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Sharma HK, Kyriakakos C, Jabbour TE, Ward S, Buckstein M, Taouli B, Lewis S. Longitudinal assessment of hepatocellular carcinoma response to stereotactic body radiation using gadoxetate-enhanced MRI: A case series. Eur J Radiol 2023; 167:111077. [PMID: 37688918 DOI: 10.1016/j.ejrad.2023.111077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/09/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE To describe the longitudinal response in patients with hepatocellular carcinoma (HCC) treated with stereotactic body radiation therapy (SBRT) and who underwent liver transplant (LT) using gadoxetate-enhanced MRI. METHODS Five men (median age 61y, range 57-64y) with 6 HCCs treated with SBRT (median dose 50 Gy) who subsequently underwent LT were included in this retrospective study. Patients underwent gadoxetate-enhanced MRI before and after SBRT over a period of 3-18 months. Response was assessed using RECIST1.1, mRECIST, LI-RADS and image subtraction, by 2 observers in consensus. Percentage of pathologic tumor necrosis was evaluated. RESULTS LT was performed 278 days (IQR, 148-418d) after completion of SBRT and 48d after the last MRI. Histopathology demonstrated tumor necrosis of 48 ± 42% (range, 10-100%). Mean tumor size at baseline and last post-treatment MRIs pre-LT were 2.6 ± 0.8 cm and 2.4 ± 0.9 cm. Enhancing tumor component size at baseline MRI and last post-treatment MRI pre-LT were 1.6 ± 0.8 cm and 0.9 ± 1.0 cm. Responses assessed at the last LRI pre-LT were: partial response (PR, n = 3), stable disease (SD, n = 3) using RECIST1.1; complete response (CR, n = 2), partial response (PR, n = 2), stable disease (SD, n = 2) using mRECIST; and LR-TR viable (n = 4), LR-TR non-viable (n = 2) using LI-RADS. At the last MRI pre-LT, per-lesion features of arterial phase hyperenhancement (APHE, 4/6), portal venous washout (3/6) and capsule (3/6) were observed. 5/6 lesions displayed a hypointense perilesional halo on hepatobiliary phase with a mean delay of 3.1 months post-SBRT. CONCLUSIONS This case-series showed decreased size, persistent APHE, and incomplete pathologic necrosis in most HCCs treated with SBRT undergoing transplant.
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Affiliation(s)
- Himanshu Kumar Sharma
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Christopher Kyriakakos
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Tony El Jabbour
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, 15th Floor, 1468 Madison Avenue, New York, NY 10029, USA
| | - Stephen Ward
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, 15th Floor, 1468 Madison Avenue, New York, NY 10029, USA
| | - Michael Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, 1184 5th Avenue, First Floor, New York, NY 10029, USA
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
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Kuang D, Zhang N, Zhang M, Li H, Han X, Ren J, Duan X. Correlation between magnetic resonance images of peritumor margin enhancement and prognosis in hepatocellular carcinoma after drug-eluting bead transcatheter arterial chemoembolization. Front Oncol 2023; 13:957710. [PMID: 37081977 PMCID: PMC10110982 DOI: 10.3389/fonc.2023.957710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/22/2023] [Indexed: 04/07/2023] Open
Abstract
PurposeThe aim of this study is to investigate the morphological characteristics and clinical significance of magnetic resonance (MR) images of peritumor margin enhancement in hepatocellular carcinoma (HCC) after drug-eluting bead transcatheter arterial chemoembolization (DEB-TACE).MethodsFrom January 2017 to December 2020, a total of 162 patients who received a diagnosis of HCC were included in our study. We began the follow-up with magnetic resonance imaging (MRI) for complete response assessment, and peritumor margin enhancements were classified as sharp and rough types according to morphology. During the follow-up, data such as progression or remission of the two enhancement modalities, morphological changes in terms of margin enhancements observed in MR images, and alpha-fetoprotein (AFP) levels were recorded.ResultsIn the follow-up period of 36 months, 70 and 92 patients with sharp- and rough-type peritumor margins, respectively, were observed. At the end of the follow-up, patients with sharp-type margins had lower AFP levels and longer progression-free survival than those with rough-type margins (P < 0.05). Furthermore, the sharp-type margin was thinner than the rough-type margin (all P < 0.05). Moreover, the sharp-type group had a high incidence of tumors with a diameter of < 5 cm, whereas the rough-type group had a high incidence of tumors with a diameter of ≥ 5 cm. Continuous enhancements of peritumor margins in MRI were greater in the sharp-type group than in the rough-type group. Most of the patients with a sharp-type margin achieved disease remission (94.3%, P < 0.05), whereas most of those with a rough-type margin experienced disease progression (84.8%, P < 0.05).ConclusionsPatients with HCC with a sharp-type margin enhancement on MRI after DEB-TACE mostly demonstrated benign lesions with a good prognosis, whereas those with a rough-type margin mostly demonstrated malignant growth.
