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Karim H, Thormann M, Omari J, Surov A, Schinner R, Seidensticker R, Ingenerf M, Ricke J, Schmid-Tannwald C. Diffusion-weighted MRI (DWI) for assessment of response to high-dose-rate CT-guided brachytherapy (HDR-BT) of hepatocellular carcinoma. Acta Radiol 2024; 65:14-22. [PMID: 36843430 DOI: 10.1177/02841851231154498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND High-dose-rate computed tomography (CT)-guided brachytherapy (HDR-BT) has shown promising results in patients with hepatocellular carcinoma (HCC). While growing evidence shows clear limitations of mRECIST, diffusion-weighted imaging (DWI) has relevant potential in improving the response assessment. PURPOSE To assess whether DWI allows evaluation of short- and long-term tumor response in patients with HCC after HDR-BT. MATERIAL AND METHODS A total of 22 patients with 11 non-responding HCCs (NR-HCC; local tumor recurrence within two years) and 24 responding HCCs (R-HCC; follow-up at least two years) were included in this retrospective bi-center study. HCCs were treated with HDR-BT and patients underwent pre- and post-interventional magnetic resonance imaging (MRI). Analyses of DWI were evaluated and compared between pre-interventional MRI, 1.follow-up after 3 months and 2.follow-up at the time of the local tumor recurrence (in NR-HCC) or after 12 months (in R-HCC). RESULTS ADCmean of R-HCC increased significantly after HDR-BT on the first and second follow-up (ADCmean: 0.87 ± 0.18 × 10-3 mm2/s [pre-interventional]: 1.14 ± 0.23 × 10-3 mm2/s [1. post-interventional]; 1.42 ± 0.32 × 10-3 mm2/s [2. post-interventional]; P < 0.001). ADCmean of NR-HCC did not show a significant increase from pre-intervention to 1. post-interventional MRI (ADCmean: 0.85 ± 0.24 × 10-3 mm2/s and 1.00 ± 0.30 × 10-3 mm2/s, respectively; P = 0.131). ADCmean increase was significant between pre-intervention and 2. follow-up (ADCmean: 1.03 ± 0.19 × 10-3 mm2/s; P = 0.018). There was no significant increase of ADCmean between the first and second follow-up. There was, however, a significant increase of ADCmin after 12 months (ADCmin: 0.87 ± 0.29 × 10-3 mm2/s) compared to pre-interventional MRI and first follow-up (P < 0.005) only in R-HCC. CONCLUSION The tumor response after CT-guided HDR-BT was associated with a significantly higher increase in ADCmean and ADCmin in short- and long-term follow-up.
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Affiliation(s)
- Homeira Karim
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Thormann
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Regina Schinner
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Maria Ingenerf
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Stocker D, King MJ, Homsi ME, Gnerre J, Marinelli B, Wurnig M, Schwartz M, Kim E, Taouli B. Early post-treatment MRI predicts long-term hepatocellular carcinoma response to radiation segmentectomy. Eur Radiol 2024; 34:475-484. [PMID: 37540318 PMCID: PMC10791774 DOI: 10.1007/s00330-023-10045-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Radiation segmentectomy using yttrium-90 plays an emerging role in the management of early-stage HCC. However, the value of early post-treatment MRI for response assessment is uncertain. We assessed the value of response criteria obtained early after radiation segmentectomy in predicting long-term response in patients with HCC. MATERIALS AND METHODS Patients with HCC who underwent contrast-enhanced MRI before, early, and 12 months after radiation segmentectomy were included in this retrospective single-center study. Three independent radiologists reviewed images at baseline and 1st follow-up after radiation segmentectomy and assessed lesion-based response according to mRECIST, LI-RADS treatment response algorithm (TRA), and image subtraction. The endpoint was response at 12 months based on consensus readout of two separate radiologists. Diagnostic accuracy for predicting complete response (CR) at 12 months based on the 1st post-treatment MRI was calculated. RESULTS Eighty patients (M/F 60/20, mean age 67.7 years) with 80 HCCs were assessed (median size baseline, 1.8 cm [IQR, 1.4-2.9 cm]). At 12 months, 74 patients were classified as CR (92.5%), 5 as partial response (6.3%), and 1 as progressive disease (1.2%). Diagnostic accuracy for predicting CR was fair to good for all readers with excellent positive predictive value (PPV): mRECIST (range between 3 readers, accuracy: 0.763-0.825, PPV: 0.966-1), LI-RADS TRA (accuracy: 0.700-0.825, PPV: 0.983-1), and subtraction (accuracy: 0.775-0.825, PPV: 0.967-1), with no difference in accuracy between criteria (p range 0.053 to > 0.9). CONCLUSION mRECIST, LI-RADS TRA, and subtraction obtained on early post-treatment MRI show similar performance for predicting long-term response in patients with HCC treated with radiation segmentectomy. CLINICAL RELEVANCE STATEMENT Response assessment extracted from early post-treatment MRI after radiation segmentectomy predicts complete response in patients with HCC with high PPV (≥ 0.96). KEY POINTS • Early post-treatment response assessment on MRI predicts response in patients with HCC treated with radiation segmentectomy with fair to good accuracy and excellent positive predictive value. • There was no difference in diagnostic accuracy between mRECIST, LI-RADS, and subtraction for predicting HCC response to radiation segmentectomy.
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Affiliation(s)
- Daniel Stocker
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Michael J King
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria El Homsi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey Gnerre
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brett Marinelli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Moritz Wurnig
- Institute of Radiology, Spital Lachen AG, Lachen, Switzerland
| | - Myron Schwartz
- Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Edward Kim
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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3
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Dioguardi Burgio M, Garzelli L, Cannella R, Ronot M, Vilgrain V. Hepatocellular Carcinoma: Optimal Radiological Evaluation before Liver Transplantation. Life (Basel) 2023; 13:2267. [PMID: 38137868 PMCID: PMC10744421 DOI: 10.3390/life13122267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/27/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
Liver transplantation (LT) is the recommended curative-intent treatment for patients with early or intermediate-stage hepatocellular carcinoma (HCC) who are ineligible for resection. Imaging plays a central role in staging and for selecting the best LT candidates. This review will discuss recent developments in pre-LT imaging assessment, in particular LT eligibility criteria on imaging, the technical requirements and the diagnostic performance of imaging for the pre-LT diagnosis of HCC including the recent Liver Imaging Reporting and Data System (LI-RADS) criteria, the evaluation of the response to locoregional therapy, as well as the non-invasive prediction of HCC aggressiveness and its impact on the outcome of LT. We will also briefly discuss the role of nuclear medicine in the pre-LT evaluation and the emerging role of artificial intelligence models in patients with HCC.
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Affiliation(s)
- Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, AP-HP. Nord, 100 Boulevard du Général Leclerc, 92110 Clichy, France (V.V.)
- Centre de Recherche sur l’Inflammation, UMR1149, Université Paris Cité, 75018 Paris, France
| | - Lorenzo Garzelli
- Service d’Imagerie Medicale, Centre Hospitalier de Cayenne, Avenue des Flamboyants, Cayenne 97306, French Guiana
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy
| | - Maxime Ronot
- Department of Radiology, Hôpital Beaujon, AP-HP. Nord, 100 Boulevard du Général Leclerc, 92110 Clichy, France (V.V.)
- Centre de Recherche sur l’Inflammation, UMR1149, Université Paris Cité, 75018 Paris, France
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, AP-HP. Nord, 100 Boulevard du Général Leclerc, 92110 Clichy, France (V.V.)
- Centre de Recherche sur l’Inflammation, UMR1149, Université Paris Cité, 75018 Paris, France
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Cox DRA, Chung W, Grace J, Wong D, Kutaiba N, Ranatunga D, Khor R, Perini MV, Fink M, Jones R, Goodwin M, Dobrovic A, Testro A, Muralidharan V. Evaluating treatment response following locoregional therapy for hepatocellular carcinoma: A review of the available serological and radiological tools for assessment. JGH OPEN 2023; 7:249-260. [PMID: 37125252 PMCID: PMC10134770 DOI: 10.1002/jgh3.12879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 04/05/2023]
Abstract
Hepatocellular carcinoma (HCC) is an aggressive primary malignancy of the liver and is the third most common cause of cancer-related global mortality. There has been a steady increase in treatment options for HCC in recent years, including innovations in both curative and non-curative therapies. These advances have brought new challenges and necessary improvements in strategies of disease monitoring, to allow early detection of HCC recurrence. Current serological and radiological strategies for post-treatment monitoring and prognostication and their limitations will be discussed and evaluated in this review.
