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Najem E, Marin T, Zhuo Y, Lahoud RM, Tian F, Beddok A, Rozenblum L, Xing F, Moteabbed M, Lim R, Liu X, Woo J, Lostetter SJ, Lamane A, Chen YLE, Ma C, El Fakhri G. The role of 18F-FDG PET in minimizing variability in gross tumor volume delineation of soft tissue sarcomas. Radiother Oncol 2024; 194:110186. [PMID: 38412906 PMCID: PMC11042980 DOI: 10.1016/j.radonc.2024.110186] [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: 08/18/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Accurate gross tumor volume (GTV) delineation is a critical step in radiation therapy treatment planning. However, it is reader dependent and thus susceptible to intra- and inter-reader variability. GTV delineation of soft tissue sarcoma (STS) often relies on CT and MR images. PURPOSE This study investigates the potential role of 18F-FDG PET in reducing intra- and inter-reader variability thereby improving reproducibility of GTV delineation in STS, without incurring additional costs or radiation exposure. MATERIALS AND METHODS Three readers performed independent GTV delineation of 61 patients with STS using first CT and MR followed by CT, MR, and 18F-FDG PET images. Each reader performed a total of six delineation trials, three trials per imaging modality group. Dice Similarity Coefficient (DSC) score and Hausdorff distance (HD) were used to assess both intra- and inter-reader variability using generated simultaneous truth and performance level estimation (STAPLE) GTVs as ground truth. Statistical analysis was performed using a Wilcoxon signed-ranked test. RESULTS There was a statistically significant decrease in both intra- and inter-reader variability in GTV delineation using CT, MR 18F-FDG PET images vs. CT and MR images. This was translated by an increase in the DSC score and a decrease in the HD for GTVs drawn from CT, MR and 18F-FDG PET images vs. GTVs drawn from CT and MR for all readers and across all three trials. CONCLUSION Incorporation of 18F-FDG PET into CT and MR images decreased intra- and inter-reader variability and subsequently increased reproducibility of GTV delineation in STS.
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Affiliation(s)
- Elie Najem
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Thibault Marin
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Yue Zhuo
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Rita Maria Lahoud
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Fei Tian
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Arnaud Beddok
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Laura Rozenblum
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Fangxu Xing
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Maryam Moteabbed
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA; Radiation Oncology Department, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Ruth Lim
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Xiaofeng Liu
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Jonghye Woo
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Stephen John Lostetter
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Abdallah Lamane
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Yen-Lin Evelyn Chen
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA; Radiation Oncology Department, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Chao Ma
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Georges El Fakhri
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA.
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Ye Y, Zhang N, Wu D, Huang B, Cai X, Ruan X, Chen L, Huang K, Li ZP, Wu PM, Jiang J, Dan G, Peng Z. Deep Learning Combined with Radiologist's Intervention Achieves Accurate Segmentation of Hepatocellular Carcinoma in Dual-Phase Magnetic Resonance Images. BIOMED RESEARCH INTERNATIONAL 2024; 2024:9267554. [PMID: 38464681 PMCID: PMC10923620 DOI: 10.1155/2024/9267554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 12/20/2023] [Accepted: 02/08/2024] [Indexed: 03/12/2024]
Abstract
Purpose Segmentation of hepatocellular carcinoma (HCC) is crucial; however, manual segmentation is subjective and time-consuming. Accurate and automatic lesion contouring for HCC is desirable in clinical practice. In response to this need, our study introduced a segmentation approach for HCC combining deep convolutional neural networks (DCNNs) and radiologist intervention in magnetic resonance imaging (MRI). We sought to design a segmentation method with a deep learning method that automatically segments using manual location information for moderately experienced radiologists. In addition, we verified the viability of this method to assist radiologists in accurate and fast lesion segmentation. Method In our study, we developed a semiautomatic approach for segmenting HCC using DCNN in conjunction with radiologist intervention in dual-phase gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid- (Gd-EOB-DTPA-) enhanced MRI. We developed a DCNN and deep fusion network (DFN) trained on full-size images, namely, DCNN-F and DFN-F. Furthermore, DFN was applied to the image blocks containing tumor lesions that were roughly contoured by a radiologist with 10 years of experience in abdominal MRI, and this method was named DFN-R. Another radiologist with five years of experience (moderate experience) performed tumor lesion contouring for comparison with our proposed methods. The ground truth image was contoured by an experienced radiologist and reviewed by an independent experienced radiologist. Results The mean DSC of DCNN-F, DFN-F, and DFN-R was 0.69 ± 0.20 (median, 0.72), 0.74 ± 0.21 (median, 0.77), and 0.83 ± 0.13 (median, 0.88), respectively. The mean DSC of the segmentation by the radiologist with moderate experience was 0.79 ± 0.11 (median, 0.83), which was lower than the performance of DFN-R. Conclusions Deep learning using dual-phase MRI shows great potential for HCC lesion segmentation. The radiologist-aided semiautomated method (DFN-R) achieved improved performance compared to manual contouring by the radiologist with moderate experience, although the difference was not statistically significant.
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Affiliation(s)
- Yufeng Ye
- The First Clinical College of Jinan University, Guangzhou, China
- Department of Radiology, Panyu Central Hospital, Guangzhou, China
| | - Naiwen Zhang
- Medical AI Lab, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China
| | - Dasheng Wu
- Medical AI Lab, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China
| | - Bingsheng Huang
- Department of Radiology, Panyu Central Hospital, Guangzhou, China
- Medical AI Lab, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China
- Shenzhen University Clinical Research Center for Neurological Diseases, Shenzhen, Guangdong, China
| | - Xun Cai
- Medical AI Lab, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China
| | - Xiaolei Ruan
- Jiuquan Satellite Launch Center, Lanzhou, Gansu, China
| | - Liangliang Chen
- Medical AI Lab, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China
| | - Kun Huang
- Department of Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Zi-Ping Li
- Department of Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Po-Man Wu
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Jinzhao Jiang
- Department of Radiology, Shenzhen University General Hospital, Shenzhen, China
| | - Guo Dan
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China
| | - Zhenpeng Peng
- Department of Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Fieux M, Tournegros R, Hermann R, Tringali S. Allograft bone vs. bioactive glass in rehabilitation of canal wall-down surgery. Sci Rep 2023; 13:17945. [PMID: 37864103 PMCID: PMC10589328 DOI: 10.1038/s41598-023-44901-1] [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: 11/05/2022] [Accepted: 10/13/2023] [Indexed: 10/22/2023] Open
Abstract
Canal wall-down (CWD) mastoidectomy creates a radical cavity that modifies the anatomy and physiology of the middle ear, thus preventing it from being self-cleaning and causing epidermal stagnation in the posterior cavities. Canal wall-down tympanomastoidectomy with reconstruction (CWDTwR) can obliterate such radical cavities. The main objective of this study was to compare postoperative results after CWDTwR by using either bone allografts or 45S5 bioactive glass as a filling tissue with an 18-month follow-up. This was a single-center observational trial including all patients undergoing CWDTwR. Patients were divided into two groups according to the filling material used: allograft bone (AB group) or 45S5 bioactive glass (BG group). Clinical monitoring was performed regularly, with control imaging performed at 18 months (CT scan and DW MRI). The two groups were compared with the t test for quantitative variables and the chi square test for qualitative variables (no revision surgery, audiometric results, complications, mastoid obliteration volume). Thirty-two patients underwent CWDTwR between October 2015 and 2018. The mean age was 48 years, and 71.9% (23/32) were men. A total of 46.9% (15/32) of the patients had undergone at least 3 middle-ear surgeries prior to CWDTwR. The most frequent preoperative symptom was otorrhea (100.0%, 32/32), and only 12.5% (4/32) experienced dizziness. Fifteen and 17 patients underwent surgery with bone allografts and 45S5 bioactive glass, respectively. At 18 months post-operation, 53.3% of the patients (8/15) in the AB group presented with recurrent otorrhea versus 5.9% (1/17) of patients in the BG group (p = 0.005). Seventy-eight percent (7/9) of symptomatic patients had undergone revision surgery at 18 months postoperation: 40.0% (6/15) in the AB group and 5.9% (1/17) in the BG group (p = 0.033). One patient's surgery was cancelled due to the COVID-19 pandemic, and one patient refused surgery. The effects of CWDTwR with bone allografts are disappointing in early follow-up, with significant resorption leading to a 40.0% revision surgery rate. 45S5 BG is a simple solution, with preliminary results that are superior to those of AB. However, prospective controlled studies with longer follow-up times are needed to evaluate the value of BG versus other synthetic materials (such as hydroxyapatite) in surgical management of CWDTwR.Trial registration: retrospectively registered.