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Affiliation(s)
| | | | | | | | | | | | - Xuhua Duan
- *Correspondence: Jianzhuang Ren, ; Xuhua Duan,
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Culp WTN, Johnson EG, Giuffrida MA, Rebhun RB, Cawthra JK, Schwanz HA, Burton JH, Kent MS. Evaluation of the use of a novel bioabsorbable polymer drug-eluting microsphere for transarterial embolization of hepatocellular neoplasia in dogs. PLoS One 2022; 17:e0269941. [PMID: 35939428 PMCID: PMC9359553 DOI: 10.1371/journal.pone.0269941] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/31/2022] [Indexed: 01/26/2023] Open
Abstract
In dogs with non-resectable hepatic neoplasia, treatment options are limited. The objectives of this study were to describe the use of a novel drug-eluting embolic microsphere containing paclitaxel for use during transarterial chemoembolization (TACE), to compare results of liver-specific owner questionnaires and tumor volume pre- and post-TACE, and to measure systemic paclitaxel concentration post-TACE. Client-owned dogs with non-resectable hepatic neoplasia were prospectively enrolled. All owners completed questionnaires validated for the assessment of subjective outcomes in dogs with cancer before the TACE procedure and approximately 4 weeks after the TACE procedure. A CT scan was performed before TACE and 1 month after TACE; results were compared. Blood samples were obtained at specified time points post-TACE to determine systemic paclitaxel concentrations. Seven dogs (median weight: 8.9 kg; range, 4.3-31 kg) were enrolled. TACE was successfully performed in all dogs, and no intra-procedural complications were encountered. Questionnaire scores improved significantly post-TACE. Among the 6 dogs for which full data were available, median pre-TACE tumor volume was 390 cc (range 152-1,484; interquartile range 231-1,139) and median post-TACE tumor volume was 203 cc (range 98-889; interquartile range 151-369), which was significantly (P = .028) lower. All 6 dogs had a reduction in volume at the post-TACE measurement. Mean percent change in tumor volume was -45.6% (95%CI -58.6 to -32.6%). The mean plasma paclitaxel concentration in canine blood peaked at 4 days post-TACE procedure and was 25.7 ng/mL (range = 3.09-110 ng/mL) Median survival time was 629 days (95%CI 18 to upper limit not reached). The use of a novel paclitaxel-eluting microsphere in this cohort of dogs successfully decreased tumor volume significantly after TACE and improved clinical signs. Future investigation into the use of TACE and other similar therapies is warranted due to the promising outcomes noted in this cohort.
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Affiliation(s)
- William T. N. Culp
- Department of Veterinary Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California, United States of America
- * E-mail:
| | - Eric G. Johnson
- Department of Veterinary Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California, United States of America
| | - Michelle A. Giuffrida
- Department of Veterinary Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California, United States of America
| | - Robert B. Rebhun
- Department of Veterinary Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California, United States of America
| | - James K. Cawthra
- Boston Scientific Corporation, Marlborough, Massachusetts, United States of America
| | - Heidi A. Schwanz
- Boston Scientific Corporation, Marlborough, Massachusetts, United States of America
| | - Jenna H. Burton
- Department of Veterinary Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California, United States of America
| | - Michael S. Kent
- Department of Veterinary Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California, United States of America
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Rim Enhancement after Technically Successful Transarterial Chemoembolization in Hepatocellular Carcinoma: A Potential Mimic of Incomplete Embolization or Reactive Hyperemia? Tomography 2022; 8:1148-1158. [PMID: 35448728 PMCID: PMC9028792 DOI: 10.3390/tomography8020094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022] Open
Abstract