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Affiliation(s)
- Daniel R A Cox
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
| | - William Chung
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Josephine Grace
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Darren Wong
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Numan Kutaiba
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Dinesh Ranatunga
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Richard Khor
- Department of Radiation Oncology Austin Health Melbourne Victoria Australia
- School of Molecular Sciences, La Trobe University Melbourne Victoria Australia
- Department of Medical Imaging and Radiation Sciences Monash University Melbourne Victoria Australia
| | - Marcos V Perini
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
| | - Michael Fink
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
| | - Robert Jones
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Mark Goodwin
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Alex Dobrovic
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
| | - Adam Testro
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
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5
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Mangieri CW, Valenzuela CD, Strode MA, Erali RA, Shen P, Howerton R, Clark CJ. Effect of preoperative liver-directed therapy prior to hepatic resection. Am J Surg 2023; 225:703-708. [PMID: 36307334 DOI: 10.1016/j.amjsurg.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Hepatobiliary malignancies present with advanced disease precluding upfront resection. Liver-directed therapy (LDT), particularly Y-90 radioembolization and transarterial chemoembolization (TACE), has become increasingly utilized to facilitate attempt at oncologic resection. However, the safety profile of preoperative LDT is limited. METHODS Retrospective review of the ACS NSQIP main and targeted hepatectomy registries for 2014-2016. Primary objective was evaluation of outcomes between preoperative LDT cases and those that received upfront resection. RESULTS A total of 8923 cases met selection criteria. 192 cases (2.15%) received either Y-90 or TACE prior to hepatectomy. Multivariate analysis for all study patients revealed preoperative LDT significantly increased the risk of perioperative transfusion (OR 2.19, 95% CI 1.445-3.328, P < 0.0001), sepsis (OR 2.21, 95% CI 1.104-4.411, P = 0.022), and liver failure (OR 2.72, 95% CI 1.562-4.747, P < 0.0001). Subgroup analysis found for primary hepatobiliary malignancies LDT only increased the risk for liver failure. While for secondary hepatic tumors LDT significantly increased perioperative transfusion, sepsis, cardiac failure, renal failure, liver failure, and mortality. The complication profile also significantly increased with advanced T stage. Conversely, on propensity score matching preoperative LDT did not significantly increase perioperative complications. CONCLUSION Preoperative LDT has the potential to convert inoperable hepatic tumors into resectable disease but there is a general increased risk for significant postoperative complications, most notable liver failure. However, on controlled analysis preoperative LDT does not increase perioperative complications and should not be considered a contraindication to resection.
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Affiliation(s)
- Christopher W Mangieri
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, United States.
| | - Cristian D Valenzuela
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, United States
| | - Matthew A Strode
- Womack Army Medical Center, Department of General Surgery, United States
| | - Richard A Erali
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, United States
| | - Perry Shen
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, United States
| | - Russell Howerton
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, United States
| | - Clancy J Clark
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, United States
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6
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Fahmy D, Alksas A, Elnakib A, Mahmoud A, Kandil H, Khalil A, Ghazal M, van Bogaert E, Contractor S, El-Baz A. The Role of Radiomics and AI Technologies in the Segmentation, Detection, and Management of Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:cancers14246123. [PMID: 36551606 PMCID: PMC9777232 DOI: 10.3390/cancers14246123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary hepatic neoplasm. Thanks to recent advances in computed tomography (CT) and magnetic resonance imaging (MRI), there is potential to improve detection, segmentation, discrimination from HCC mimics, and monitoring of therapeutic response. Radiomics, artificial intelligence (AI), and derived tools have already been applied in other areas of diagnostic imaging with promising results. In this review, we briefly discuss the current clinical applications of radiomics and AI in the detection, segmentation, and management of HCC. Moreover, we investigate their potential to reach a more accurate diagnosis of HCC and to guide proper treatment planning.
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Affiliation(s)
- Dalia Fahmy
- Diagnostic Radiology Department, Mansoura University Hospital, Mansoura 35516, Egypt
| | - Ahmed Alksas
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Ahmed Elnakib
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Ali Mahmoud
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Heba Kandil
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
- Faculty of Computer Sciences and Information, Mansoura University, Mansoura 35516, Egypt
| | - Ashraf Khalil
- College of Technological Innovation, Zayed University, Abu Dhabi 4783, United Arab Emirates
| | - Mohammed Ghazal
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates
| | - Eric van Bogaert
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Sohail Contractor
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Ayman El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
- Correspondence:
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Waddell JJ, Townsend PH, Collins ZS, Walter C. Liver-Directed Therapy for Metastatic Colon Cancer: Update. CURRENT COLORECTAL CANCER REPORTS 2022. [DOI: 10.1007/s11888-022-00474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Miller FH, Lopes Vendrami C, Gabr A, Horowitz JM, Kelahan LC, Riaz A, Salem R, Lewandowski RJ. Evolution of Radioembolization in Treatment of Hepatocellular Carcinoma: A Pictorial Review. Radiographics 2021; 41:1802-1818. [PMID: 34559587 DOI: 10.1148/rg.2021210014] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Transarterial radioembolization (TARE) with yttrium 90 has increasingly been performed to treat hepatocellular carcinoma (HCC). TARE was historically used as a palliative lobar therapy for patients with advanced HCC beyond surgical options, ablation, or transarterial chemoembolization, but recent advancements have led to its application across the Barcelona Clinic Liver Cancer staging paradigm. Newer techniques, termed radiation lobectomy and radiation segmentectomy, are being performed before liver resection to facilitate hypertrophy of the future liver remnant, before liver transplant to bridge or downstage to transplant, or as a definite curative treatment. Imaging assessment of therapeutic response to TARE is challenging as the intent of TARE is to deliver local high-dose radiation to tumors through microembolic microspheres, preserving blood flow to promote radiation injury to the tumor. Because of the microembolic nature, early imaging assessment after TARE cannot rely solely on changes in size. Knowledge of the evolving methods of TARE along with the tools to assess posttreatment imaging and response is essential to optimize TARE as a therapeutic option for patients with HCC. ©RSNA, 2021.
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Affiliation(s)
- Frank H Miller
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Camila Lopes Vendrami
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Ahmed Gabr
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Jeanne M Horowitz
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Linda C Kelahan
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Ahsun Riaz
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Riad Salem
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Robert J Lewandowski
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
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Delaney LJ, Tantawi M, Wessner CE, Machado P, Forsberg F, Lyshchik A, O'Kane P, Liu JB, Civan J, Tan A, Anton K, Shaw CM, Eisenbrey JR. Predicting Long-Term Hepatocellular Carcinoma Response to Transarterial Radioembolization Using Contrast-Enhanced Ultrasound: Initial Experiences. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2523-2531. [PMID: 34130880 PMCID: PMC8355136 DOI: 10.1016/j.ultrasmedbio.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/26/2021] [Accepted: 05/06/2021] [Indexed: 05/12/2023]
Abstract
Conventional cross-sectional imaging done shortly after radioembolization of hepatocellular carcinoma (HCC) does not reliably predict long-term response to treatment. This study evaluated whether quantitative contrast-enhanced ultrasound (CEUS) can predict the long-term response of HCC to yttrium-90 (Y-90) treatment. Fifteen patients underwent CEUS at three time points: immediately following treatment and 1 and 2 wk post-treatment. Response 3-6 mo after treatment was categorized on contrast-enhanced magnetic resonance imaging by two experienced radiologists using the Modified Response Evaluation Criteria in Solid Tumors. CEUS data were analyzed by quantifying tumor perfusion and residual fractional vascularity using time-intensity curves. Patients with stable disease on magnetic resonance imaging had significantly greater fractional vascularity 2 wk post-treatment (65.15%) than those with partial or complete response (13.8 ± 9.9%, p = 0.007, and 14.9 ± 15.4%, p = 0.009, respectively). Complete responders had lower tumor vascularity at 2 wk than at post-operative examination (-38.3 ± 15.4%, p = 0.045). Thus, this pilot study suggests CEUS may provide an earlier indication of Y-90 treatment response than cross-sectional imaging.