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Affiliation(s)
- Maxime Fieux
- Service d'ORLd'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite Cedex, France.
- Université de Lyon, Université Lyon 1, 69003, Lyon, France.
- UMR 5305, Laboratoire de Biologie Tissulaire et d'Ingénierie Thérapeutique, Institut de Biologie et Chimie des Protéines, CNRS/Université Claude Bernard Lyon 1, 7 Passage du Vercors, 69367, Lyon Cedex 07, France.
| | - Romain Tournegros
- Service d'ORLd'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite Cedex, France
| | - Ruben Hermann
- Université de Lyon, Université Lyon 1, 69003, Lyon, France
- Service d'ORL et de chirurgie cervico-faciale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003, Lyon, France
| | - Stéphane Tringali
- Service d'ORLd'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite Cedex, France
- Université de Lyon, Université Lyon 1, 69003, Lyon, France
- UMR 5305, Laboratoire de Biologie Tissulaire et d'Ingénierie Thérapeutique, Institut de Biologie et Chimie des Protéines, CNRS/Université Claude Bernard Lyon 1, 7 Passage du Vercors, 69367, Lyon Cedex 07, France
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Paudyal R, Shah AD, Akin O, Do RKG, Konar AS, Hatzoglou V, Mahmood U, Lee N, Wong RJ, Banerjee S, Shin J, Veeraraghavan H, Shukla-Dave A. Artificial Intelligence in CT and MR Imaging for Oncological Applications. Cancers (Basel) 2023; 15:cancers15092573. [PMID: 37174039 PMCID: PMC10177423 DOI: 10.3390/cancers15092573] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023] Open
Abstract
Cancer care increasingly relies on imaging for patient management. The two most common cross-sectional imaging modalities in oncology are computed tomography (CT) and magnetic resonance imaging (MRI), which provide high-resolution anatomic and physiological imaging. Herewith is a summary of recent applications of rapidly advancing artificial intelligence (AI) in CT and MRI oncological imaging that addresses the benefits and challenges of the resultant opportunities with examples. Major challenges remain, such as how best to integrate AI developments into clinical radiology practice, the vigorous assessment of quantitative CT and MR imaging data accuracy, and reliability for clinical utility and research integrity in oncology. Such challenges necessitate an evaluation of the robustness of imaging biomarkers to be included in AI developments, a culture of data sharing, and the cooperation of knowledgeable academics with vendor scientists and companies operating in radiology and oncology fields. Herein, we will illustrate a few challenges and solutions of these efforts using novel methods for synthesizing different contrast modality images, auto-segmentation, and image reconstruction with examples from lung CT as well as abdome, pelvis, and head and neck MRI. The imaging community must embrace the need for quantitative CT and MRI metrics beyond lesion size measurement. AI methods for the extraction and longitudinal tracking of imaging metrics from registered lesions and understanding the tumor environment will be invaluable for interpreting disease status and treatment efficacy. This is an exciting time to work together to move the imaging field forward with narrow AI-specific tasks. New AI developments using CT and MRI datasets will be used to improve the personalized management of cancer patients.
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Affiliation(s)
- Ramesh Paudyal
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Akash D Shah
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Amaresha Shridhar Konar
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Vaios Hatzoglou
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Richard J Wong
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | | | | | - Harini Veeraraghavan
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
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Assouline J, Cannella R, Porrello G, de Mestier L, Dioguardi Burgio M, Raynaud L, Hentic O, Cros J, Tselikas L, Ruszniewski P, Vullierme MP, Vilgrain V, Duran R, Ronot M. Volumetric Enhancing Tumor Burden at CT to Predict Survival Outcomes in Patients with Neuroendocrine Liver Metastases after Intra-arterial Treatment. Radiol Imaging Cancer 2023; 5:e220051. [PMID: 36607243 PMCID: PMC9896229 DOI: 10.1148/rycan.220051] [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] [Indexed: 01/07/2023]
Abstract
Purpose To investigate whether liver enhancing tumor burden (LETB) assessed at contrast-enhanced CT indicates early response and helps predict survival outcomes in patients with multifocal neuroendocrine liver metastases (NELM) after intra-arterial treatment. Materials and Methods This retrospective study included patients with NELM who underwent intra-arterial treatment with transarterial embolization (TAE) or chemoembolization (TACE) between April 2006 and December 2018. Tumor response in treated NELM was evaluated by using the Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST). LETB was measured as attenuation 2 SDs greater than that of a region of interest in the nontumoral liver parenchyma. Overall survival (OS); time to unTA(C)Eable progression, defined as the time from the initial treatment until the time when intra-arterial treatments were considered technically unfeasible, either not recommended by the multidisciplinary tumor board or until death; and hepatic and whole-body progression-free survival (PFS) were evaluated using multivariable Cox proportional hazards analyses, the Kaplan-Meier method, and log-rank test. Results The study included 119 patients (mean age, 60 years ± 11 [SD]; 61 men) who underwent 161 treatments. A median LETB change of -25.8% best discriminated OS (83 months in responders vs 51 months in nonresponders; P = .02) and whole-body PFS (18 vs 8 months, respectively; P < .001). A -10% LETB change best discriminated time to unTA(C)Eable progression (32 months in responders vs 12 months in nonresponders; P < .001) and hepatic PFS (18 vs 8 months, respectively; P < .001). LETB change remained independently associated with improved OS (hazard ratio [HR], 0.56), time to unTA(C)Eable progression (HR, 0.44), hepatic PFS (HR, 0.42), and whole-body PFS (HR, 0.47) on multivariable analysis. Neither RECIST nor mRECIST helped predict patient outcome. Conclusion Response according to LETB change helped predict survival outcomes in patients with NELM after intra-arterial treatments, with better discrimination than RECIST and mRECIST. Keywords: CT, Chemoembolization, Embolization, Abdomen/GI, Liver Supplemental material is available for this article. © RSNA, 2023.
