with treatment-naïve HCC with ≤ 7-cm and ≤ 5 lesions treated with conventional transarterial chemoembolization using guidance software were selected. Technical success was classified into 3 grades by computed tomography performed 1 week after transarterial chemoembolization: (i) A, complete embolization with a safety margin; (ii) B, entire tumor embolization without a safety margin; and (iii) C, incomplete embolization. Intrahepatic tumor recurrence was classified into 2 categories: local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Overall survival (OS) and tumor recurrence rates were calculated by the Kaplan-Meier method. Additionally, the incidences of LTP between grade A and B tumors, IDR with/without LTP, and OS with/without LTP were compared by the log-rank test., Results: One hundred fifty-six (82.1%) tumors were determined to be grade A, 26 (13.7%) were determined to be grade B, and 8 (4.2%) were determined to be grade C. The 1-, 3-, and 5-year LTP and IDR rates were 31.7%, 49.4%, and 59.4% and 33.9%, 58.2%, and 73.3%, respectively. LTP developed more frequently in grade B tumors than grade A tumors (P = .0016). IDR developed more frequently in patients with LTP than without LTP (P = .0004). The 1-, 3-, and 5-year OS rates were 96.1%, 71.1%, and 60%, respectively; the 1-, 3-, and 5-year OS rates in patients with/without LTP were 95.7%, 69.8%, and 59.3% and 96.2%, 71.6%, and 59.4%, respectively (P = .9984)., Conclusions: Transarterial chemoembolization guidance software promotes the technical success of transarterial chemoembolization and excellent OS in HCC patients., (Copyright © 2018 SIR. Published by Elsevier Inc. All rights reserved.)

We report the usefulness of dual-phase cone-beam computed tomography during angiography (CBCTA) and automated tumour-feeder detection software (AFD) in transarterial embolization (TAE) for three consecutive cases of obscure arterial bleeding in the abdomen. Two patients presented with lower gastrointestinal bleeding and one showed bleeding into the pancreatic pseudocyst. Superior mesenteric or common hepatic angiography did not demonstrate extravasation, but dual-phase CBCTA and AFD could identify extravasation and an access route to the bleeding point. TAE with gelatin sponge particles and a microcoil was successfully performed under AFD guidance in all patients without any complication, and haemostasis could be achieved., (© 2018 The Royal Australian and New Zealand College of Radiologists.)

The mortality rate of patients with ruptured pancreaticoduodenal artery aneurysms is high; therefore, it is recommended to treat pancreaticoduodenal artery aneurysms regardless of their size. In small pancreaticoduodenal artery aneurysms, however, identification of the access route on two-dimensional arteriography is sometimes difficult because of the superimposition of many hypertrophied branches of pancreaticoduodenal arteries on the aneurysm. We report two cases of ruptured pancreaticoduodenal artery aneurysm embolized successfully with metallic coils, assisted by automated feeder-detection software using cone-beam computed tomography data. This new technology may reduce physicians' workload during the procedure., (© The Author(s) 2015.)

Purpose: 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.

Purpose: This study was designed to compare technical success and local recurrence rates of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with/without monitoring of embolized areas using cone-beam computed tomography (CBCT)., Methods: A total of 207 HCCs ≤6 cm were treated with superselective TACE using digital subtraction angiography (DSA) alone (DSA group, 98 tumors of 70 patients) or plus CBCT monitoring (CBCT group, 109 tumors of 79 patients). 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≥ and ≤60 mm; grade A), without a margin in parts (grade B), or the entire tumor was not embolized (grade C). Technical success and local recurrence rates in the DSA and CBCT groups were compared. Local recurrence rates of grade A and B tumors were also compared., Results: The grade A/B/C tumors in the DSA and CBCT groups were 64 (65.3%)/25 (25.5%)/9 (9.2%) and 95 (87.2%)/11 (10.1%)/3 (2.8%), respectively. Local recurrence developed in 46/158 (29.1%) grade A tumors and 24/36 (66.7%) grade B. There were significant differences in technical success between the DSA and CBCT groups (p < 0.001) and local recurrence rates between grade A and B tumors (p < 0.001). The 1-, 2-, and 3-year local recurrence rates in the DSA and CBCT groups were 33.3 and 22.3%, 41.3 and 26.8%, and 48 and 30.6%, respectively (p = 0.0217)., Conclusion: Intraprocedural CBCT monitoring of embolized areas reduces the local tumor recurrence.

Purpose: To evaluate the performance of transcatheter arterial chemoembolization guidance software that uses cone-beam computed tomography (CT) technology in identifying small hepatocellular carcinoma (HCC) tumors and feeding branches., Materials and Methods: Cone-beam CT and manual feeder vessel detection (MFD) software were used in chemoembolization of 68 HCCs 30 mm or smaller (mean ± standard deviation, 15.3 mm ± 5.2). Detectability of tumors and tumor-feeding sub-subsegmental arteries was compared versus that of nonselective digital subtraction angiography (DSA). Technical success of chemoembolization was divided into three grades according to 1-week CT findings: entire tumor embolized with at least a 5-mm-wide margin (ie, complete), tumor embolized without a margin in parts (ie, adequate), or entire tumor not embolized (ie, incomplete). All cone-beam CT data were also reanalyzed with automatic feeder vessel detection (AFD) software that was developed later., Results: Cone-beam CT could depict all tumors, including eight that were first discovered during chemoembolization. Sixty-one tumors (89.7%) were detected on CT during arterial portography and during hepatic arteriography, and seven (10.3%) were detected with one or the other. Nonselective DSA depicted 49 tumors (72.1%). Among 100 tumor-feeding vessels, 81 were identified with MFD and 38 with nonselective DSA. Detectability of tumors with CT and tumor-feeding branches with MFD was significantly better than with nonselective DSA (both P<.001). Fifty-nine tumors (86.8%) were completely embolized and nine (13.2%) were adequately embolized. AFD identified 96 feeder vessels; 88 (88%) represented true-positive findings., Conclusions: Transcatheter arterial chemoembolization guidance software with cone-beam CT technology has a sufficient performance level to detect small HCCs and their feeding branches., (Copyright © 2013. Published by Elsevier Inc.)