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Affiliation(s)
- Lauren J Delaney
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mohamed Tantawi
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Patrick O'Kane
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jesse Civan
- Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Allison Tan
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin Anton
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Colette M Shaw
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Aslam A, Kamath A, Spieler B, Maschiocchi M, Sabottke CF, Chernyak V, Lewis SC. Assessing locoregional treatment response to Hepatocellular Carcinoma: comparison of hepatobiliary contrast agents to extracellular contrast agents. Abdom Radiol (NY) 2021; 46:3565-3578. [PMID: 33856509 DOI: 10.1007/s00261-021-03076-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 12/17/2022]
Abstract
Cross-sectional imaging with contrast-enhanced magnetic resonance imaging (MRI) is routinely performed in patients with hepatocellular carcinoma (HCC) to assess tumor response to locoregional therapy (LRT). Current response assessment algorithms, such as the Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (TRA), allow assessment using conventional gadolinium-based extracellular contrast agents (ECA) for accurate tumor response assessment following LRT. MRI with hepatobiliary agents (HBA) allows an acquisition of hepatobiliary phase (HBP), which is proven to increase sensitivity for detection of observations in at-risk patients, particularly for findings < 2 cm. The use of HBA is not yet incorporated into the TRA; however, it is increasingly used in clinical practice. Few published studies have evaluated the performance of LI-RADS TRA by applying ancillary features related to HBP that has resulted in category adjustment, enabling more sensitive and unequivocal diagnosis. This may help timely management of viable cases, without a significant loss of specificity in comparison with the ECA-based LI-RADS TRA assessment. In this review, we will describe and compare the imaging appearance of treated HCC on MRI using extracellular and hepatobiliary contrast agents and discuss emerging evidence and pitfalls in the assessment of tumor response following LRT with HBA.
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Affiliation(s)
- Anum Aslam
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109-5030, USA.
| | - Amita Kamath
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Bradley Spieler
- Department of Radiology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, Rm 343, New Orleans, LA, 70112, USA
| | - Mark Maschiocchi
- Umass Memorial Medical Center- University Campus, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Carl F Sabottke
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Victoria Chernyak
- Department of Radiology and Urology, Albert Einstein College of Medicine, New York, 10467, USA
| | - Sara C Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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11
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Treatment response assessment following transarterial radioembolization for hepatocellular carcinoma. Abdom Radiol (NY) 2021; 46:3596-3614. [PMID: 33909092 DOI: 10.1007/s00261-021-03095-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/01/2021] [Accepted: 04/10/2021] [Indexed: 12/17/2022]
Abstract
Transarterial radioembolization with yttrium-90 microspheres is an established therapy for hepatocellular carcinoma. Post-procedural imaging is important for the assessment of both treatment response and procedural complications. A variety of challenging treatment-specific imaging phenomena complicate imaging assessment, such as changes in tumoral size, tumoral and peritumoral enhancement, and extrahepatic complications. A review of the procedural steps, emerging variations, and timelines for post-treatment tumoral and extra-tumoral imaging changes are presented, which may aid the reporting radiologist in the interpretation of post-procedural imaging. Furthermore, a description of post-procedural complications and their significance is provided.
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Spieler B, Sabottke C, Moawad AW, Gabr AM, Bashir MR, Do RKG, Yaghmai V, Rozenberg R, Gerena M, Yacoub J, Elsayes KM. Artificial intelligence in assessment of hepatocellular carcinoma treatment response. Abdom Radiol (NY) 2021; 46:3660-3671. [PMID: 33786653 DOI: 10.1007/s00261-021-03056-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 02/08/2023]
Abstract
Artificial Intelligence (AI) continues to shape the practice of radiology, with imaging of hepatocellular carcinoma (HCC) being of no exception. This article prepared by members of the LI-RADS Treatment Response (TR LI-RADS) work group and associates, presents recent trends in the utility of AI applications for the volumetric evaluation and assessment of HCC treatment response. Various topics including radiomics, prognostic imaging findings, and locoregional therapy (LRT) specific issues will be discussed in the framework of HCC treatment response classification systems with focus on the Liver Reporting and Data System treatment response algorithm (LI-RADS TRA).
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Kampalath R, Tran-Harding K, Do RKG, Mendiratta-Lala M, Yaghmai V. Evaluation of Hepatocellular Carcinoma Treatment Response After Locoregional Therapy. Magn Reson Imaging Clin N Am 2021; 29:389-403. [PMID: 34243925 DOI: 10.1016/j.mric.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Locoregional therapy (LRT) for hepatocellular carcinoma can be used alone or with other treatment modalities to reduce rates of progression, improve survival, or act as a bridge to cure. As the use of LRT expands, so too has the need for systems to evaluate treatment response, such as the World Health Organization and modified Response Evaluation Criteria In Solid Tumors systems and more recently, the Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (TRA). Early validation results for LI-RADS TRA have been promising, and as research accrues, the TRA is expected to evolve in the near future.
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Affiliation(s)
- Rony Kampalath
- Department of Radiological Sciences, University of California Irvine, 101 The City Drive South, Orange, CA 92868, USA
| | - Karen Tran-Harding
- Department of Radiological Sciences, University of California Irvine, 101 The City Drive South, Orange, CA 92868, USA
| | - Richard K G Do
- Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Radiology, Weill Medical College of Cornell University, New York, NY, USA.
| | - Mishal Mendiratta-Lala
- Radiology, University of Michigan School of Medicine, 1500 East Medical Center Drive, UH B2A209R, Ann Arbor, MI 48109-5030, USA
| | - Vahid Yaghmai
- University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA
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Parikh ND, Cuneo K, Mendiratta‐Lala M. Radiation Therapies for the Treatment of Hepatocellular Carcinoma. Clin Liver Dis (Hoboken) 2021; 17:341-346. [PMID: 34136139 PMCID: PMC8177829 DOI: 10.1002/cld.1060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/11/2020] [Accepted: 10/25/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Neehar D. Parikh
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMI
| | - Kyle Cuneo
- Department of Radiation OncologyUniversity of MichiganAnn ArborMI
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Determination of Tumor Dose Response Thresholds in Patients with Chemorefractory Intrahepatic Cholangiocarcinoma Treated with Resin and Glass-based Y90 Radioembolization. Cardiovasc Intervent Radiol 2021; 44:1194-1203. [PMID: 33890170 DOI: 10.1007/s00270-021-02834-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 03/30/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To compare the efficacies of glass and resin-based Yttrium-90 microspheres by comparing absorbed tumor dose (TD) with both tumor response (TR) and overall survival (OS) in patients with chemorefractory intrahepatic cholangiocarcinoma (ICC). METHODS Post-Y90 treatment bremsstrahlung SPECT/CT of 38 consecutive patients receiving 45 treatments (21 resin microspheres, 24 glass microspheres) were analyzed retrospectively. MIM software v6.9.4 (MIM Software Inc, Cleveland, OH) was used to calculate targeted tumors' dose volume histogram. Modified Response Evaluation Criteria in Solid Tumors was used to evaluate tumor response 3 months post-treatment. Kaplan Meier estimation was used for survival analysis. T-test was used to compare the devices on various dosimetric parameters. RESULTS Thresholds for TD to predict TR with ≥ 80% specificity were as follows: mean TD (Resin: 78.9 Gy; Glass: 254.7 Gy), maximum TD (Resin: 162.9 Gy; Glass: 591 Gy), minimum TD (Resin: 53.7 Gy; Glass: 149.1 Gy). Microsphere type had no effect on survival from first Y90 (Resin: 11.2 mo; Glass 10.9 mo [p = 0.548]). In patients receiving resin microspheres, mean TD ≥ 75 Gy or maximum TD ≥ 150 Gy was associated with median OS of 20.2 mo compared to 6.5 mo for those receiving less (p = 0.001, 0.002, respectively). For patients treated with glass microspheres, those receiving a mean TD ≥ 150 Gy had a median OS of 14.6 mo vs. 2.6 mo for those receiving less (p = 0.031). CONCLUSION TD thresholds predictive of TR and OS differ significantly between glass and resin microspheres. However, microsphere type has no impact on survival in patients with chemorefractory ICC. LEVEL OF EVIDENCE Level 3, Retrospective Study.