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Zhao Y, Haroun RR, Sahu S, Schernthaner RE, Smolka S, Lin MD, Hong KK, Georgiades C, Duran R. Three-Dimensional Quantitative Tumor Response and Survival Analysis of Hepatocellular Carcinoma Patients Who Failed Initial Transarterial Chemoembolization: Repeat or Switch Treatment? Cancers (Basel) 2022; 14:cancers14153615. [PMID: 35892874 PMCID: PMC9329887 DOI: 10.3390/cancers14153615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES The purpose of this study was to assess treatment responses and evaluate survival outcomes between responders and non-responders after each transarterial chemoembolization (TACE) session using the 3D quantitative criteria of the European Association for the Study of the Liver (qEASL) in hepatocellular carcinoma (HCC) patients. METHODS A total of 94 consecutive patients who underwent MR imaging before and after TACE were retrospectively included. Volumetric tumor enhancement (qEASL) was expressed in cubic centimeters (cm3). The Kaplan-Meier method with the log-rank test was used to calculate the overall survival (OS) for the non-/responders. RESULTS In total, 28 (29.8%) patients showed a response after the first TACE. These responders demonstrated a clear trend toward longer OS compared with the non-responders (36.7 vs. 21.5 months, p = 0.071). Of the 43 initial non-responders who underwent a second TACE within 3 months and had complete follow-up imaging, 15/43 (34.9%) achieved a response, and their median OS was significantly longer than that of the 28 non-responders to the second TACE (47.8 vs. 13.6 months, p = 0.01). Furthermore, there was no significant difference in OS between the 28 patients who achieved a response after the first TACE and the 15 initial non-responders who achieved a response after the second TACE (36.7 vs. 47.8 months, p = 0.701). The difference in OS between the responders and non-responders after the third TACE was not significant (11.4 months vs. 13.5 months, p = 0.986). CONCLUSION Our study quantitatively demonstrated that a second TACE can be beneficial in terms of tumor response and survival for HCC patients who do not initially respond to TACE.
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Affiliation(s)
- Yan Zhao
- Department of Gastroenterology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China;
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD 21287, USA; (R.R.H.); (S.S.); (R.E.S.); (K.K.H.); (C.G.)
| | - Reham R. Haroun
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD 21287, USA; (R.R.H.); (S.S.); (R.E.S.); (K.K.H.); (C.G.)
- Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Sonia Sahu
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD 21287, USA; (R.R.H.); (S.S.); (R.E.S.); (K.K.H.); (C.G.)
| | - Ruediger E. Schernthaner
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD 21287, USA; (R.R.H.); (S.S.); (R.E.S.); (K.K.H.); (C.G.)
| | - Susanne Smolka
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT 06520, USA; (S.S.); (M.-D.L.)
| | - Ming-De Lin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT 06520, USA; (S.S.); (M.-D.L.)
| | - Kelvin K. Hong
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD 21287, USA; (R.R.H.); (S.S.); (R.E.S.); (K.K.H.); (C.G.)
| | - Christos Georgiades
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD 21287, USA; (R.R.H.); (S.S.); (R.E.S.); (K.K.H.); (C.G.)
| | - Rafael Duran
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD 21287, USA; (R.R.H.); (S.S.); (R.E.S.); (K.K.H.); (C.G.)
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-(21)-3144444; Fax: +41-(21)-3144443
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Borde T, Nezami N, Laage Gaupp F, Savic LJ, Taddei T, Jaffe A, Strazzabosco M, Lin M, Duran R, Georgiades C, Hong K, Chapiro J. Optimization of the BCLC Staging System for Locoregional Therapy for Hepatocellular Carcinoma by Using Quantitative Tumor Burden Imaging Biomarkers at MRI. Radiology 2022; 304:228-237. [PMID: 35412368 PMCID: PMC9270683 DOI: 10.1148/radiol.212426] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Patients with intermediate- and advanced-stage hepatocellular carcinoma (HCC) represent a highly heterogeneous patient collective with substantial differences in overall survival. Purpose To evaluate enhancing tumor volume (ETV) and enhancing tumor burden (ETB) as new criteria within the Barcelona Clinic Liver Cancer (BCLC) staging system for optimized allocation of patients with intermediate- and advanced-stage HCC to undergo transarterial chemoembolization (TACE). Materials and Methods In this retrospective study, 682 patients with HCC who underwent conventional TACE or TACE with drug-eluting beads from January 2000 to December 2014 were evaluated. Quantitative three-dimensional analysis of contrast-enhanced MRI was performed to determine thresholds of ETV and ETB (ratio of ETV to normal liver volume). Patients with ETV below 65 cm3 or ETB below 4% were reassigned to BCLC Bn, whereas patients with ETV or ETB above the determined cutoffs were restratified or remained in BCLC Cn by means of stepwise verification of the median overall survival (mOS). Results This study included 494 patients (median age, 62 years [IQR, 56-71 years]; 401 men). Originally, 123 patients were classified as BCLC B with mOS of 24.3 months (95% CI: 21.4, 32.9) and 371 patients as BCLC C with mOS of 11.9 months (95% CI: 10.5, 14.8). The mOS of all included patients (including the BCLC B and C groups) was 15 months (95% CI: 12.3, 17.2). A total of 152 patients with BCLC C tumors were restratified into a new BCLC Bn class, in which the mOS was then 25.1 months (95% CI: 21.8, 29.7; P < .001). The mOS of the remaining patients (ie, BCLC Cn group) (n = 222; ETV ≥65 cm3 or ETB ≥4%) was 8.4 months (95% CI: 6.1, 11.2). Conclusion Substratification of patients with intermediate- and advanced-stage hepatocellular carcinoma according to three-dimensional quantitative tumor burden identified patients with a survival benefit from transarterial chemoembolization before therapy. © RSNA, 2022 Online supplemental material is available for this article.
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Malpani R, Petty CW, Yang J, Bhatt N, Zeevi T, Chockalingam V, Raju R, Petukhova-Greenstein A, Santana JG, Schlachter TR, Madoff DC, Chapiro J, Duncan J, Lin M. Quantitative Automated Segmentation of Lipiodol Deposits on Cone Beam CT Imaging acquired during Transarterial Chemoembolization for Liver Tumors: A Deep Learning Approach. J Vasc Interv Radiol 2021; 33:324-332.e2. [PMID: 34923098 DOI: 10.1016/j.jvir.2021.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study was to show that a deep learning-based, automated model for Lipiodol segmentation on CBCT after cTACE performs closer to the "ground truth segmentation" than a conventional thresholding-based model. MATERIALS & METHODS This post-hoc analysis included 36 patients with a diagnosis of HCC or other solid liver tumor who underwent cTACE with an intra-procedural CBCT. Semi-automatic segmentation of Lipiodol were obtained. Then, a convolutional U-net model was used to output a binary mask that predicts Lipiodol deposition. A threshold value of signal intensity on CBCT was used to obtain a Lipiodol mask for comparison. Dice similarity coefficient (DSC), Mean-squared error (MSE), and Center of Mass (CM), and fractional volume ratios for both masks were obtained by comparing them to the ground truth (radiologist segmented Lipiodol deposits) to obtain accuracy metrics for the two masks. These results were used to compare the model vs. the threshold technique. RESULTS For all metrics, the U-net outperformed the threshold technique: DSC (0.65±0.17 vs. 0.45±0.22,p<0.001) and MSE (125.53±107.36 vs. 185.98±93.82,p=0.005). Difference between the CM predicted, and the actual CM was (15.31±14.63mm vs. 31.34±30.24mm,p<0.001), with lesser distance indicating higher accuracy. The fraction of volume present ([predicted Lipiodol volume]/[ground truth Lipiodol volume]) was 1.22±0.84vs.2.58±3.52,p=0.048 for our model's prediction and threshold technique, respectively. CONCLUSION This study showed that a deep learning framework could detect Lipiodol in CBCT imaging and was capable of outperforming the conventionally used thresholding technique over several metrics. Further optimization will allow for more accurate, quantitative predictions of Lipiodol depositions intra-procedurally.
