| Objective: DSA analysis 1.0 image processing software was used for processing of hepatic arteriography image before interventional TACE treatment, to obtain the time-video density curve (TVDC) of cancer focus, paracancer liver tissue and background liver tissue, and to perform a quantitative TVDC analysis, with a view to achieving the following objectives:①preliminary study of correlation of various parameters and hemodynamics in cancer, paracancer liver tissue, background liver tissue and their differences, and preliminary analysis of the characteristics, significance of various hemodynamic parameters, and their role on the semi-quantitative analysis of hemodynamics;②preliminary evaluation of the correlation between liver hemodynamics and lipiodol deposition.Methods: There were a total of 42 cases who underwent liver cancer TACE in this study. After excluding 8 patients because they did not meet requirement for image analysis, 34 cases were included in the final study, with 28 males and 6 females, average age of 56 years (28 - 76 years). All patients after being clinically diagnosed as primary liver cancer underwent interventional therapy for the first time. None underwent surgery, chemoradiotherapy nor any other treatment prior to interventional therapy. GE Innova 3100 flat panel with large C-arm Digital Subtraction X-ray with Medrad Mark V power injector and hewlett-packard XW8200 AW workstation was used for interventional therapy. Image processing was done using DSA analysis 1.0, a sofware developed by the department.All cases underwent proper hepatic artery study with a high pressure bolus injection of 15 mL of iopamidol-370 (concentration 370 mgI/ml) as contrast agent at a flow rate of 5 ml/s, an exposure delay of 0.5 s after injection, 15 s continuous image acquisition at a frame rate of 4/s (fps) to obtain 60 (4×15) images. After angiogragraphy, superselective catheterisation of supplying cancer artery was performed with subsequent pulse injection of a mixture of chemotherapy drugs and lipiodol for embolotherapyDSA analysis 1.0 image processing software was used for analysis of DSA source image of hepatic arteriography. ROI's were drawn around tumor vessel supply and tumor staining of background liver tissue, stained tumor and adjacent paracancer liver tissue foci to generate the TVDC of each ROI. Analysis of each TVDC was done to obtain parameters related to hemodynamics. Average of 5 ROI's were taken. Analysis of TVDC characteristics and comparison of the difference in parameters in each area was performed. Parameters related to hemodynamics were: incremental peak (ΔPV), time-to-peak time (TP), Time to the start of developing (TS) , time to end staining, display time (TD), maximum gradient of declining slope (KmaxD) and maximum gradient of the increasing slope (KmaxU) of TVDC.According to the degree and area of deposition of lipiodol after interventional embolotherapy, every patient was assessed for lipiodol deposition in the liver cancer ROI and a lipiodol deposition index was calculated. Two groups were made and their parameter differences were studied: good deposition group had an average deposition index≥4 points while the poor deposition group had <4 points. Each hemodynamic parameter were evaluated for correlation with lipiodol deposition index. A scatterplot was drawn with the parameter that had the best correlation and correlation coefficient was found.Results: (1) On comparing the display time (TD) and the maximum gradient of the declining slope (KmaxD) between the TVDC of cancer, paracancer liver tissue, and background liver tissue, a significant difference was found. TD in cancer> paracancer liver tissue> background liver tissue. KmaxD in background liver tissue> paracancer lier tissue> cancer. However, for other parameters, there was no statistical significance (P> 0.05) between the 3 groups.(2) There was a very significant difference between the TD of good lipiodol deposition and poor deposition groups but no statistical difference in other parameters. The correlation coeficient of parameters of the cancer group with lipiodol deposition index in descending order was: TD> KmaxD> KmaxU>APV > TP, with negative correlation with KmaxD, TP and lipiodol deposition index while others were positively correlated. Among the parameters, the correlation of TD, KmaxD values with lipiodol deposition index were relatively good with statiscal significance (P <0.05) and TD having the greatest correlation coefficient.Conclusion:1. Through the analysis of TVDC obtained from DSA analysis 1.0 software, semi-quantitative parameters of hemodynamics can be obtained with TD, KmaxD reflecting to some extent the hemodynamic differences between cancer, paracancer liver tissue and background liver tissue;2. Parameter values obtained from the analysis of T-VDC in the cancer focus group, TD was correlated with lipiodol deposition.
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