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Kennedy P, Lewis S, Bane O, Hectors SJ, Kim E, Schwartz M, Taouli B. Early effect of 90Y radioembolisation on hepatocellular carcinoma and liver parenchyma stiffness measured with MR elastography: initial experience. Eur Radiol 2021; 31:5791-5801. [PMID: 33475773 DOI: 10.1007/s00330-020-07636-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/24/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To quantify hepatocellular carcinoma (HCC) and liver parenchyma stiffness using MR elastography (MRE) and serum alpha fetoprotein (AFP), before and 6 weeks (6w) after 90Y radioembolisation (RE), and to assess the value of baseline tumour and liver stiffness (TS/LS) and AFP in predicting response at 6w and 6 months (6 m). METHODS Twenty-three patients (M/F 18/5, mean age 68.3 ± 9.3 years) scheduled to undergo RE were recruited into this prospective single-centre study. Patients underwent an MRI exam at baseline and 6w following RE (range 39-47 days) which included MRE using a prototype 2D EPI sequence. TS, peritumoural LS/LS remote from the tumour, tumour size, and AFP were measured at baseline and at 6w. Treatment response was determined using mRECIST at 6w and 6 m. RESULTS MRE was technically successful in 17 tumours which were classified at 6w as complete response (CR, n = 7), partial response (PR, n = 4), and stable disease (SD, n = 6). TS and peritumoural LS were significantly increased following RE (p = 0.016, p = 0.039, respectively), while LS remote from tumour was unchanged (p = 0.245). Baseline TS was significantly lower in patients who achieved CR at 6w (p = 0.014). Baseline TS, peritumoural LS (both AUC = 0.857), and AFP (AUC = 0.798) showed fair/excellent diagnostic performance in predicting CR at 6w, but were not significant predictors of OR or CR at 6 m. CONCLUSION Our initial results suggest that HCC TS and peritumoural LS increase early after RE. Baseline TS, peritumoural LS, and AFP were all significant predictors of CR to RE at 6w. These results should be confirmed in a larger study. KEY POINTS • Magnetic resonance elastography-derived tumour stiffness and peritumoural liver stiffness increase significantly at 6 weeks post radioembolisation whereas liver stiffness remote from the tumour is unchanged. • Baseline tumour stiffness and peritumoural liver stiffness are lower in patients who achieve complete response at 6 weeks post radioembolisation. • Baseline tumour size is significantly correlated with baseline tumour stiffness.
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Affiliation(s)
- Paul Kennedy
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA
| | - Octavia Bane
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefanie J Hectors
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Edward Kim
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA
| | - Myron Schwartz
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA.
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Aslam A, Do RKG, Kambadakone A, Spieler B, Miller FH, Gabr AM, Charalel RA, Kim CY, Madoff DC, Mendiratta-Lala M. Hepatocellular carcinoma Liver Imaging Reporting and Data Systems treatment response assessment: Lessons learned and future directions. World J Hepatol 2020; 12:738-753. [PMID: 33200013 PMCID: PMC7643220 DOI: 10.4254/wjh.v12.i10.738] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/07/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality worldwide, with rising clinical and economic burden as incidence increases. There are a multitude of evolving treatment options, including locoregional therapies which can be used alone, in combination with each other, or in combination with systemic therapy. These treatment options have shown to be effective in achieving remission, controlling tumor progression, improving disease free and overall survival in patients who cannot undergo resection and providing a bridge to transplant by debulking tumor burden to downstage patients. Following locoregional therapy (LRT), it is crucial to provide treatment response assessment to guide management and liver transplant candidacy. Therefore, Liver Imaging Reporting and Data Systems (LI-RADS) Treatment Response Algorithm (TRA) was created to provide a standardized assessment of HCC following LRT. LI-RADS TRA provides a step by step approach to evaluate each lesion independently for accurate tumor assessment. In this review, we provide an overview of different locoregional therapies for HCC, describe the expected post treatment imaging appearance following treatment, and review the LI-RADS TRA with guidance for its application in clinical practice. Unique to other publications, we will also review emerging literature supporting the use of LI-RADS for assessment of HCC treatment response after LRT.
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Affiliation(s)
- Anum Aslam
- Department of Radiology, University of Michigan, Ann Arbor, MI 48019, United States.
| | - Richard Kinh Gian Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Avinash Kambadakone
- Abdominal Imaging and Interventional Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Bradley Spieler
- Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Ahmed M Gabr
- Department of Interventional Radiology, OHSU and Tanta University, Egypt, Portland, OR 97239, United States
| | - Resmi A Charalel
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, United States
| | - Charles Y Kim
- Department of Radiology, Duke University Medical Center, Duke University, Durham, NC 27710, United States
| | - David C Madoff
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06520, United States
| | - Mishal Mendiratta-Lala
- School of Medicine, 1500 East Medical Center Drive, University of Michigan, Ann Arbor, MI 48109, United States
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Gabr A, Entezari P, Riaz A, Salem R, Lewandowski RJ. Contemporary Techniques and Applications of Radioembolization in Patients with Hepatocellular Carcinoma. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.yacr.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Establishment and validation of a risk prediction model in patients with hepatocellular carcinoma treated with transarterial radioembolization. Eur J Gastroenterol Hepatol 2020; 32:739-747. [PMID: 31764406 DOI: 10.1097/meg.0000000000001585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIMS Few studies have reported the treatment outcomes of transarterial radioembolization (TARE) using yttrium-90 (Y) for hepatocellular carcinoma (HCC). We established and validated a new risk prediction model for patients with HCC treated with TARE. METHODS Between 2010 and 2017, 113 and 35 patients with intrahepatic HCC treated with TARE were selected for the training and validation cohorts, respectively. The modified response evaluation criteria in solid tumors (mRECIST) were used for response evaluation. RESULTS In the training cohort, the median age was 64.1 years (92 males and 21 females) and the mean survival after TARE was 50.3 months. The cumulative survival rates at six and 12 months were 92.0 and 84.0%, respectively. A new risk prediction model for patients with HCC treated with TARE (Y-scoring system) was established from the training cohort using five independent baseline variables [serum albumin < 3.5 g/dL, hazard ratio = 5.446; alpha-fetoprotein > 200 ng/mL (hazard ratio = 5.071); tumor number ≥ 3 (hazard ratio = 2.933); portal vein thrombosis (hazard ratio = 4.915); and hepatic vein invasion (hazard ratio = 8.500)] and two on-treatment variables [no des-gamma-carboxy prothrombin response (hazard ratio = 15.346) and progressive disease at three months (hazard ratio = 4.154)] for mortality (all P < 0.05). The predictive accuracy of the Y-scoring system was acceptable to predict six [area under the curve (AUC) = 0.845], nine (AUC = 0.868), and 12-month mortality (AUC = 0.886) (all P < 0.05). The predictive accuracy of the system was similarly maintained in the validation cohort (AUC 0.737-0.901 at 6-12 months). CONCLUSION Our new risk prediction model can be used to stratify different prognoses in patients with HCC treated with TARE. Validation studies are required.
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Delli Pizzi A, Mastrodicasa D, Cianci R, Serafini FL, Mincuzzi E, Di Fabio F, Giammarino A, Mannetta G, Basilico R, Caulo M. Multimodality Imaging of Hepatocellular Carcinoma: From Diagnosis to Treatment Response Assessment in Everyday Clinical Practice. Can Assoc Radiol J 2020; 72:714-727. [PMID: 32436394 DOI: 10.1177/0846537120923982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) is a recently developed classification aiming to improve the standardization of liver imaging assessment in patients at risk of developing hepatocellular carcinoma (HCC). The LI-RADS v2017 implemented new algorithms for ultrasound (US) screening and surveillance, contrast-enhanced US diagnosis and computed tomography/magnetic resonance imaging treatment response assessment. A minor update of LI-RADS was released in 2018 to comply with the American Association for the Study of the Liver Diseases guidance recommendations. The scope of this review is to provide a practical overview of LI-RADS v2018 focused both on the multimodality HCC diagnosis and treatment response assessment.
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Affiliation(s)
- Andrea Delli Pizzi
- ITAB-Institute of Advanced Biomedical Technologies, "G. d'Annunzio" University, Chieti, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | | | - Roberta Cianci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | | | - Erica Mincuzzi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Francesca Di Fabio
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Alberto Giammarino
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Gianluca Mannetta
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Raffaella Basilico
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Massimo Caulo
- ITAB-Institute of Advanced Biomedical Technologies, "G. d'Annunzio" University, Chieti, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
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Mendiratta-Lala M, Masch WR, Shampain K, Zhang A, Jo AS, Moorman S, Aslam A, Maturen KE, Davenport MS. MRI Assessment of Hepatocellular Carcinoma after Local-Regional Therapy: A Comprehensive Review. Radiol Imaging Cancer 2020; 2:e190024. [PMID: 33778692 DOI: 10.1148/rycan.2020190024] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/29/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022]
Abstract
Nearly 80% of cirrhotic patients diagnosed with hepatocellular carcinoma (HCC) are not eligible for surgical resection and instead undergo local-regional treatment. After therapy for HCC, patients undergo imaging surveillance to assess treatment efficacy and identify potential sites of progressive tumor elsewhere within the liver. Accurate interpretation of posttreatment imaging is essential for guiding further management decisions, and radiologists must understand expected treatment-specific imaging findings for each of the local-regional therapies. Of interest, expected imaging findings seen after radiation-based therapies (transarterial radioembolization and stereotactic body radiation therapy) are different than those seen after thermal ablation and transarterial chemoembolization. Given differences in expected posttreatment imaging findings, the current radiologic treatment response assessment algorithms used for HCC (modified Response Evaluation Criteria in Solid Tumors classification, European Association for the Study of Liver Diseases criteria, and Liver Imaging and Reporting Data System Treatment Response Algorithm) must be applied cautiously for radiation-based therapies in which persistent arterial phase hyperenhancement in the early posttreatment period is common and expected. This article will review the concept of tumor response assessment for HCC, the forms of local-regional therapy for HCC, and the expected posttreatment findings for each form of therapy. Keywords: Abdomen/GI, Liver, MR-Imaging, Treatment Effects, Tumor Response © RSNA, 2020.
