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

 Seung-Moon Joo  ;  Yong Pyo Kim  ;  Tae Jun Yum  ;  Na Lae Eun  ;  Dahye Lee  ;  Kwang-Hun Lee 
 KOREAN JOURNAL OF RADIOLOGY, Vol.17(5) : 771-778, 2016 
Journal Title
Issue Date
Adult ; Aged ; Angiography, Digital Subtraction/methods ; Carcinoma, Hepatocellular/blood supply ; Carcinoma, Hepatocellular/diagnostic imaging ; Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/therapy* ; Chemoembolization, Therapeutic/methods* ; Cone-Beam Computed Tomography/methods ; Female ; Humans ; Liver Neoplasms/blood supply ; Liver Neoplasms/diagnostic imaging ; Liver Neoplasms/pathology ; Liver Neoplasms/therapy* ; Male ; Middle Aged ; Neovascularization, Pathologic/diagnostic imaging ; Neovascularization, Pathologic/therapy ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; Software
Chemoembolization ; Cone-beam CT ; FlightPlan ; HCC ; Hepatoma ; Liver ; TACE
OBJECTIVE: To 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 METHODS: The 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.

RESULTS: In 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.

CONCLUSION: FlightPlan 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.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Pyo(김용표)
Yum, Tae Jun(염태준)
Eun, Na Lae(은나래) ORCID logo https://orcid.org/0000-0002-7299-3051
Lee, Kwang Hun(이광훈)
Joo, Seung Moon(주승문) ORCID logo https://orcid.org/0000-0002-0647-2880
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