Liver cancer is the sixth most common cancer in the world and the fourth leading cause of cancer mortality. In unresectable liver cancers, especially hepatocellular carcinoma (HCC), transarterial radioembolisation (TARE) can be considered for treatment. TARE treatment involves a contrast-enhanced magnetic resonance imaging (CE-MRI) exam performed beforehand to delineate the liver and tumour(s) in order to perform dosimetry calculation. Due to the significant amount of time and expertise required to perform the delineation process, there is a strong need for automation. Unfortunately, the lack of publicly available CE-MRI datasets with liver tumour annotations has hindered the development of fully automatic solutions for liver and tumour segmentation. The “Tumour and Liver Automatic Segmentation” (ATLAS) dataset that we present consists of 90 liver-focused CE-MRI covering the entire liver of 90 patients with unresectable HCC, along with 90 liver and liver tumour segmentation masks. To the best of our knowledge, the ATLAS dataset is the first public dataset providing CE-MRI of HCC with annotations. The public availability of this dataset should greatly facilitate the development of automated tools designed to optimise the delineation process, which is essential for treatment planning in liver cancer patients.

The aim of our study was to assess the efficacy of a computed tomography (CT)-Navigation™ electromagnetic system compared to conventional CT methods for percutaneous lung biopsies (PLB). In this single-center retrospective study, data of a CT-Navigation™ system guided PLB (NAV-group) and conventional CT PLB (CT-group) performed between January 2017 and February 2020 were reviewed. The primary endpoint was the diagnostic success. Secondary endpoints were technical success, total procedure duration, number of CT acquisitions and the dose length product (DLP) during step ∆1 (from planning to initial needle placement), step ∆2 (progression to target), and the entire intervention (from planning to final control) and complications. Additional parameters were recorded, such as the lesion’s size and trajectory angles. Sixty patients were included in each group. The lesions median size and median values of the two trajectory angles were significantly lower (20 vs. 29.5 mm, p = 0.006) and higher in the NAV-group (15.5° and 10° vs. 6° and 1°; p < 0.01), respectively. Technical and diagnostic success rates were similar in both groups, respectively 95% and 93.3% in the NAV-group, and 93.3% and 91.6% in the CT-group. There was no significant difference in total procedure duration (p = 0.487) and total number of CT acquisitions (p = 0.066), but the DLP was significantly lower in the NAV-group (p < 0.01). There was no significant difference in complication rate. For PLB, CT-Navigation™ system is efficient and safe as compared to the conventional CT method.

Liver tumors are common and may be unamenable to surgery or ablative treatments. Consequently, other treatments have been devised. To assess the safety and efficacy of transarterial radioembolization (TARE) with Yttrium-90 for hepatocellular carcinoma (HCC), liver-dominant hepatic colorectal cancer metastases (mCRC), and cholangiocarcinoma (CCA), performed according to current recommendations, we conducted a single-center retrospective study in 70 patients treated with TARE (HCC, n = 44; mCRC, n = 20; CCA, n = 6). Safety and toxicity were assessed using the National Cancer Institute Common Terminology Criteria. Treatment response was evaluated every 3 months on imaging studies using Response Evaluation Criteria in Solid Tumors (RECIST) or mRECIST criteria. Overall survival and progression-free survival were estimated using the Kaplan-Meier method. The median delivered dose was 1.6 GBq, with SIR-Spheres^® or TheraSphere^® microspheres. TARE-related grade 3 adverse events affected 17.1% of patients. Median follow-up was 32.1 months. Median progression-free survival was 5.6 months and median overall time from TARE to death was 16.1 months and was significantly shorter in men. Progression-free survival was significantly longer in women (HR, 0.49; 95%CI, 0.26–0.90; p = 0.031). Risk of death or progression increased with the number of systemic chemotherapy lines. TARE can be safe and effective in patients with intermediate- or advanced-stage HCC, CCA, or mCRC refractory or intolerant to appropriate treatments.

Background: Selective internal radiation therapy (SIRT) increasingly relies on accurate magnetic resonance imaging (MRI) to computed tomography (CT) registration and accurate liver and tumour segmentation, for effective pre-treatment planning. This study evaluates the impact of automatic registration and segmentation techniques on dosimetry calculations for SIRT treatment planning. It compares semi-automatic and automatic registration, as well as manual and automatic deep learning-based segmentation. Methods: Pre-treatment data from 90 patients with hepatocellular carcinoma were analysed. The dataset consisted of contrast-enhanced T1-weighted MRI scans with manually delineated liver and tumour volumes of interest (VOIs), as well as single-photon emission computed tomography (SPECT)/CT scans with manually or semi-automatically delineated liver VOI. The clinical routine pipeline, which involves semi-automatic registration and manual/semi-automatic segmentation, was used as the baseline pipeline and compared to experimental pipelines that use intensity-based deformable automatic registration or deep learning-based automatic segmentation. Dosimetric accuracy was assessed via metrics such as the mean absorbed dose, the minimum dose received by 70% of the volume (D70), and inverted cumulative dose-volume histograms. Results: Semi-automatic and automatic MRI to CT liver registration achieved comparable Dice scores of 92%. However, tumour registration varied significantly between registration methods yielding average Dice scores of 79%. Multimodal tumour segmentation approaches outperformed monomodal ones, achieving average Dice scores of 66.6 versus 62.5%. Using the baseline pipeline, the average tumour absorbed dose per patient was 115.6 Gy. Using the fully automatic approach, tumour absorbed doses differed from baseline values by an average of 6.6 Gy. Differences ranged from 0.3 Gy in the best case to 202.8 Gy when the automatic tumour segmentation markedly deviated from the manual delineation. Finally, it was found that a Dice score of at least 80% was required to avoid statistically significant differences in absorbed dose estimates between the clinical and automatic approaches. Conclusion: Semi-automatic and automatic registration show equivalent performance, allowing for complete automation. Automatic segmentation demonstrates promising results, with approximately 40% of patients achieving tumour Dice scores above the 80% threshold. 30% of cases show intermediate performance (60–80% tumour Dice scores), while the remaining 30% are still challenging. Further refinement of segmentation methods is required to enhance dosimetric accuracy.