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Affiliation(s)
- Mishal Mendiratta-Lala
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - William R Masch
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - Kimberly Shampain
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - Andrew Zhang
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - Alexandria S Jo
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - Sarah Moorman
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - Anum Aslam
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - Katherine E Maturen
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - Matthew S Davenport
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
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Multi-Objective Design Optimization of a Shape Memory Alloy Flexural Actuator. ACTUATORS 2019. [DOI: 10.3390/act8010013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper presents a computational model and design optimization strategy for shape memory alloy (SMA) flexural actuators. These actuators consist of curved SMA wires embedded within elastic structures; one potential application is positioning microcatheters inside blood vessels during clinical treatments. Each SMA wire is shape-set to an initial curvature and inserted along the neutral axis of a straight elastic member (cast polydimethylsiloxane, PDMS). The elastic structure preloads the SMA, reducing the equilibrium curvature of the composite actuator. Temperature-induced phase transformations in the SMA are achieved via Joule heating, enabling strain recovery and increased bending (increased curvature) in the actuator. Actuator behavior is modeled using the homogenized energy framework, and the effects of two critical design parameters (initial SMA curvature and flexural rigidity of the elastic sleeve) on activation curvature are investigated. Finally, a multi-objective genetic algorithm is utilized to optimize actuator performance and generate a Pareto frontier, which is subsequently experimentally validated.
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Hussein RS, Tantawy W, Abbas YA. MRI assessment of hepatocellular carcinoma after locoregional therapy. Insights Imaging 2019; 10:8. [PMID: 30694398 PMCID: PMC6352610 DOI: 10.1186/s13244-019-0690-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 01/03/2019] [Indexed: 12/16/2022] Open
Abstract
Liver cirrhosis and hepatocellular carcinoma (HCC) constitute one of the major causes of morbidity, mortality, and high health care costs worldwide. Multiple treatment options are available for HCC depending on the clinical status of the patient, size and location of the tumor, and available techniques and expertise. Locoregional treatment options are multiple. The most challenging part is how to assess the treatment response by different imaging modalities, but our scope will be assessing the response to locoregional therapy for HCC by MRI. This will be addressed by conventional MR methods using LI-RADS v2018 and by functional MR using diffusion-weighted imaging, perfusion, and highlighting the value of the novel intravoxel incoherent motion (IVIM).
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Affiliation(s)
- Rasha S Hussein
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt.
| | - Wahid Tantawy
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt
| | - Yasser A Abbas
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt
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Young S, Taylor A, Golzarian J, Flanagan S, D'Souza D, Sanghvi T. Clinical utility of one month imaging following selective internal radiation therapy. Diagn Interv Imaging 2019; 100:39-46. [DOI: 10.1016/j.diii.2018.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/21/2018] [Accepted: 07/06/2018] [Indexed: 01/15/2023]
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25
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Lo EC, N. Rucker A, Federle MP. Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Imaging for Diagnosis, Tumor Response to Treatment and Liver Response to Radiation. Semin Radiat Oncol 2018; 28:267-276. [DOI: 10.1016/j.semradonc.2018.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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26
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Mora RA, Ali R, Gabr A, Abouchaleh N, Asadi AA, Kallini JR, Miller FH, Yaghmai V, Mouli S, Thornburg B, Desai K, Riaz A, Lewandowski RJ, Salem R. Pictorial essay: imaging findings following Y90 radiation segmentectomy for hepatocellular carcinoma. Abdom Radiol (NY) 2018; 43:1723-1738. [PMID: 29147766 DOI: 10.1007/s00261-017-1391-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Transarterial radioembolization is a novel therapy that has gained rapid clinical acceptance for the treatment of hepatocellular carcinoma (HCC). Segmental radioembolization [also termed radiation segmentectomy (RS)] is a technique that can deliver high doses (> 190 Gy) of radiation selectively to the hepatic segment(s) containing the tumor. The aim of this comprehensive review is to provide an illustrative summary of the most relevant imaging findings encountered after radiation segmentectomy. A 62-patient cohort of Child-Pugh A patients with solitary HCC < 5 cm in size was identified. A comprehensive retrospective imaging review was done by interventional radiology staff at our institution. Important imaging findings were reported and illustrated in a descriptive account. For the purposes of completeness, specific patients outside our initial cohort with unique educational imaging features that also underwent segmentectomy were included in this pictorial essay. This review shows that response assessment after RS requires a learning curve with common drawbacks that can lead to false-positive interpretations and secondary unnecessary treatments. It is important to recognize that treatment responses and pathological changes both are time dependent. Findings such as benign geographical enhancement and initial benign pathological enhancement can easily be misinterpreted. Capsular retraction and segmental atrophy are some other examples of unique post-RS response that are not seen in any other treatment.
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Affiliation(s)
- Ronald A Mora
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Rehan Ali
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Nadine Abouchaleh
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ali Al Asadi
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Joseph Ralph Kallini
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Frank H Miller
- Department of Radiology, Section of Body Imaging, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Vahid Yaghmai
- Department of Radiology, Section of Body Imaging, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Samdeep Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Kush Desai
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA.
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
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Ahmed AF, Samreen N, Grajo JR, Zendejas I, Sistrom CL, Collinsworth A, Esnakula A, Shah JL, Cabrera R, Geller BS, Toskich BB. Angiosomal radiopathologic analysis of transarterial radioembolization for the treatment of hepatocellular carcinoma. Abdom Radiol (NY) 2018; 43:1825-1836. [PMID: 29052747 DOI: 10.1007/s00261-017-1354-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess the radiopathologic correlation following Yttrium-90 transarterial radioembolization (TARE) of hepatocellular carcinoma (HCC) using variable radiodosimetry to identify imaging surrogates of histologic response. METHODS Twelve patients with HCC underwent ablative (≥ 190 Gy) and/or non-ablative (< 190 Gy) TARE delivered in a segmental, lobar, or combined fashion as a surgical neoadjuvant or bridge to transplantation. Both targeted tumor and treatment angiosome were analyzed before and after TARE utilizing hepatocyte-specific contrast-enhanced MRI or contrast-enhanced CT. Responses were graded using EASL and mRECIST criteria. Histologic findings including percent tumor necrosis and adjacent hepatic substrate effects were correlated with imaging features. RESULTS Complete pathologic necrosis (CPN) was observed in 7/12 tumors post-TARE. Ablative and non-ablative dosing resulted in CPN in 5/6 and 2/6 tumors, respectively. Hyperintensity on T2-weighted imaging, the absence of hepatocyte-specific gadolinium contrast uptake, and plateau or persistent enhancement kinetics in the angiosome correlated with CPN and performed similarly to EASL and mRECIST criteria in predicting CPN. CONCLUSIONS The absence of hepatocyte-specific contrast uptake, increased signal on T2-weighted sequences, and plateau or persistent enhancement in the angiosome may represent MRI surrogates of CPN following TARE of HCC. These findings correlated with EASL and mRECIST response criteria. Further investigation is needed to determine the role of these findings as possible adjuncts to conventional imaging criteria.