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Affiliation(s)
- Rohil Malpani
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Christopher W Petty
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Junlin Yang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Neha Bhatt
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Tal Zeevi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Vijay Chockalingam
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Rajiv Raju
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Alexandra Petukhova-Greenstein
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Jessica Gois Santana
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Todd R Schlachter
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - David C Madoff
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA.
| | - James Duncan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA; Visage Imaging, Inc., 12625 High Bluff Drive, Suite 205, San Diego, CA 92130, USA
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9
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Frangakis C, Sohn JH, Bas A, Chapiro J, Schernthaner RE, Lin M, Hamilton JP, Pawlik TM, Hong K, Duran R. Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure. Front Oncol 2021; 11:639235. [PMID: 34804911 PMCID: PMC8602787 DOI: 10.3389/fonc.2021.639235] [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: 12/08/2020] [Accepted: 10/22/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives Investigate long-term effects of repeated transarterial chemoembolization (TACE) on portal venous pressure (PVP) using non-invasive surrogate markers of portal hypertension. Methods Retrospective, Institutional Review Board-approved study. 99 patients [hepatocellular carcinoma (HCC) group (n=57); liver metastasis group (n=42)] who underwent 279TACEs and had longitudinal pre-/post-therapy contrast-enhanced-MRI (n=388) and complete blood work were included. Outcomes of interest were platelet count (PC), spleen volume, ascites and portosystemic collaterals. Variables included TACE type/number, tumor type, microcatheter location, Child-Pugh, baseline tumor burden (tumor number/total/largest size), vessel invasion, alpha-fetoprotein, Eastern Cooperative Oncology Group (ECOG) performance status, and Model for End-Stage Liver Disease (MELD) score. Generalized Estimating Equations assessed the associations between TACE and outcomes. Power analysis determined the sample size was sufficient. Results No significant change in PC over time was observed in either groups, regardless of liver function (P>0.05). Baseline spleen volume was 226 cm3 for metastatic group, and was larger by 204 cm3 for HCC group (P<0.001). Spleen volume increased by 20 cm3 (95%CI: 8-32; P=0.001) for both groups after 1stTACE and by 16cm3/TACE (P=0.099) over the full follow-up (up to 9TACEs). Spleen volume also tended to increase by 23cm3 (95%CI: -1–48; P=0.064) with higher tumor burden. Odds of developing moderate/severe ascites for metastatic patients was decreased by 0.5 (95%CI: 0.3–0.9; P=0.014), regardless of the Child-Pugh, and increased by 1.5 (95%CI: 1.2–1.9; P<0.001) among HCC patients with unstable Child-Pugh, whereas no change was noted with stable Child-Pugh. HCC patients with unstable Child-Pugh demonstrated a significant increase in portosystemic collaterals number over time (P=0.008). PVP-related complications such as variceal bleeding post-TACE were low (0.4%). Conclusion Repeated TACEs did seem to have an impact on PVP. However, the increase in PVP had marginal effects with low portal hypertension-related complications.
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Affiliation(s)
- Constantine Frangakis
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jae Ho Sohn
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Ahmet Bas
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Julius Chapiro
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - Ruediger E Schernthaner
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - MingDe Lin
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - James P Hamilton
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, United States
| | - Kelvin Hong
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Rafael Duran
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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10
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Auer TA, Della Seta M, Collettini F, Chapiro J, Zschaeck S, Ghadjar P, Badakhshi H, Florange J, Hamm B, Budach V, Kaul D. Quantitative volumetric assessment of baseline enhancing tumor volume as an imaging biomarker predicts overall survival in patients with glioblastoma. Acta Radiol 2021; 62:1200-1207. [PMID: 32938221 DOI: 10.1177/0284185120953796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is the commonest malignant primary brain tumor and still has one of the worst prognoses among cancers in general. There is a need for non-invasive methods to predict individual prognosis in patients with GBM. PURPOSE To evaluate quantitative volumetric tissue assessment of enhancing tumor volume on cranial magnetic resonance imaging (MRI) as an imaging biomarker for predicting overall survival (OS) in patients with GBM. MATERIAL AND METHODS MRI scans of 49 patients with histopathologically confirmed GBM were analyzed retrospectively. Baseline contrast-enhanced (CE) MRI sequences were transferred to a segmentation-based three-dimensional quantification tool, and the enhancing tumor component was analyzed. Based on a cut-off percentage of the enhancing tumor volume (PoETV) of >84.78%, samples were dichotomized, and the OS and intracranial progression-free survival (PFS) were evaluated. Univariable and multivariable analyses, including variables such as sex, Karnofsky Performance Status score, O6-methylguanine-DNA-methyltransferase status, age, and resection status, were performed using the Cox regression model. RESULTS The median OS and PFS were 16.9 and 7 months in the entire cohort, respectively. Patients with a CE tumor volume of >84.78% showed a significantly shortened OS (12.9 months) compared to those with a CE tumor volume of ≤84.78% (17.7 months) (hazard ratio [HR] 2.72; 95% confidence interval [CI] 1.22-6.03; P = 0.01). Multivariable analysis confirmed that PoETV had a significant prognostic role (HR 2.47; 95% CI 1.08-5.65; P = 0.03). CONCLUSION We observed a correlation between PoETV and OS. This imaging biomarker may help predict the OS of patients with GBM.
