A new software tool for planning interventional procedures in liver cancer.

ABSTRACT

INTRODUCTION: Intra-arterial therapy is an effective way of performing chemotherapy or radiation therapy in patients with primary liver cancer (i.e. hepatocellular carcinoma). Although this minimally invasive approach is now an established treatment option, support tools for pre-operative planning and intra-operative assistance might be helpful. MATERIAL AND METHODS: We developed an approach for semi-automatic segmentation of computed tomography angiography images of the main arterial branches (required for access path to the treatment site), automatic segmentation of the liver, arterial and venous tree, and interactive segmentation of the tumors (required for procedure-specific planning). This approach was then integrated into a liver-specific workflow within EndoSize® solution, a planning software for endovascular procedures. The main branches extraction approach was qualitatively evaluated inside the software, while the automatic segmentation methods were quantitatively assessed. RESULTS: Main branches extraction provides a success rate of 85% (i.e. all arteries correctly extracted) in a dataset of 172 patients. On public databases, a mean DICE of 0.91, 0.47 and 0.92 was obtained for liver, venous and arterial trees segmentation, respectively. CONCLUSIONS: This pipeline is suitable for directly accessing the treatment site, giving anatomic measurements, and visualizing the hepatic trees, liver, and surrounding arteries during the pre-operative planning. ABBREVIATIONS HCC hepatocellular carcinoma; TACE transarterial chemoembolization; SIRT selective internal radiation therapy; CT computed tomography; CTA computed tomography angiography; AMS superior mesenteric artery; LGA left gastric artery; RHA right hepatic artery; LHA left hepatic artery; rbHA right branch of the hepatic artery; lbHA left branch of the hepatic artery; GDA gastroduodenal artery; VOI volume of interest; SD standard deviation; MICCAI medical image computing and computer assisted interventions; MR magnetic resonance.