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Adcock CS, Florez E, Zand KA, Patel A, Howard CM, Fatemi A. Assessment of Treatment Response Following Yttrium-90 Transarterial Radioembolization of Liver Malignancies. Cureus 2018; 10:e2895. [PMID: 30175001 PMCID: PMC6116887 DOI: 10.7759/cureus.2895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Transarterial radioembolization using yttrium-90 microspheres is an established and effective treatment for liver malignancies. Determining response to this treatment is difficult due to the radical changes that occur in tissue as a response to radiation. Though accurate assessment of treatment response is paramount for proper patient disposition, there is currently no standardized assessment protocol. Current methods of assessment often consider changes in size, necrosis, vascularity, fluorodeoxyglucose-positron emission tomography FDG-PET metabolic activity, and diffusion using diffusion-weighted magnetic resonance imaging (DWI). Current methods of assessment require a lag time of one to two months post-treatment to determine treatment effectiveness. This delay is a hindrance to obtaining better patient outcomes, giving rise to a need to identify markers for faster determination of treatment efficacy.
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Affiliation(s)
- Charles S Adcock
- Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Edward Florez
- Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Kevin A Zand
- Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Akash Patel
- Interventional Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Candace M Howard
- Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Ali Fatemi
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
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Young S, Taylor AJ, Sanghvi T. Post Locoregional Therapy Treatment Imaging in Hepatocellular Carcinoma Patients: A Literature-based Review. J Clin Transl Hepatol 2018; 6:189-197. [PMID: 29951364 PMCID: PMC6018307 DOI: 10.14218/jcth.2017.00059] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/14/2017] [Accepted: 12/22/2017] [Indexed: 12/19/2022] Open
Abstract
Imaging plays a crucial role in the diagnosis of hepatocellular carcinoma (HCC) as well as in determining treatment efficacy, or complications, following therapy. Unlike other cancers, HCC is most commonly treated by locoregional therapies (LRTs) such as thermal ablation, transarterial chemoembolization, and transarterial radioembolization. These treatments can lead to changes on imaging that make determination of residual/recurrent disease difficult. This literature-based review discusses the expected postimaging findings following LRT.
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Affiliation(s)
- Shamar Young
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Andrew J. Taylor
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- *Correspondence to: Andrew J. Taylor, Department of Radiology, University of Minnesota, 420 Delaware Street SE, MMC 292, Minneapolis, MN 55455, USA. Tel: +1-612-626-6638, Fax: +1-612-626-5505, E-mail:
| | - Tina Sanghvi
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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Bargellini I, Crocetti L, Turini FM, Lorenzoni G, Boni G, Traino AC, Caramella D, Cioni R. Response Assessment by Volumetric Iodine Uptake Measurement: Preliminary Experience in Patients with Intermediate-Advanced Hepatocellular Carcinoma Treated with Yttrium-90 Radioembolization. Cardiovasc Intervent Radiol 2018; 41:1373-1383. [PMID: 29654507 DOI: 10.1007/s00270-018-1962-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/05/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE To retrospectively compare early response to yttrium-90 radioembolization (Y90) according to volumetric iodine uptake (VIU) changes, Response Evaluation Criteria In Solid Tumor 1.1 (RECIST 1.1) and modified RECIST (mRECIST) in patients with intermediate-advanced hepatocellular carcinoma (HCC) and to explore their association with survival. MATERIALS AND METHODS Twenty-four patients treated with Y90 and evaluated with dual-energy computed tomography before and 6 weeks after treatment were included. VIU was measured on late arterial phase spectral images; 6-week VIU response was defined as: complete response (CR, absence of enhancing tumor), partial response (PR, ≥ 15% VIU reduction), progressive disease (PD, ≥ 10% VIU increase) and stable disease (criteria of CR/PR/PD not met). RECIST 1.1 and mRECIST were evaluated at 6 weeks and 6 months. Responders included CR and PR. Overall survival (OS) was evaluated by Kaplan-Meier analysis and compared by Cox regression analysis. RESULTS High intraobserver and interobserver agreements were observed in VIU measurements (k > 0.98). VIU identified a higher number of responders (18 patients, 75%), compared to RECIST 1.1 (12.5% at 6 weeks and 23.8% at 6 months) and mRECIST (29.2% at 6 weeks and 61.9% at 6 months). There was no significant correlation between OS and RECIST 1.1 (P = 0.45 at 6 weeks; P = 0.21 at 6 months) or mRECIST (P = 0.38 at 6 weeks; P = 0.79 at 6 months); median OS was significantly higher in VIU responders (17.2 months) compared to non-responders (7.4 months) (P = 0.0022; HR 8.85; 95% CI 1.29-88.1). CONCLUSION VIU is highly reproducible; as opposite to mRECIST and RECIST 1.1, early VIU response correlates with OS after Y90 in intermediate-advanced HCC patients.
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Affiliation(s)
- Irene Bargellini
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy.
| | - Laura Crocetti
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
| | - Francesca Maria Turini
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
| | - Giulia Lorenzoni
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
| | - Giuseppe Boni
- Department of Nuclear Medicine, Pisa University Hospital, Via Roma 55, 56126, Pisa, Italy
| | | | - Davide Caramella
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
| | - Roberto Cioni
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
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Joo I, Kim HC, Kim GM, Paeng JC. Imaging Evaluation Following 90Y Radioembolization of Liver Tumors: What Radiologists Should Know. Korean J Radiol 2018. [PMID: 29520178 PMCID: PMC5840049 DOI: 10.3348/kjr.2018.19.2.209] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Radioembolization using beta-emitting yttrium-90 microspheres is being increasingly used for the treatment of primary and metastatic liver cancers. It is a form of intra-arterial brachytherapy which delivers intense radiation to liver tumors with little embolic effect; this mode of action results in unique post-treatment imaging findings. It is important to understand these imaging findings to avoid misinterpretation of tumor response and to determine further management of the disease. Herein, we discuss the current concepts for assessing tumor response, common post-treatment imaging features, and associated complications following radioembolization.
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Affiliation(s)
- Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Seoul 03722, Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
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Kielar A, Fowler KJ, Lewis S, Yaghmai V, Miller FH, Yarmohammadi H, Kim C, Chernyak V, Yokoo T, Meyer J, Newton I, Do RK. Locoregional therapies for hepatocellular carcinoma and the new LI-RADS treatment response algorithm. Abdom Radiol (NY) 2018; 43:218-230. [PMID: 28780679 DOI: 10.1007/s00261-017-1281-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Radiologists play a central role in the assessment of patient response to locoregional therapies for hepatocellular carcinoma (HCC). The identification of viable tumor following treatment guides further management and potentially affects transplantation eligibility. Liver Imaging Reporting and Data Systems (LI-RADS) first introduced the concept of LR-treated in 2014, and a new treatment response algorithm is included in the 2017 update to assist radiologists in image interpretation of HCC after locoregional therapy. In addition to offering imaging criteria for viable and nonviable HCC, new concepts of nonevaluable tumors as well as tumors with equivocal viability are introduced. Existing guidelines provided by response evaluation criteria in solid tumors (RECIST) and modified RECIST address patient-level assessments and are routinely used in clinical trials but do not address the variable appearances following different locoregional therapies. The new LI-RADS treatment response algorithm addresses this gap and offers a comprehensive approach to assess treatment response for individual lesions after a variety of locoregional therapies, using either contrast-enhanced CT or MRI.
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Affiliation(s)
- Ania Kielar
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Kathryn J Fowler
- Department of Radiology, Washington University, St. Louis, MO, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vahid Yaghmai
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Hooman Yarmohammadi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles Kim
- Department of Radiology, Duke University, Durham, NC, USA
| | - Victoria Chernyak
- Department of Radiology, Montefiore Medical Center, New York, NY, USA
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Isabel Newton
- Department of Radiology, UC San Diego, San Diego, CA, USA
| | - Richard K Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Imaging of Hepatocellular Carcinoma Response After 90Y Radioembolization. AJR Am J Roentgenol 2017; 209:W263-W276. [DOI: 10.2214/ajr.17.17993] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Clinical outcomes of Y90 radioembolization for recurrent hepatocellular carcinoma following curative resection. Eur J Nucl Med Mol Imaging 2017; 44:2195-2202. [DOI: 10.1007/s00259-017-3792-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
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Padia SA, Lewandowski RJ, Johnson GE, Sze DY, Ward TJ, Gaba RC, Baerlocher MO, Gates VL, Riaz A, Brown DB, Siddiqi NH, Walker TG, Silberzweig JE, Mitchell JW, Nikolic B, Salem R. Radioembolization of Hepatic Malignancies: Background, Quality Improvement Guidelines, and Future Directions. J Vasc Interv Radiol 2017; 28:1-15. [DOI: 10.1016/j.jvir.2016.09.024] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/18/2016] [Accepted: 09/20/2016] [Indexed: 02/09/2023] Open
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Colagrande S, Inghilesi AL, Aburas S, Taliani GG, Nardi C, Marra F. Challenges of advanced hepatocellular carcinoma. World J Gastroenterol 2016; 22:7645-7659. [PMID: 27678348 PMCID: PMC5016365 DOI: 10.3748/wjg.v22.i34.7645] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is an aggressive malignancy, resulting as the third cause of death by cancer each year. The management of patients with HCC is complex, as both the tumour stage and any underlying liver disease must be considered conjointly. Although surveillance by imaging, clinical and biochemical parameters is routinely performed, a lot of patients suffering from cirrhosis have an advanced stage HCC at the first diagnosis. Advanced stage HCC includes heterogeneous groups of patients with different clinical condition and radiological features and sorafenib is the only approved treatment according to Barcelona Clinic Liver Cancer. Since the introduction of sorafenib in clinical practice, several phase III clinical trials have failed to demonstrate any superiority over sorafenib in the frontline setting. Loco-regional therapies have also been tested as first line treatment, but their role in advanced HCC is still matter of debate. No single agent or combination therapies have been shown to impact outcomes after sorafenib failure. Therefore this review will focus on the range of experimental therapeutics for patients with advanced HCC and highlights the successes and failures of these treatments as well as areas for future development. Specifics such as dose limiting toxicity and safety profile in patients with liver dysfunction related to the underlying chronic liver disease should be considered when developing therapies in HCC. Finally, robust validated and reproducible surrogate end-points as well as predictive biomarkers should be defined in future randomized trials.