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Affiliation(s)
- Timo A Auer
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marta Della Seta
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Federico Collettini
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Julius Chapiro
- Department of Radiology, Yale University, New Haven, CT, USA
| | - Sebastian Zschaeck
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Harun Badakhshi
- Department of Radiation Oncology, Ernst von Bergmann Medical Center, Potsdam, Germany
| | - Julian Florange
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
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11
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Dionisio FCF, Oliveira LS, Hernandes MDA, Engel EE, de Azevedo-Marques PM, Nogueira-Barbosa MH. Manual versus semiautomatic segmentation of soft-tissue sarcomas on magnetic resonance imaging: evaluation of similarity and comparison of segmentation times. Radiol Bras 2021; 54:155-164. [PMID: 34108762 PMCID: PMC8177681 DOI: 10.1590/0100-3984.2020.0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective To evaluate the degree of similarity between manual and semiautomatic segmentation of soft-tissue sarcomas on magnetic resonance imaging (MRI). Materials and Methods This was a retrospective study of 15 MRI examinations of patients with histopathologically confirmed soft-tissue sarcomas acquired before therapeutic intervention. Manual and semiautomatic segmentations were performed by three radiologists, working independently, using the software 3D Slicer. The Dice similarity coefficient (DSC) and the Hausdorff distance were calculated in order to evaluate the similarity between manual and semiautomatic segmentation. To compare the two modalities in terms of the tumor volumes obtained, we also calculated descriptive statistics and intraclass correlation coefficients (ICCs). Results In the comparison between manual and semiautomatic segmentation, the DSC values ranged from 0.871 to 0.973. The comparison of the volumes segmented by the two modalities resulted in ICCs between 0.9927 and 0.9990. The DSC values ranged from 0.849 to 0.979 for intraobserver variability and from 0.741 to 0.972 for interobserver variability. There was no significant difference between the semiautomatic and manual modalities in terms of the segmentation times (p > 0.05). Conclusion There appears to be a high degree of similarity between manual and semiautomatic segmentation, with no significant difference between the two modalities in terms of the time required for segmentation.
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Affiliation(s)
| | - Larissa Santos Oliveira
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Mateus de Andrade Hernandes
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Edgard Eduard Engel
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
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12
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Ghani MA, Fereydooni A, Chen E, Letzen B, Laage-Gaupp F, Nezami N, Deng Y, Gan G, Thakur V, Lin M, Papademetris X, Schernthaner RE, Huber S, Chapiro J, Hong K, Georgiades C. Identifying enhancement-based staging markers on baseline MRI in patients with colorectal cancer liver metastases undergoing intra-arterial tumor therapy. Eur Radiol 2021; 31:8858-8867. [PMID: 34061209 DOI: 10.1007/s00330-021-08058-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine if three-dimensional whole liver and baseline tumor enhancement features on MRI can serve as staging biomarkers and help predict survival of patients with colorectal cancer liver metastases (CRCLM) more accurately than one-dimensional and non-enhancement-based features. METHODS This retrospective study included 88 patients with CRCLM, treated with transarterial chemoembolization or Y90 transarterial radioembolization between 2001 and 2014. Semi-automated segmentations of up to three dominant lesions were performed on pre-treatment MRI to calculate total tumor volume (TTV) and total liver volumes (TLV). Quantitative 3D analysis was performed to calculate enhancing tumor volume (ETV), enhancing tumor burden (ETB, calculated as ETV/TLV), enhancing liver volume (ELV), and enhancing liver burden (ELB, calculated as ELV/TLV). Overall and enhancing tumor diameters were also measured. A modified Kaplan-Meier method was used to determine appropriate cutoff values for each metric. The predictive value of each parameter was assessed by Kaplan-Meier survival curves and univariable and multivariable cox proportional hazard models. RESULTS All methods except whole liver (ELB, ELV) and one-dimensional/non-enhancement-based methods were independent predictors of survival. Multivariable analysis showed a HR of 2.1 (95% CI 1.3-3.4, p = 0.004) for enhancing tumor diameter, HR 1.7 (95% CI 1.1-2.8, p = 0.04) for TTV, HR 2.3 (95% CI 1.4-3.9, p < 0.001) for ETV, and HR 2.4 (95% CI 1.4-4.0, p = 0.001) for ETB. CONCLUSIONS Tumor enhancement of CRCLM on baseline MRI is strongly associated with patient survival after intra-arterial therapy, suggesting that enhancing tumor volume and enhancing tumor burden are better prognostic indicators than non-enhancement-based and one-dimensional-based markers. KEY POINTS • Tumor enhancement of colorectal cancer liver metastases on MRI prior to treatment with intra-arterial therapies is strongly associated with patient survival. • Three-dimensional, enhancement-based imaging biomarkers such as enhancing tumor volume and enhancing tumor burden may serve as the basis of a novel prognostic staging system for patients with liver-dominant colorectal cancer metastases.
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Affiliation(s)
- Mansur A Ghani
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - Arash Fereydooni
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - Evan Chen
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - Brian Letzen
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - Fabian Laage-Gaupp
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - Nariman Nezami
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA.,Russel H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA.,Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Yanhong Deng
- Yale Center for Analytical Science, Yale School of Public Health, New Haven, CT, USA
| | - Geliang Gan
- Yale Center for Analytical Science, Yale School of Public Health, New Haven, CT, USA
| | - Vinayak Thakur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - Xenophon Papademetris
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA.,Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Ruediger E Schernthaner
- Russel H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Diagnostic and Interventional Radiology, Hospital Landstraße, Vienna, Austria
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA. .,Russel H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Kelvin Hong
- Russel H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Christos Georgiades
- Russel H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
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13
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Ding J, Xiao H, Deng W, Liu F, Zhu R, Ha R. Feasibility of quantitative and volumetric enhancement measurement to assess tumor response in patients with breast cancer after early neoadjuvant chemotherapy. J Int Med Res 2021; 49:300060521991017. [PMID: 33682494 PMCID: PMC7944542 DOI: 10.1177/0300060521991017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective To evaluate the feasibility of quantitative enhancing lesion volume (ELV) for evaluating the responsiveness of breast cancer patients to early neoadjuvant chemotherapy (NAC) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Methods Seventy-five women with breast cancer underwent DCE-MRI before and after NAC. Lesions were assessed by ELV, response evaluation criteria in solid tumors 1.1 (RECIST 1.1), and total lesion volume (TLV). The diagnostic and pathological predictive performances of the methods were compared and color maps were compared with pathological results. Results ELV identified 29%, 67%, and 4% of cases with partial response, stable disease, and progressive disease, respectively. There was no significant difference in evaluation performances among the methods. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of ELV for predicting pathologic response were 72%, 92%, 81.8%, 86.8%, and 85.3%, respectively, with the highest sensitivity, NPV, and accuracy of the three methods. The area under the receiver operating characteristic curve was also highest for ELV. Pre- and post-NAC color maps reflecting tumor activity were consistent with pathological necrosis. Conclusions ELV may help evaluate the responsiveness of breast cancer patients to NAC, and may provide a good tumor-response indicator through the ability to indicate tumor viability.
