Cone-Beam CT Angiography for Determination of Tumor-Feeding Vessels During Chemoembolization of Liver Tumors: Comparison of Conventional and Dedicated-Software Analysis

Abstract

PurposeTo compare the ability of dedicated software and conventional cone-beam computed tomography (CT) analysis to identify tumor-feeding vessels in hypervascular liver tumors treated with chemoembolization. Material and MethodsBetween January 2012 and January 2013, 45 patients (32 men, mean age of 61 y; range, 27–85 y) were enrolled, and 66 tumors were treated (mean, 32 mm ± 18; range, 10–81 mm) with conventional chemoembolization with arterial cone-beam CT. Data were independently analyzed by six interventional radiologists with standard postprocessing software, a computer-aided analysis with FlightPlan for liver (FPFL; ie, “raw FPFL”), and a review of this computer-aided FPFL analysis (“reviewed FPFL”). Analyses were compared with a reference reading established by two study supervisors in consensus who had access to all imaging data. Sensitivities, positive predictive values (PPVs), and false-positive (FP) ratios were compared by McNemar, χ2, and Fisher exact tests. Analysis durations were compared by Mann–Whitney test, and interreader agreement was assessed. ResultsReference reading identified 179 feeder vessels. The sensitivity of raw FPFL was significantly higher than those of reviewed FPFL and conventional analyses (90.9% vs 83.2% and 82.1%; P < .0001), with lower PPV (82.9% vs 91.2% and 90.6%, respectively; P < .0001), higher FP ratio (17.1% vs 9.4% and 8.8%, respectively; P < .0001), and greater interreader agreement (92% vs 80% and 79%, respectively; P < .0001). Reviewed FPFL analysis took significantly longer than both other analyses (P < .0001). ConclusionsThe FPFL analysis software enabled a fast, accurate, and sensitive detection of tumor feeder vessels.