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Comparison of Choi criteria and Response Evaluation Criteria in Solid Tumors (RECIST) for intrahepatic cholangiocarcinoma treated with glass-microspheres Yttrium-90 selective internal radiation therapy (SIRT). Eur J Radiol 2016; 85:1445-52. [DOI: 10.1016/j.ejrad.2016.05.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 05/22/2016] [Accepted: 05/31/2016] [Indexed: 01/04/2023]
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Abstract
PURPOSE To discuss guidelines and salient imaging findings of solid tumors treated with common intra-arterial procedures used in interventional oncology. METHODS A meticulous literature search of PubMed-indexed articles was conducted. Key words included "imaging + embolization," "imaging + TACE," "imaging + radioembolization," "imaging + Y90," "mRECIST," and "EASL." Representative post-treatment cross-sectional images were obtained from past cases in this institution. RESULTS Intra-arterial therapy (IAT) in interventional oncology includes bland embolization, chemoembolization, and radioembolization. Solid tumors of the liver are the primary focus of these procedures. Cross-sectional CT and/or MR are the main modalities used to image tumors after treatment. Traditional size-based response criteria (WHO and RECIST) alone are of limited utility in determining response to IAT; tumoral necrosis and enhancement must be considered. Specifically for HCC, the EASL and mRECIST guidelines are becoming widely adopted response criteria to assess these factors. DWI, FDG-PET, and CEUS are modalities that play an adjunctive but controversial role. CONCLUSIONS Radiologists must be aware that the different forms of intra-arterial therapy yield characteristic findings on cross-sectional imaging. Knowledge of these findings is integral to accurate assessment of tumor response and progression.
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Chiu RYW, Yap WW, Patel R, Liu D, Klass D, Harris AC. Hepatocellular Carcinoma Post Embolotherapy: Imaging Appearances and Pitfalls on Computed Tomography and Magnetic Resonance Imaging. Can Assoc Radiol J 2016; 67:158-72. [PMID: 26961737 DOI: 10.1016/j.carj.2015.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/26/2015] [Accepted: 09/07/2015] [Indexed: 02/07/2023] Open
Abstract
Embolotherapies used in the treatment of hepatocellular carcinoma (HCC) include bland embolization, conventional transarterial chemoembolization (cTACE) using ethiodol as a carrier, TACE with drug-eluting beads and super absorbent polymer microspheres (DEB-TACE), and selective internal radiation therapy (SIRT). Successfully treated HCC lesions undergo coagulation necrosis, and appear as nonenhancing hypoattenuating or hypointense lesions in the embolized region on computed tomography (CT) and magnetic resonance. Residual or recurrent tumours demonstrate arterial enhancement with portal venous phase wash-out of contrast, features characteristic of HCC, in and/or around the embolized area. Certain imaging features that result from the procedure itself may limit assessment of response. In conventional TACE, the high-attenuating retained ethiodized oil may obscure arterially-enhancing tumours and limit detection of residual tumours; thus a noncontrast CT on follow-up imaging is important post-cTACE. Hyperenhancement within or around the treated zone can be seen after cTACE, DEB-TACE, or SIRT due to physiologic inflammatory response and may mimic residual tumour. Recognition of these pitfalls is important in the evaluation embolotherapy response.
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Affiliation(s)
- Rita Y W Chiu
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Wan W Yap
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roshni Patel
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Liu
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Klass
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison C Harris
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Gaba RC, Lewandowski RJ, Hickey R, Baerlocher MO, Cohen EI, Dariushnia SR, Janne d'Othée B, Padia SA, Salem R, Wang DS, Nikolic B, Brown DB. Transcatheter Therapy for Hepatic Malignancy: Standardization of Terminology and Reporting Criteria. J Vasc Interv Radiol 2016; 27:457-73. [PMID: 26851158 DOI: 10.1016/j.jvir.2015.12.752] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ron C Gaba
- Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ryan Hickey
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Mark O Baerlocher
- Department of Radiology, Royal Victoria Hospital, Barrie, Ontario, Canada
| | - Emil I Cohen
- Department of Radiology, Medstar Washington Hospital Center, Washington, DC
| | - Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Bertrand Janne d'Othée
- Department of Diagnostic Radiology and Nuclear Medicine, Division of Vascular and Interventional Radiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Siddharth A Padia
- Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - David S Wang
- Division of Interventional Radiology, Stanford University Medical Center, Stanford, California
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
| | - Daniel B Brown
- Department of Radiology, Division of Interventional Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
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41
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Riaz A, Lewandowski RJ, Salem R. Locoregional Therapies for Primary and Secondary Hepatic Malignancies. Cancer Treat Res 2016; 168:233-256. [PMID: 29206376 DOI: 10.1007/978-3-319-34244-3_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Management of hepatic malignancies is a multidisciplinary task with the involvement of hepatologists, medical/surgical oncologists, transplant surgeons, and interventional radiologists. The patients should be selected for a specific targeted therapy after multidisciplinary consensus. Interventional oncology has established its role in the management of hepatic malignancies. Image-guided locoregional therapies decrease the rate of systemic toxicity without compromising tumoricidal effect.
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Gaba RC, Baerlocher MO, Nikolic B, Venkatesan AM, Lewandowski RJ. Clinical and Imaging Follow-up Practices after Transarterial Therapy for Primary and Secondary Hepatic Malignancies: Results of an Online Survey. Acad Radiol 2015; 22:1510-5. [PMID: 26432072 DOI: 10.1016/j.acra.2015.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/14/2015] [Accepted: 08/15/2015] [Indexed: 12/22/2022]
Abstract
RATIONALE AND OBJECTIVES To characterize practices and quantify variation in longitudinal follow-up approaches among interventional radiologists (IRs) after liver transarterial locoregional therapy (LRT) in contemporary Interventional Oncology practice. MATERIALS AND METHODS In November/December 2014, Society of Interventional Radiology members were invited to participate in a survey regarding clinical and imaging follow-up of liver cancer patients treated with transarterial LRT. On survey closure, responses were compiled and analyzed. RESULTS The 30-item survey response rate was 11% (361 of 3290). Respondents were predominantly American IRs (311 of 355, 88%) who perform 1-5 LRTs monthly (196 of 354, 55%). Most (305 of 336, 91%) IRs reported longitudinal follow-up, with patient encounters within 1-month (73%, 211 of 290) postprocedure and every 3 months (68%, 196 of 287) thereafter and involvement in imaging (up to 80%, 235 of 290) ordering and evaluation. Preferred timing of first follow-up imaging (1 month vs. 3 months) and response criteria used (mRECIST favored) varied. CONCLUSIONS Although IRs are actively involved in clinical and imaging follow-up of patients with liver malignancies treated with transarterial LRTs, there are differences in imaging frequency and response assessment. These data may serve as a starting point for standardization of LRT follow-up.
