Preferential Flow Into Liver Tumors Based On Multimodal Image Analysis For Pre-treatment Planning Of Radioembolization Therapy

Transarterial radioembolization (TARE) is a key treatment for hepatic malignancies where radioactive particles are delivered intra-arterially to a tumor. Hepatic blood supply comes from a combination of the hepatic portal vein and the hepatic artery. Through angiogenesis, pathologic blood flow into liver tumors is increased in the tumor-feeding arteries, leading to an arterial flow shunting effect. Procedures like TARE rely on this preferential flow to deliver drug to the tumor. Thus, treatment accuracy can be improved with better characterization of this preferential arterial flow into the tumor. Here, we develop a methodology to estimate preferential flow into the tumor based on direct analysis of standard-of-care multi-modal imaging for TARE pre-treatment planning for liver tumors. A combination of CT Angiography, Cone-beam CT, and Digital Subtraction Angiography (DSA) images are used. Tumor location and tumor-feeding vessels are co-located across the three, following which an automatic registration and postprocessing of the identified region of interest in the DSA sequence is used to identify preferential flow ratios. We will end with demonstration of this methodology on sample patient cases, and discuss integration with high-resolution CFD models for hepatic tumor flow.