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Affiliation(s)
- Jie Ding
- Medical Imaging Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Hongyan Xiao
- The Pathology Department, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | | | - Fengjiao Liu
- Medical Imaging Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Rongrong Zhu
- Medical Imaging Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Ruoshui Ha
- Medical Imaging Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
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Role of 3D quantitative tumor analysis for predicting overall survival after conventional chemoembolization of intrahepatic cholangiocarcinoma. Sci Rep 2021; 11:9337. [PMID: 33927226 PMCID: PMC8085245 DOI: 10.1038/s41598-021-88426-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/09/2021] [Indexed: 02/07/2023] Open
Abstract
This study was designed to assess 3D vs. 1D and 2D quantitative tumor analysis for prediction of overall survival (OS) in patients with Intrahepatic Cholangiocarcinoma (ICC) who underwent conventional transarterial chemoembolization (cTACE). 73 ICC patients who underwent cTACE were included in this retrospective analysis between Oct 2001 and Feb 2015. The overall and enhancing tumor diameters and the maximum cross-sectional and enhancing tumor areas were measured on baseline images. 3D quantitative tumor analysis was used to assess total tumor volume (TTV), enhancing tumor volume (ETV), and enhancing tumor burden (ETB) (ratio between ETV and liver volume). Patients were divided into low (LTB) and high tumor burden (HTB) groups. There was a significant separation between survival curves of the LTB and HTB groups using enhancing tumor diameter (p = 0.003), enhancing tumor area (p = 0.03), TTV (p = 0.03), and ETV (p = 0.01). Multivariate analysis showed a hazard ratio of 0.46 (95%CI: 0.27–0.78, p = 0.004) for enhancing tumor diameter, 0.56 (95% CI 0.33–0.96, p = 0.04) for enhancing tumor area, 0.58 (95%CI: 0.34–0.98, p = 0.04) for TTV, and 0.52 (95%CI: 0.30–0.91, p = 0.02) for ETV. TTV and ETV, as well as the largest enhancing tumor diameter and maximum enhancing tumor area, reliably predict the OS of patients with ICC after cTACE and could identify ICC patients who are most likely to benefit from cTACE.
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15
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MRI Monitoring of Residual Vestibular Schwannomas: Modeling and Predictors of Growth. Otol Neurotol 2020; 41:1131-1139. [DOI: 10.1097/mao.0000000000002742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Use of Spectral Detector Computed Tomography to Improve Liver Segmentation and Volumetry. J Comput Assist Tomogr 2020; 44:197-203. [PMID: 32195798 DOI: 10.1097/rct.0000000000000987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Liver segmentation and volumetry have traditionally been performed using computed tomography (CT) attenuation to discriminate liver from other tissues. In this project, we evaluated if spectral detector CT (SDCT) can improve liver segmentation over conventional CT on 2 segmentation methods. MATERIALS AND METHODS In this Health Insurance Portability and Accountability Act-compliant institutional review board-approved retrospective study, 30 contrast-enhanced SDCT scans with healthy livers were selected. The first segmentation method is based on Gaussian mixture models of the SDCT data. The second method is a convolutional neural network-based technique called U-Net. Both methods were compared against equivalent algorithms, which used conventional CT attenuation, with hand segmentation as the reference standard. Agreement to the reference standard was assessed using Dice similarity coefficient. RESULTS Dice similarity coefficients to the reference standard are 0.93 ± 0.02 for the Gaussian mixture model method and 0.90 ± 0.04 for the CNN-based method (all 2 methods applied on SDCT). These were significantly higher compared with equivalent algorithms applied on conventional CT, with Dice coefficients of 0.90 ± 0.06 (P = 0.007) and 0.86 ± 0.06 (P < 0.001), respectively. CONCLUSION On both liver segmentation methods tested, we demonstrated higher segmentation performance when the algorithms are applied on SDCT data compared with equivalent algorithms applied on conventional CT data.
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Della Seta M, Collettini F, Chapiro J, Angelidis A, Engeling F, Hamm B, Kaul D. A 3D quantitative imaging biomarker in pre-treatment MRI predicts overall survival after stereotactic radiation therapy of patients with a singular brain metastasis. Acta Radiol 2019; 60:1496-1503. [PMID: 30841703 DOI: 10.1177/0284185119831692] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Marta Della Seta
- Department of Radiology, Charité - University Medicine, Berlin, Germany
| | - Federico Collettini
- Department of Radiology, Charité - University Medicine, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Julius Chapiro
- Department of Radiology, Yale University, New Haven, CT, USA
| | - Alexander Angelidis
- Department of Radiation Oncology, Charité - University Medicine, Berlin, Germany
| | - Fidelis Engeling
- Department of Radiation Oncology, Charité - University Medicine, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - University Medicine, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité - University Medicine, Berlin, Germany
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Feasibility of Yttrium-90 Radioembolization Dose Calculation Utilizing Intra-procedural Open Trajectory Cone Beam CT. Cardiovasc Intervent Radiol 2019; 43:295-301. [DOI: 10.1007/s00270-019-02198-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/06/2019] [Indexed: 11/30/2022]
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Zitzelsberger T, Syha R, Grözinger G, Partovi S, Nikolaou K, Grosse U. Image quality of arterial phase and parenchymal blood volume (PBV) maps derived from C-arm computed tomography in the evaluation of transarterial chemoembolization. Cancer Imaging 2018; 18:16. [PMID: 29720249 PMCID: PMC5932894 DOI: 10.1186/s40644-018-0151-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/25/2018] [Indexed: 02/08/2023] Open
Abstract
Background To evaluate the benefits of arterial phase imaging and parenchymal blood volume (PBV) maps acquired by C-arm computed tomography during TACE procedure in comparison to cross-sectional imaging (CSI) using CT or MRI. Methods From January 2014 to December 2016, a total of 29 patients with HCC stage A or B (mean age 65 years; range 47 to 81 years, 86% male) were included in this study. These patients were referred to our department for TACE treatment and received peri-interventional C-arm CT. Dual phase findings of each lesion in terms of overall image quality, conspicuity, tumor size and feeding arteries were compared between arterial phase imaging and PBV using 5-point semi-quantitative Likert-scale, whereby pre-interventional CSI served as reference standard. Results A significantly higher overall image quality of the PBV maps compared to arterial phase C-arm CT acquisitions (4.34 (±0.55) vs. 3.93 (±0.59), p = 0.0032) as well as a higher conspicuity of HCC lesions (4.27 ± 0.74 vs. 3.83 ± 1.08, p < 0.0001) was observed. Arterial phase imaging led to an overestimation of tumor size (mean size, 26.5 ± 15.9 mm) compared to PBV (24.9 ± 15.2 mm, p = 0.0004) as well as CSI (25.2 ± 15.1 mm), p = 0.021). Regarding detectability of tumor feeding arterial vessels, significantly more feeding vessels were detected in arterial phase C-arm CT (n = 1.67 ± 0.92 vessels) compared to PBV maps (n = 1.27 ± 0.63 vessels) (p = 0.0001). One lesion was missed in pre-interventional CT imaging, but detected by C-arm CT. Conclusion The combination of PBV maps and arterial phase images acquired by C-arm CT during TACE procedure enables precise detection of the majority of HCC lesions and tumor feeding arteries and has therefore the potential to improve patient outcome.
