Development and preliminary evaluation of software for planning selective liver embolizations from three-dimensional rotational fluoroscopy imaging

Purpose: Liver cancer can be treated by transcatheter hepatic arterial embolization. Selective embolizations are desirable as they impact tumors and with limited damage to the surrounding healthy liver. These interventions are typically performed under fluoroscopy guidance. The advent of modern C-arms allows for the acquisition of three-dimensional images that offer a very detailed, unambiguous view of the hepatic arterial network. Methods: We developed a software specifically for planning selective liver tumor embolization from three-dimensional fluoroscopy. Based on the geometry of the vasculature around a targeted tumor, feeding vessels are inferred and highlighted. This accelerates and simplifies the determination of selective treatment points. Results: A retrospective study on nine patients (15 tumors) in two centers showed that the proposed software detected 89% of tumor feeding vessels (unaided radiologists detected 69% based on two-dimensional fluoroscopy) with a positive predictive value of 94% (90% for radiologists). Processing time was 142 s. Conclusion: The current report describes a feasibility analysis of a treatment planning software specifically geared to selective transcatheter delivery procedures in interventional oncology. This software takes advantage of recent advances in three-dimensional rotational angiography and vascular segmentation algorithms. It is likely that in the near term these types of tools will become integral parts of transcatheter therapies.