Cone-beam computed tomography (CBCT) using a flat-panel detector is an alternative method of obtaining cross-sectional images. This technique is now being used during transcatheter arterial chemoembolization (TACE) for inoperable hepatocellular carcinoma (HCC). Several CBCT techniques are performed to detect HCC lesions: CBCT during portography (CBCTAP), CBCT during hepatic arteriography (CBCTHA), CBCT after iodized oil injection (LipCBCT), CBCT during arteriography (CBCTA) of extrahepatic collaterals. Almost all HCC lesions can be detected using these CBCT images. Three-dimensional arteriography using maximum intensity projection from CBCTHA images can identify the tumor-feeding branch. In particular, this technique is useful when the tumor stain cannot be demonstrated on arteriography. In addition, dual-phase CBCTHA can improve the diagnostic accuracy for hypervascular HCCs because corona enhancement can be detected around the tumor. To monitor the embolized area during TACE, selective CBCTHA or LipCBCT at the embolization point is useful. Two sequential CBCT scans without and with contrast material injection is also useful to confirm each embolized area of two vessels. Furthermore, CBCTA can prevent nontarget embolization. Although the image quality of CBCT is low compared to that of conventional CT, CBCT provides useful information that helps perform TACE for HCCs safely and effectively.

The purpose of this study was to evaluate the detectability of corona enhancement around the hypervascular hepatocellular carcinoma (HCC) by dual-phase cone-beam computed tomography during hepatic arteriography (CBCTHA). Dual-phase CBCTHA was performed for 71 HCC lesions (mean ± SD 1.7 ± 0.9 cm), including seven presenting a nodule-in-nodule appearance and nine hypervascular pseudolesions. The first scan was performed during injection of 30-40 ml half-diluted contrast material at a rate of 1.5-2 ml/s through the hepatic artery. Scanning was initiated 7 s after the beginning of contrast material injection. The second scan was started 30 s after the end of the first scan. Detectability of corona enhancement on second-phase CBCTHA was evaluated. Thickness of corona enhancement was also analyzed as thin (≤2 mm) or thick (>2 mm). Corona enhancement was detected in 63 (88.7%) of 71 tumors (1.8 ± 0.9 cm), but it was not detected in eight tumors (1.0 ± 0.2 cm). Thin corona enhancement was seen in 18 tumors (1.2 ± 0.5 cm), and thick corona enhancement was seen in 45 tumors (2.0 ± 0.9 cm). There was a significant difference in tumor diameter between tumors with and those without corona enhancement (P = 0.0157) and between thin and thick corona enhancement (P = 0.001). In all seven early-stage tumors, corona enhancement was demonstrated around the hypervascular focus within the hypovascular tumor portion. None of the nine pseudolesions showed any corona enhancement. Dual-phase CBCTHA depicted corona enhancement in 88.7% of hypervascular HCC lesions. This technique may improve the diagnostic accuracy of HCC.

This study evaluated the usefulness of cone-beam computed tomography (CBCT) during ultraselective transcatheter arterial chemoembolization (TACE) for hepatocellular carcinomas (HCC) that could not be demonstrated on angiography. Twenty-eight patients with 33 angiographically occult tumors (mean diameter 1.3 +/- 0.3 cm) were enrolled in the study. The ability of CBCT during arterial portography (CBCTAP), during hepatic arteriography (CBCTHA), and after iodized oil injection (LipCBCT) to detect HCC lesions was retrospectively analyzed. The technical success of TACE was divided into three grades: complete (the embolized area included the entire tumor with at least a 5-mm wide margin), adequate (the embolized area included the entire tumor but without a 5-mm wide margin in parts), and incomplete (the embolized area did not include the entire tumor) according to computed axial tomographic (CAT) images obtained 1 week after TACE. Local tumor progression was also evaluated. CBCTAP, CBCTHA, and LipCBCT detected HCC lesions in 93.9% (31 of 33), 96.7% (29 of 30), and 100% (29 of 29) of patients, respectively. A single branch was embolized in 28 tumors, and 2 branches were embolized in five tumors. Twenty-seven tumors (81.8%) were classed as complete, and 6 (18.2%) were classed as adequate. None of the tumors were classed as incomplete. Twenty-five tumors (75.8%) had not recurred during 12.0 +/- 6.2 months. Eight tumors (24.2%), 5 (18.5%) of 27 complete success and 3 (50%) of 6 adequate success, recurred during 10.1 +/- 6.2 months. CBCT during TACE is useful in detecting and treating small HCC lesions that cannot not be demonstrated on angiography.