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Affiliation(s)
- Tanja Zitzelsberger
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Roland Syha
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany.
| | - Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Sasan Partovi
- Department of Radiology, Section of Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Ulrich Grosse
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
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Chiaradia M, Izamis ML, Radaelli A, Prevoo W, Maleux G, Schlachter T, Mayer J, Luciani A, Kobeiter H, Tacher V. Sensitivity and Reproducibility of Automated Feeding Artery Detection Software during Transarterial Chemoembolization of Hepatocellular Carcinoma. J Vasc Interv Radiol 2018; 29:425-431. [PMID: 29402612 DOI: 10.1016/j.jvir.2017.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To evaluate the performance of automated feeder detection (AFD) software (EmboGuide; Philips Healthcare, Best, The Netherlands) on hepatocellular carcinoma (HCC) tumors during transarterial chemoembolization. MATERIALS AND METHODS Forty-four first-time transarterial chemoembolization patients (37 men; mean age, 62 ± 11 years) were enrolled between May 2012 and July 2013. A total of 86 HCC lesions were treated (2.0 ± 1.4 lesions per patient; 27.6 ± 15.9 mm maximum diameter). One hundred forty-seven feeding arteries were found with digital subtraction angiography (DSA), cone-beam computed tomography (CT), and AFD software with the option of manual adjustment (MA). Three independent interventional radiologists analyzed the cone-beam CT images retrospectively with and without AFD and MA. Compared with the number of treated vessels, the number of true positives, false positives, false negatives, sensitivity, and interreader agreement were determined using clustered binary data analysis. RESULTS Cone-beam CT enabled detection of 100 ± 3.5 feeding arteries (70% sensitivity) with 68.6% agreement among readers. AFD software significantly improved detection to 127±0.6 feeding arteries (86% sensitivity, P = .008) with 99.7% reader agreement and reduced the number of false negatives from an average of 47 ± 3.5 to 20 ± 0.6 (P = .008). MA of the AFD results produced similar feeding artery detection rates (127 ± 5.1, 86% sensitivity, P = .8), with lower interreader agreement (91.6%) and slightly fewer false positives (16 ± 0.0 to 14 ± 2.5, P = .4). CONCLUSIONS AFD software significantly improved feeding artery detection rates during transarterial chemoembolization of HCC lesions with better user reproducibility compared with cone-beam CT alone. In conjunction with DSA, AFD enables maximum feeding artery detection in this setting.
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Affiliation(s)
- Mélanie Chiaradia
- Department of Radiology and Medical Imaging, Henri Mondor University Hospital, 51 Avenue du maréchal de Lattre de Tassigny, 94010 Creteil, France
| | | | | | - Warner Prevoo
- Department of Radiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; The Netherlands Katholieke Universiteit, Amsterdam, The Netherlands
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Todd Schlachter
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Julie Mayer
- Department of Radiology and Medical Imaging, Henri Mondor University Hospital, 51 Avenue du maréchal de Lattre de Tassigny, 94010 Creteil, France
| | - Alain Luciani
- Department of Radiology and Medical Imaging, Henri Mondor University Hospital, 51 Avenue du maréchal de Lattre de Tassigny, 94010 Creteil, France; Medical School, Université Paris Est Créteil, Créteil, France; Unité INSERM U 955, Equipe 18, Créteil, France
| | - Hicham Kobeiter
- Department of Radiology and Medical Imaging, Henri Mondor University Hospital, 51 Avenue du maréchal de Lattre de Tassigny, 94010 Creteil, France; Medical School, Université Paris Est Créteil, Créteil, France
| | - Vania Tacher
- Department of Radiology and Medical Imaging, Henri Mondor University Hospital, 51 Avenue du maréchal de Lattre de Tassigny, 94010 Creteil, France; Medical School, Université Paris Est Créteil, Créteil, France; Unité INSERM U 955, Equipe 18, Créteil, France.
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Accuracy of a Cone-Beam CT Virtual Parenchymal Perfusion Algorithm for Liver Cancer Targeting during Intra-arterial Therapy. J Vasc Interv Radiol 2017; 29:254-261.e2. [PMID: 29191614 DOI: 10.1016/j.jvir.2017.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/10/2017] [Accepted: 08/17/2017] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate accuracy of virtual parenchymal perfusion (VPP) algorithm developed for targeting liver cancer during intra-arterial therapy (IAT) using cone-beam CT guidance. MATERIALS AND METHODS VPP was retrospectively applied to 15 patients who underwent IAT for liver cancer. Virtual territory (VT) was estimated after positioning a virtual injection point on nonselective dual-phase (DP) cone-beam CT images acquired during hepatic arteriography at the same position chosen for selective treatment. Targeted territory (TT) was used as the gold standard and was defined by parenchymal phase enhancement of selective DP cone-beam CT performed before treatment start. Qualitative evaluation of anatomic conformity between VT and TT was performed using a 3-rank scale (poor, acceptable, excellent) by 3 double-blinded readers. VT and TT were also quantitatively compared using spatial overlap-based (Dice similarity coefficient [DSC], sensitivity, and positive predictive value), distance-based (mean surface distance [MSD]), and volume-based (absolute volume error and correlation between pairwise volumes) metrics. Interreader agreement was evaluated for the 2 evaluation methods. RESULTS Eighteen DP cone-beam CT scans were performed. Qualitative evaluation showed excellent overlap between VT and TT in 88.9%-94.4%, depending on the readers. DSC was 0.78 ± 0.1, sensitivity was 80%, positive predictive value was 83%, and MSD was 5.1 mm ± 2.4. Absolute volume error was 15%, and R2 Pearson correlation factor was 0.99. Interreader agreement was good for both qualitative and quantitative evaluations. CONCLUSIONS VPP algorithm is accurate and reliable in identification of liver arterial territories during IAT using cone-beam CT guidance.
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22
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Zhao Y, Duran R, Bai W, Sahu S, Wang W, Kabus S, Lin M, Han G, Geschwind JF. Which Criteria Applied in Multi-Phasic CT Can Predict Early Tumor Response in Patients with Hepatocellular Carcinoma Treated Using Conventional TACE: RECIST, mRECIST, EASL or qEASL? Cardiovasc Intervent Radiol 2017; 41:433-442. [PMID: 29086058 DOI: 10.1007/s00270-017-1829-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/19/2017] [Indexed: 12/27/2022]
Abstract
PURPOSE Our study aimed to evaluate quantitative tumor response assessment (quantitative EASL-[qEASL]) on computed tomography (CT) images in patients with hepatocellular carcinoma (HCC) treated using conventional transarterial chemoembolization (cTACE), compared to existing 1-dimensional and 2-dimensional methods (RECIST, mRECIST, EASL). MATERIALS AND METHODS In this IRB-approved, single-institution retrospective cohort study, 52 consecutive patients with intermediate-stage HCC were consecutively included. All patients underwent contrast-enhanced CT scan at baseline and 4 weeks after cTACE. RESULTS Median follow-up period was 13.5 months (range 1.2-54.1). RECIST, mRECIST and EASL identified progression in 2 (4%), 1 (2%) and 1 (2%) patients, respectively, whereas qEASL identified 10 (19%) patients. qEASL was the only tumor response method able to predict survival among different tumor response groups (P < 0.05), whereas RECIST, mRECIST and EASL did not (P > 0.05). Both EASL and qEASL were able to identify responders and non-responders and were predictive of survival (P < 0.05). Multivariate analysis showed that progression was an independent predictor of overall survival with hazard ratio of 1.9 (P = 0.025). Patients who demonstrated progression with qEASL had significantly shorter survival than those with non-progression (7.6 vs. 20.4 months, P = 0.012). Similar multivariate analysis using RECIST, mRECIST and EASL could not be performed because too few patients were categorized as progressive disease. CONCLUSION qEASL could be applied on CT images to assess tumor response following cTACE and is a more sensitive biomarker to predict survival and identify tumor progression than RECIST, mRECIST and EASL at an early time point. LEVEL OF EVIDENCE Level 2a, retrospective cohort study.
