Evaluation of the Value of Automated 3D Navigation Software in Identifying the Arterial Supply for Chemoembolization in the Treatment of Hepatocellular Carcinoma

Abstract This article evaluates the use of automated feeder detection (AFD) software in the accurate detection of feeding arteries for hepatocellular carcinoma (HCC), and how its use affects radiation exposure time, radiation dose, and the amount of contrast agent used in transarterial chemoembolization (TACE). This is a descriptive prospection, controlled study. The research group consisted of 14 patients with 18 lesions of HCC indicated for TACE, and a control group of 16 patients with 18 HCC lesions. TACE in the study group was performed on an angiography machine with AFD software for automatic identification of feeding vessels (syngo Embolization Guidance, Siemens Healthineers, Forchheim, Germany), while the control group underwent TACE on the same angiography machine (Artis Q, Siemens Healthineers) without AFD software. Complete concordance in detecting tumor-feeding arteries by AFD software was achieved in 66.7% of tumors, while missed feeders occurred in 5.5% and additional (false-positive) feeders in 27.8%. The average number of digital subtraction angiography (DSA) runs was lower in the AFD group (5.6 runs) compared to the control group (6.6 runs). The average contrast agent volume and fluoroscopy time were lower in the AFD group (176.07 ± 57.25 mL and 20.0 ± 8.67 minutes) than in the control group (231.25 ± 210.46 mL and 27.84 ± 18.45 minutes). However, total radiation dose was higher in the AFD group (473.81 ± 198.96 mGy) compared to the control group (357.28 ± 257.92 mGy) due to cone-beam computed tomography (CBCT) acquisition. AFD software and CBCT provide additional information about the feeding vessels of the tumor, allowing for more targeted and effective embolization, especially for small tumors where feeding vessels are difficult to detect on conventional DSA. The radiation exposure time and contrast agent volume were lower. Larger studies are needed.