{"title":"Dynamic Multi-Phase-Fused Photon-Counting CT for Pre-TACE Feeding Artery Mapping and DSA Procedural Road-Mapping in Hepatocellular Carcinoma.","authors":"Hao Chen, Hao Deng, Xin Wei, Xi Liu, Weijuan Chen","doi":"10.3390/cancers18193152","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background/Objectives:</b> Accurate preoperative feeding artery mapping remains challenging for hepatocellular carcinoma (HCC) even with modern CT techniques. This study aimed to optimize dynamic multi-phase photon-counting CT (PCCT) hepatic artery protocols and assess dynamic-fusion PCCT against best single-phase PCCT and energy-integrating-detector dual-energy CT (EID-DECT) for feeding artery detection, vascular-map construction and digital subtraction angiography (DSA) path-planning prior to transarterial chemoembolization (TACE) in HCC. <b>Methods:</b> This prospective single-center study contained workflow-optimization among cirrhotic non-HCC patients and clinical validation in TACE-candidate HCC patients. Two radiologists performed blinded independent reading. The composite reference standard consisted of DSA, selective/superselective angiography, available cone-beam computed tomography (CBCT) and embolization records. Primary endpoint: patient-level paired difference in DSA-verified feeding artery coverage. Secondary endpoints included complete-atlas rate, DSA-path-prediction accuracy, missed-vessel count and extrahepatic-supply detection. A pre-specified comparison between dynamic-fusion PCCT and EID-DECT was performed. <b>Results:</b> Dynamic phase 1-6 fusion was the optimal PCCT scheme, while optimal single-phase varied individually. Dynamic-fusion PCCT achieved superior feeding artery coverage (97.78% ± 8.61% vs. 88.33% ± 15.37%, difference 9.44 pp, 95% CI 1.82-17.06, <i>p</i> = 0.016), complete-atlas rate (93.3% vs. 53.3%, <i>p</i> = 0.039) and path-prediction accuracy (96.67% ± 11.18% vs. 80.00% ± 24.49%), with fewer missed culprit vessels. Two extrahepatic feeders were only detected by dynamic-fusion PCCT. Compared with EID-DECT, dynamic-fusion PCCT showed favorable atlas-related metrics without statistically significant difference in feeding artery coverage. <b>Conclusions:</b> Dynamic-fusion PCCT outperforms single-phase PCCT in pre-TACE feeding artery mapping and DSA path-prediction and shows potential benefits over EID-DECT. It delivers comprehensive preoperative vascular data and may reduce intraoperative exploratory procedures.</p>","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"18 19","pages":""},"PeriodicalIF":4.8000,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664630/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancers","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3390/cancers18193152","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background/Objectives: Accurate preoperative feeding artery mapping remains challenging for hepatocellular carcinoma (HCC) even with modern CT techniques. This study aimed to optimize dynamic multi-phase photon-counting CT (PCCT) hepatic artery protocols and assess dynamic-fusion PCCT against best single-phase PCCT and energy-integrating-detector dual-energy CT (EID-DECT) for feeding artery detection, vascular-map construction and digital subtraction angiography (DSA) path-planning prior to transarterial chemoembolization (TACE) in HCC. Methods: This prospective single-center study contained workflow-optimization among cirrhotic non-HCC patients and clinical validation in TACE-candidate HCC patients. Two radiologists performed blinded independent reading. The composite reference standard consisted of DSA, selective/superselective angiography, available cone-beam computed tomography (CBCT) and embolization records. Primary endpoint: patient-level paired difference in DSA-verified feeding artery coverage. Secondary endpoints included complete-atlas rate, DSA-path-prediction accuracy, missed-vessel count and extrahepatic-supply detection. A pre-specified comparison between dynamic-fusion PCCT and EID-DECT was performed. Results: Dynamic phase 1-6 fusion was the optimal PCCT scheme, while optimal single-phase varied individually. Dynamic-fusion PCCT achieved superior feeding artery coverage (97.78% ± 8.61% vs. 88.33% ± 15.37%, difference 9.44 pp, 95% CI 1.82-17.06, p = 0.016), complete-atlas rate (93.3% vs. 53.3%, p = 0.039) and path-prediction accuracy (96.67% ± 11.18% vs. 80.00% ± 24.49%), with fewer missed culprit vessels. Two extrahepatic feeders were only detected by dynamic-fusion PCCT. Compared with EID-DECT, dynamic-fusion PCCT showed favorable atlas-related metrics without statistically significant difference in feeding artery coverage. Conclusions: Dynamic-fusion PCCT outperforms single-phase PCCT in pre-TACE feeding artery mapping and DSA path-prediction and shows potential benefits over EID-DECT. It delivers comprehensive preoperative vascular data and may reduce intraoperative exploratory procedures.
期刊介绍：
Cancers (ISSN 2072-6694) is an international, peer-reviewed open access journal on oncology. It publishes reviews, regular research papers and short communications. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