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Ludwig JM, Camacho JC, Kokabi N, Xing M, Kim HS. The Role of Diffusion-Weighted Imaging (DWI) in Locoregional Therapy Outcome Prediction and Response Assessment for Hepatocellular Carcinoma (HCC): The New Era of Functional Imaging Biomarkers. Diagnostics (Basel) 2015; 5:546-63. [PMID: 26854170 PMCID: PMC4728474 DOI: 10.3390/diagnostics5040546] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 11/12/2015] [Accepted: 11/19/2015] [Indexed: 12/12/2022] Open
Abstract
Reliable response criteria are critical for the evaluation of therapeutic response in hepatocellular carcinoma (HCC). Current response assessment is mainly based on: (1) changes in size, which is at times unreliable and lag behind the result of therapy; and (2) contrast enhancement, which can be difficult to quantify in the presence of benign post-procedural changes and in tumors presenting with a heterogeneous pattern of enhancement. Given these challenges, functional magnetic resonance imaging (MRI) techniques, such as diffusion-weighted imaging (DWI) have been recently investigated, aiding specificity to locoregional therapy response assessment and outcome prediction. Briefly, DWI quantifies diffusion of water occurring naturally at a cellular level (Brownian movement), which is restricted in multiple neoplasms because of high cellularity. Disruption of cellular integrity secondary to therapy results in increased water diffusion across the injured membranes. This review will provide an overview of the current literature on DWI therapy response assessment and outcome prediction in HCC following treatment with locoregional therapies.
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Affiliation(s)
- Johannes M Ludwig
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT 06510, USA.
| | - Juan C Camacho
- Division of Interventional Radiology and Image-guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | - Nima Kokabi
- Division of Interventional Radiology and Image-guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | - Minzhi Xing
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT 06510, USA.
| | - Hyun S Kim
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT 06510, USA.
- Yale Cancer Center, Yale School of Medicine, New Haven, CT 06519, USA.
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Imaging of the Liver Following Interventional Therapy for Hepatic Neoplasms. Radiol Clin North Am 2015; 53:1061-76. [DOI: 10.1016/j.rcl.2015.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Corona-Villalobos CP, Zhang Y, Zhang WD, Kamel IR. Magnetic resonance imaging of the liver after loco-regional and systemic therapy. Magn Reson Imaging Clin N Am 2015; 22:353-72. [PMID: 25086934 DOI: 10.1016/j.mric.2014.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Assessment of tumor response is crucial in determining the effectiveness of loco-regional and systemic therapy, and for determining the need for subsequent treatment. The ultimate goal is to improve patient's survival. Changes in tumor size and enhancement after therapy may not be detected early by the traditional response criteria. Tumor response is better assessed in the entire tumor volume rather than in a single axial plane. The purpose of this article is to familiarize the reader with early treatment response assessed by anatomic and volumetric functional magnetic resonance imaging metrics of the liver after loco-regional and systemic therapy.
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Affiliation(s)
- Celia Pamela Corona-Villalobos
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, MRI 110B, Baltimore, MD 21287, USA
| | - Yan Zhang
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, 601 North Caroline Street, Room 4240, Baltimore, MD 21287, USA; Department of Radiology, Shandong Medical Imaging Research Institute, 324 Jingwu Road, MRI, Jinan 250021, Republic of China
| | - Wei-Dong Zhang
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, 601 North Caroline Street, Room 4240, Baltimore, MD 21287, USA
| | - Ihab R Kamel
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, MRI 143, Baltimore, MD 21287, USA.
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Franklin JM, Gebski V, Poston GJ, Sharma RA. Clinical trials of interventional oncology—moving from efficacy to outcomes. Nat Rev Clin Oncol 2014; 12:93-104. [DOI: 10.1038/nrclinonc.2014.199] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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47
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Vouche M, Salem R, Lewandowski RJ, Miller FH. Can volumetric ADC measurement help predict response to Y90 radioembolization in HCC? ACTA ACUST UNITED AC 2014; 40:1471-80. [DOI: 10.1007/s00261-014-0295-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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48
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Riaz A, Awais R, Salem R. Side effects of yttrium-90 radioembolization. Front Oncol 2014; 4:198. [PMID: 25120955 PMCID: PMC4114299 DOI: 10.3389/fonc.2014.00198] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 07/15/2014] [Indexed: 12/12/2022] Open
Abstract
Limited therapeutic options are available for hepatic malignancies. Image guided targeted therapies have established their role in management of primary and secondary hepatic malignancies. Radioembolization with yttrium-90 ((90)Y) microspheres is safe and efficacious for treatment of hepatic malignancies. The tumoricidal effect of radioembolization is predominantly due to radioactivity and not ischemia. This article will present a comprehensive review of the side effects that have been associated with radioembolization using (90)Y microspheres. Some of the described side effects are associated with all transarterial procedures. Side effects specific to radioembolization will also be discussed in detail. Methods to decrease the incidence of these potential side effects will also be discussed.
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Affiliation(s)
- Ahsun Riaz
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University , Chicago, IL , USA
| | - Rafia Awais
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University , Chicago, IL , USA
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University , Chicago, IL , USA
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Yttrium-90 radioembolization of malignant tumors of the liver: gallbladder effects. AJR Am J Roentgenol 2014; 202:1130-5. [PMID: 24758670 DOI: 10.2214/ajr.13.10548] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE After (90)Y-microsphere radioembolization for unresectable hepatic neoplasms, the nearby gallbladder is susceptible to radiation-induced cholecystitis, an uncommon complication. The purpose of this study was to characterize the imaging findings after (90)Y radioembolization of the gallbladder and to assess the incidence of clinically significant radiation-induced cholecystitis. MATERIALS AND METHODS Medical records were retrospectively reviewed for cholecystectomy after (90)Y treatment of 133 consecutively registered patients (76 men, 57 women; average age, 65 years). Thirty-four of the patients had primary and 99 had secondary liver neoplasms. The pretreatment and posttreatment cross-sectional images of 85 of the patients were available for review. RESULTS Clinically significant radiation-induced cholecystitis occurred in 1 of the 133 patients (0.8%). After radioembolization, gallbladder imaging abnormalities were found in 84 of 85 patients (99%), but none was associated with clinically significant radiation-induced cholecystitis. CONCLUSION The incidence of clinically significant radiation-induced cholecystitis was only 0.8% despite a high prevalence of gallbladder imaging abnormalities after (90)Y radioembolization. Therefore, in the postinterventional care of patients with abdominal pain after (90)Y radioembolization, even if imaging abnormalities of the gallbladder are identified, cholecystectomy should be reserved for patients in whom other causes of pain have been excluded.
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Early treatment response evaluation after yttrium-90 radioembolization of liver malignancy with CT perfusion. J Vasc Interv Radiol 2014; 25:747-59. [PMID: 24630751 DOI: 10.1016/j.jvir.2014.01.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/30/2013] [Accepted: 01/01/2014] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate computed tomography (CT) perfusion for assessment of early treatment response after transarterial radioembolization of patients with liver malignancy. MATERIALS AND METHODS Dynamic contrast-enhanced CT liver perfusion was performed before and 4 weeks after transarterial radioembolization in 40 patients (25 men and 15 women; mean age, 64 y ± 11; range, 35-80 y) with liver metastases (n = 27) or hepatocellular carcinoma (HCC) (n = 13). Arterial perfusion (AP) of tumors derived from CT perfusion and tumor diameters were measured on CT perfusion before and after transarterial radioembolization. Success of transarterial radioembolization was evaluated on morphologic follow-up imaging (median follow-up time, 4 mo) based on Response Evaluation Criteria in Solid Tumors (Version 1.1). CT perfusion parameters before and after transarterial radioembolization for different response groups were compared. Kaplan-Meier curves were plotted to illustrate overall 1-year survival rates. RESULTS Liver metastases showed significant differences in AP before and after transarterial radioembolization in responders (P < .05) but not in nonresponders (P = .164). In HCC, AP values before and after transarterial radioembolization were not significantly different in responders and nonresponders (P = .180 and P = .052). Tumor diameters were not significantly different on CT perfusion before and after transarterial radioembolization in responders and nonresponders with liver metastases and HCC (P = .654, P = .968, P = .148, P = .164). In patients with significant decrease of AP in liver metastases after transarterial radioembolization, 1-year overall survival was significantly higher than in patients showing no reduction of AP. CONCLUSIONS CT perfusion showed early reduction of AP in liver metastases responding to transarterial radioembolization; tumor diameter remained unchanged early after treatment. No significant early treatment response to transarterial radioembolization was found in patients with HCC. In patients with liver metastases, a decrease of AP after transarterial radioembolization was associated with a higher 1-year overall survival rate.
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