Contrast enhancement at the margins/rim of embolization areas in hepatocellular-carcinoma (HCC) lesions treated with transarterial chemoembolization (TACE) might be an early prognostic indicator for HCC recurrence. The aim of this study was to evaluate the predictive value of rim perfusion for TACE recurrence as determined by perfusion CT (PCT). A total of 52 patients (65.6 ± 9.3 years) underwent PCT directly before, immediately after (within 48 h) and at follow-up (95.3 ± 12.5 days) after TACE. Arterial-liver perfusion (ALP), portal-venous perfusion (PVP) and hepatic-perfusion index (HPI) were evaluated in normal liver parenchyma, and on the embolization rim as well as the tumor bed. A total of 42 lesions were successfully treated, and PCT measurements showed no residually vascularized tumor areas. Embolization was not entirely successful in 10 patients with remaining arterialized focal nodular areas (ALP 34.7 ± 10.1 vs. 4.4 ± 5.3 mL/100 mL/min, p < 0.0001). Perfusion values at the TACE rim were lower in responders compared to normal adjacent liver parenchyma and edges of incompletely embolized tumors (ALP liver 16.3 ± 10.1 mL/100 mL/min, rim responder 8.8 ± 8.7 mL/100 mL/min, rim non-responder 23.4 ± 8.6 mL/100 mL/min, p = 0.005). At follow-up, local tumor relapse was observed in 17/42, and 15/42 showed no recurrence (ALP 39.1 ± 10.1 mL/100 mL/min vs. 10.0 ± 7.4 mL/100 mL/min, p = 0.0008); four patients had de novo disseminated disease and six patients were lost in follow-up. Rim perfusion was lower compared to adjacent recurring HCC and not different between groups. HCC lesions showed no rim perfusion after TACE, neither immediately after nor at follow-up at three months, both for mid-term responders and mid-term relapsing HCCs, indicating that rim enhancement is not a sign of reactive hyperemia and not predictive of early HCC recurrence.
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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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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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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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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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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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10
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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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The value of dynamic subtraction MRI technique in the assessment of treatment response of hepatocellular carcinoma to transcatheter arterial chemoembolization. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0024-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Deipolyi AR, England RW, Ridouani F, Riedl CC, Kunin HS, Boas FE, Yarmohammadi H, Sofocleous CT. PET/CT Imaging Characteristics After Radioembolization of Hepatic Metastasis from Breast Cancer. Cardiovasc Intervent Radiol 2019; 43:488-494. [PMID: 31732778 DOI: 10.1007/s00270-019-02375-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/06/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To define positron emission tomography/computed tomography (PET/CT) imaging characteristics during follow-up of patients with metastatic breast cancer (MBC) treated with yttrium-90 (Y90) radioembolization (RE). MATERIALS AND METHODS From January 2011 to October 2017, 30 MBC patients underwent 38 Y90 glass or resin RE treatments. Pre-RE PET/CT was performed on average 51 days before RE. There were 68 PET/CTs performed after treatment. Response was assessed using modified PERCIST criteria focusing on the hepatic territory treated with RE, normalizing SUVpeak to the mean SUV of liver uninvolved by tumor. An objective response (OR) was defined as a decrease in SUVpeak by at least 30%. RESULTS Of the 68 post-RE scans, 6 were performed at 0-30 days, 15 at 31-60 days, 9 at 61-90 days, 13 at 91-120 days, 14 scans at 121-180 days, and 11 scans at > 180 days after RE. Of the 30 patients, 25 (83%) achieved OR on at least one follow-up. Median survival was 15 months after the first RE administration. Highest response rates occurred at 30-90 days, with over 75% of cases demonstrating OR at that time. After 180 days, OR was seen in only 25%. There was a median TTP of 169 days among responders. CONCLUSION In MBC, follow-up PET/CT after RE demonstrates optimal response rates at 30-90 days, with progression noted after 180 days. These results help to guide the timing of imaging and also to inform patients of expected outcomes after RE.
