Purpose Dedicated tumor feeding vessel detection soft-
ware (TFVDS) using cone beam CT has shown a higher
sensitivity to detect tumor feeding vessels during hepatic
arterial embolization (HAE) of hepatocellular carcinoma
(HCC) compared to 2D imaging. Our primary hypothesis
was that HCC tumors treated with HAE guided by a
TFVDS would show more complete response (CR) than
when treated with 2D imaging alone. Secondary analysis of
the impact on X-ray exposure was performed.
Materials and Methods Nineteen males and 8 females
(median age: 69 year, 46–85) with 44 tumors (median size:
38 mm, 6–100) treated with selective HAE between Jan-
uary 2013 and December 2014 were included. Exclusion
criteria were: extra-hepatic supply, [4 tumors, tumor size
[10 cm, and adjunctive local therapy. Baseline patient and
procedure characteristics were reviewed. Differences in CR
per modified Response Evaluation Criteria in Solid Tumors
were assessed by univariate and multivariate analyses for
tumor size, number, location, particles size, and use of
TFVDS.
Results Median imaging follow-up was 20.1 months
(2–33). Use of TFVDS (13 patients, 19 tumors) was the
only factor predictive of CR (OR = 3.85 [CI95%: 1.09,
13.67], p = 0.04) on univariate analysis but not on multi-
variate analysis (OR = 3.26 [0.87, 12.23], p = 0.08). A

• Hepatic Arterial Embolization Using Cone Beam CT with Tumor Feeding Vessel Detection Software: Impact on Hepatocellular Carcinoma Response