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Affiliation(s)
- Amy R Deipolyi
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ryan W England
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fourat Ridouani
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher C Riedl
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Henry S Kunin
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - F Edward Boas
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hooman Yarmohammadi
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Schobert I, Chapiro J, Pucar D, Saperstein L, Savic LJ. Fluorodeoxyglucose PET for Monitoring Response to Embolotherapy (Transarterial Chemoembolization) in Primary and Metastatic Liver Tumors. PET Clin 2019; 14:437-445. [DOI: 10.1016/j.cpet.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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15
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Reply to “Calcified Liver Lesions and Mimics on CT”. AJR Am J Roentgenol 2019; 212:W99. [DOI: 10.2214/ajr.18.20648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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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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17
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Gabr A, Abouchaleh N, Ali R, Baker T, Caicedo J, Katariya N, Abecassis M, Riaz A, Lewandowski RJ, Salem R. Outcomes of Surgical Resection after Radioembolization for Hepatocellular Carcinoma. J Vasc Interv Radiol 2018; 29:1502-1510.e1. [DOI: 10.1016/j.jvir.2018.06.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 12/16/2022] Open
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18
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Choi MH, Park GE, Oh SN, Park MY, Rha SE, Lee YJ, Jung SE, Choi JI. Reproducibility of mRECIST in Measurement and Response Assessment for Hepatocellular Carcinoma Treated by Transarterial Chemoembolization. Acad Radiol 2018; 25:1363-1373. [PMID: 29555570 DOI: 10.1016/j.acra.2018.02.013] [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] [Received: 01/19/2018] [Revised: 01/30/2018] [Accepted: 02/03/2018] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the reproducibility of Modified Response Evaluation Criteria in Solid Tumors (mRECIST) for hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) using multiphasic computed tomography. MATERIALS AND METHODS The institutional review board approved this retrospective study. We evaluated 97 patients who underwent TACE (60 conventional TACE [cTACE] and 37 drug-eluting bead TACE [DEB-TACE]) for HCC from 2010 to 2014. Four radiologists evaluated pairs of dynamic liver CTs scanned within 2 months before and after TACE based on mRECIST. Assessment of intra- or interobserver reproducibility for response categorization and sum of long diameter were evaluated using weighted kappa statistics (κ) and intraclass correlation coefficients, respectively. The relationship between concordance of target lesion selection and agreement of target lesion response was evaluated using Fisher exact test. RESULTS Intraobserver reproducibility for overall response was moderate to excellent (κ = 0.525-0.865). Interobserver reproducibility was improved on the second review compared to the first review and it was good in both treatment groups (κ = 0.627 for cTACE and 0.602 for DEB-TACE). Between the two treatment methods, intra- or interobserver reproducibility was better after cTACE than DEB-TACE. Intraclass correlation coefficients for sum of long diameter measurement showed excellent intra- or interobserver reproducibility. The concordance rate of target lesion selection was significantly higher for patients with radiologists' agreement for target lesion response than patients with disagreed response (P = .003). CONCLUSIONS The intra- and interobserver reproducibility of mRECIST in patients with HCC after TACE was moderate to excellent, and the reproducibility was slightly better after cTACE than DEB-TACE.
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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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20
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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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21
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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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22
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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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23
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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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24
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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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25
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Jones RH, Taylor AJ, Rostambeigi N, Spilseth B. Small hepatocellular carcinomas displayed as a ring enhancing mass on arterial phase MRI in the chronically diseased liver. Clin Radiol 2017; 72:995.e1-995.e9. [PMID: 28751038 DOI: 10.1016/j.crad.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/20/2017] [Accepted: 07/03/2017] [Indexed: 01/05/2023]
Abstract
AIM To assess the prevalence of arterial phase (AP) ring-enhancing small hepatocellular carcinomas (HCC) on magnetic resonance imaging (MRI); detail additional MRI features that enable HCC diagnosis; and examine arterial timing as one possible cause of this appearance. MATERIALS AND METHODS Patients undergoing HCC screening with both computed tomography (CT) and MRI within 40 days were examined at a single institution over a 7- year time period ending in 2013. From this initial group, small (1-3 cm), (AP) ring-enhancing HCC on MRI were studied. RESULTS From the initial group of 64 patients with 129 HCC, 20 patients with 78 HCCs had a small diameter with 32 (41%) having an AP ring at MRI. The mean age of this latter group was 63-years old, with the average tumour diameter of 1.9 cm. Histopathology and secondary imaging supported a diagnosis of HCC in 20 (100%) patients and 31 (97%) lesions. Most of the ringed lesions had early AP timing. CONCLUSION This study revealed a high prevalence (41%) of small, AP ring HCC with MRI. The use of other MRI sequences adds support in making the proper diagnosis with this appearance. Early AP timing may help create this pattern.
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Affiliation(s)
- R H Jones
- Department of Radiology, University of Minnesota, 420 Delaware Street S.E, Mayo Memorial Building, Minneapolis, MN 55455, USA
| | - A J Taylor
- Department of Radiology, University of Minnesota, 420 Delaware Street S.E, Mayo Memorial Building, Minneapolis, MN 55455, USA.
| | - N Rostambeigi
- Department of Radiology, University of Minnesota, 420 Delaware Street S.E, Mayo Memorial Building, Minneapolis, MN 55455, USA
| | - B Spilseth
- Department of Radiology, University of Minnesota, 420 Delaware Street S.E, Mayo Memorial Building, Minneapolis, MN 55455, USA
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Weiss J, Rempp H, Clasen S, Notohamiprodjo M, Keßler DE, Pereira PL, Blumenstock G, Nikolaou K, Hoffmann R. Diagnostic accuracy of different magnetic resonance imaging sequences for detecting local tumor progression after radiofrequency ablation of hepatic malignancies. Eur J Radiol 2017; 94:85-92. [PMID: 28655432 DOI: 10.1016/j.ejrad.2017.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/03/2017] [Accepted: 06/12/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of the individual sequences of a clinical routine liver MRI protocol for the detection of local tumour progression after radiofrequency (RF) ablation of hepatic malignancies. MATERIAL AND METHODS A cohort of 93 patients treated for 140 primary and secondary hepatic malignancies with RF ablation was assembled for this retrospective study. The cohort contained 31 cases of local tumour progression, which occurred 8.3±6.2months (range: 4.0-28.2 months) after treatment. All patients underwent clinical routine follow-up MRI at 1.5T including following sequences: unenhanced T1-weighted fast low angle shot (FLASH-2D), T2-weighted turbo-spin-echo sequence, contrast-enhanced (CE) T1-weighted volume-interpolated breath-hold examination (VIBE), diffusion-weighted imaging (DWI). Follow-up was 32.7±22.5months (range: 4.0-138.3 months). Two readers independently evaluated the individual sequences separately for signs of local tumour progression. Diagnostic confidence was rated on a 4-point scale. Inter-reader agreement was assessed with Coheńs kappa. Long-term follow-up and histological specimen served as standard of reference. RESULTS Both readers reached the highest sensitivity for detection of local tumour progression with unenhanced T1-FLASH 2D (88.2% and 94.1%, respectively) and the highest specificity with CE T1-VIBE (96.2% and 97.2%, respectively). Highest inter-reader agreement was reached with T1-FLASH-2D (kappa=0.83). Typical pitfalls for false-positive diagnoses were focal cholestasis and vasculature adjacent to the ablation zone. Diagnostic confidence was highest with CE T1-VIBE for reader 1 and DWI for reader 2. CONCLUSION Unenhanced T1-FLASH-2D is an essential sequence for follow-up imaging after tumour ablation with a high sensitivity for detection of local progression and a high inter-reader agreement.
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Affiliation(s)
- Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany.
| | - Hansjoerg Rempp
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany
| | - Mike Notohamiprodjo
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany
| | - David-Emanuel Keßler
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany
| | - Philippe L Pereira
- Department of Radiology, Minimally Invasive Therapies and Nuclearmedicine, SLK-Kliniken Heilbronn GmbH, Am Gesundbrunnen 20-26, 74078 Heilbronn, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, Eberhard-Karls-University, Silcherstrasse 5, 72076 Tuebingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany
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Young S, Golzarian J. Regarding: Y90 Radioembolization Significantly Prolongs Time to Progression Compared With Chemoembolization in Patients With Hepatocellular Carcinoma. Gastroenterology 2017; 152:1626-1627. [PMID: 28371623 DOI: 10.1053/j.gastro.2016.09.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/26/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Shamar Young
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, Minnesota
| | - Jafar Golzarian
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, Minnesota
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28
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Transarterial Radioembolization with Yttrium-90 for the Treatment of Hepatocellular Carcinoma. Adv Ther 2016; 33:699-714. [PMID: 27039186 PMCID: PMC4882351 DOI: 10.1007/s12325-016-0324-7] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Indexed: 12/21/2022]
Abstract
Background Hepatocellular carcinoma (HCC) is a common cause of worldwide mortality. Transarterial radioembolization (TARE) with yttrium-90 (Y90), a transcatheter intra-arterial procedure performed by interventional radiology, has become widely utilized in managing HCC. Methods The following is a focused review of TARE covering its commercially available products, clinical considerations of treatment, salient clinical trial data establishing its utility, and the current and future roles of TARE in the management of HCC. Results TARE is indicated for patients with unresectable, intermediate stage HCC. The two available products are glass and resin microspheres. All patients undergoing TARE must be assessed with a history, physical examination, clinical laboratory tests, imaging, and arteriography with macroaggregated albumin. TARE is safe and effective in the treatment of unresectable HCC, as it has a safer toxicity profile than chemoembolization, longer time-to-progression, greater ability to downsize and/or bridge patients to liver transplant, and utility in tumor complicated by portal vein thrombosis. TARE can also serve as an alternative to ablation and chemotherapy. Conclusion TARE assumes an integral role in the management of unresectable HCC and has been validated by numerous studies.
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