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Affiliation(s)
- Yan Zhao
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 27 West Changle Road, Xi'an, 710032, China.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Rafael Duran
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Wei Bai
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 27 West Changle Road, Xi'an, 710032, China
| | - Sonia Sahu
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Wenjun Wang
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 27 West Changle Road, Xi'an, 710032, China
| | - Sven Kabus
- Philips Research Hamburg, Hamburg, Germany
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.,U/S Imaging and Interventions (UII), Philips Research North America, Cambridge, MS, USA
| | - Guohong Han
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 27 West Changle Road, Xi'an, 710032, China.
| | - Jean-François Geschwind
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.,PreScience Labs LLC, Westport, CT, USA
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23
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Liver tissue classification in patients with hepatocellular carcinoma by fusing structured and rotationally invariant context representation. ACTA ACUST UNITED AC 2017. [PMID: 29900427 DOI: 10.1007/978-3-319-66179-7_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
This work addresses multi-class liver tissue classification from multi-parameter MRI in patients with hepatocellular carcinoma (HCC), and is among the first to do so. We propose a structured prediction framework to simultaneously classify parenchyma, blood vessels, viable tumor tissue, and necrosis, which overcomes limitations related to classifying these tissue classes individually and consecutively. A novel classification framework is introduced, based on the integration of multi-scale shape and appearance features to initiate the classification, which is iteratively refined by augmenting the feature space with both structured and rotationally invariant label context features. We study further the topic of rotationally invariant label context feature representations, and introduce a method for this purpose based on computing the energies of the spherical harmonic decompositions computed at different frequencies and radii. We test our method on full 3D multi-parameter MRI volumes from 47 patients with HCC and achieve promising results.
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Lucatelli P, Argirò R, Ginanni Corradini S, Saba L, Cirelli C, Fanelli F, Ricci C, Levi Sandri GB, Catalano C, Bezzi M. Comparison of Image Quality and Diagnostic Performance of Cone-Beam CT during Drug-Eluting Embolic Transarterial Chemoembolization and Multidetector CT in the Detection of Hepatocellular Carcinoma. J Vasc Interv Radiol 2017; 28:978-986. [PMID: 28495451 DOI: 10.1016/j.jvir.2017.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To compare image quality and diagnostic performance of cone-beam computed tomography (CT) and multidetector CT in the detection of hypervascular hepatocellular carcinoma (HCC) in patients with cirrhosis undergoing transarterial chemoembolization with drug-eluting embolic agents. MATERIALS AND METHODS Fifty-five consecutive patients referred for chemoembolization of hypervascular HCC were prospectively enrolled. Imaging included preprocedural multidetector CT within 1 month before planned treatment, intraprocedural cone-beam CT, and 1-month follow-up multidetector CT. Analysis of image quality was performed with calculations of lesion-to-liver contrast-to-noise ratio (LLCNR) and lesion-to-liver signal-to-noise-ratio (LLSNR). One-month follow-up multidetector CT was considered the reference standard for the detection of HCC nodules. RESULTS Median LLCNR values were 3.94 (95% confidence interval [CI], 3.06-5.05) for preprocedural multidetector CT and 6.90 (95% CI, 5.17-7.77) for intraprocedural cone-beam CT (P < .0001). Median LLSNR values were 11.53 (95% CI, 9.51-12.44) for preprocedural multidetector CT and 9.36 (95% CI, 8.12-10.39) for intraprocedural cone-beam CT (P < .0104). Preprocedural multidetector CT detected 115 hypervascular nodules with typical HCC behavior, and cone-beam CT detected 15 additional hypervascular nodules that were also visible on 1-month follow-up multidetector CT. CONCLUSIONS Cone-beam CT has a significantly higher diagnostic performance compared with preprocedural multidetector CT in the detection of HCCs and can influence management of patients with cirrhosis by identifying particularly aggressive tumors.
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy; Vascular and Interventional Radiology Unit, University of Siena, Siena, Italy
| | - Renato Argirò
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy; Department of Radiology, Interventional Radiology Unit, Ospedale Madre Giuseppina Vannini, Rome, Italy; Vascular and Interventional Radiology Unit, University of Siena, Siena, Italy.
| | | | - Luca Saba
- Department of Medical Imaging, Azienda Ospedaliero Universitaria of Cagliari-Polo di Monserrato, Cagliari, Italy
| | - Carlo Cirelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Fanelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Carmelo Ricci
- Department of Gastroenterology, Policlinio Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Carlo Catalano
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy
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Sandfort V, Kwan AC, Elumogo C, Vigneault DM, Symons R, Pourmorteza A, Rice K, Davies-Venn C, Ahlman MA, Liu CY, Zimmerman SL, Bluemke DA. Automatic high-resolution infarct detection using volumetric multiphase dual-energy CT. J Cardiovasc Comput Tomogr 2017; 11:288-294. [PMID: 28442244 DOI: 10.1016/j.jcct.2017.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/31/2017] [Accepted: 04/15/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Late contrast enhancement CT (LCE-CT) visualizes the presence of myocardial infarcts. Differentiation of the contrast-enhanced infarct from blood pool is challenging. We developed a novel method using data from first pass CT angiography (CTA) imaging to enable automatic infarct detection. MATERIALS AND METHODS A canine model of myocardial infarction was produced in 11 animals. Two months later, first pass CTA (90 kVp) and LCE-CT (dual energy 90 kVp/150 kVp tin filtered) were performed. Late gadolinium enhancement MRI was used as reference standard. The CTA and LCE-CT were co-registered using a fully automatic non-rigid method based on curved B-splines. The method allowed for limited elastic deformation and the considerable differences in attenuation between first-pass and delayed image. The blood pool was easily identified on the CTA image by high attenuation. Because CTA and LCE-CT were registered, the blood pool segmentation can be directly transferred to the LCE-CT - thereby solving the key problem of infarct/blood pool differentiation. The remaining segmentation of infarcted vs. noninfarcted myocardium was performed using a threshold. Automatic and MRI-guided expert segmentations of LCE-CT infarcts were compared to each other on volume and area basis (intraclass correlation coefficient, ICC) and on voxel basis (dice similarity coefficient, DSC between automatic and expert CT segmentation). CT infarct volumes were compared with the reference standard MRI. RESULTS The infarcts were mainly subendocardial (81%) and relatively small (median MRI infarct mass 7.4 g). The automatic segmentation showed excellent agreement with expert segmentation on volume and area measurements (ICC = 0.96 and 0.87, respectively). DSC showed moderately good agreement (DSC = 0.47). Compared to MRI there was modest agreement (ICC = 0.62) and excellent correlation (R = 0.9). Manual interaction was less than 1 min per exam. CONCLUSION We propose an automatic method for infarct segmentation on LCE-CT using multiphase CT information, which showed excellent agreement with expert readers and favorable correlation with MRI.
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Affiliation(s)
- Veit Sandfort
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Alan C Kwan
- The Johns Hopkins Hospital, Department of Medicine, Baltimore, MD, USA
| | - Comfort Elumogo
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Davis M Vigneault
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Rolf Symons
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Amir Pourmorteza
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Kelly Rice
- ORS Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA
| | - Cynthia Davies-Venn
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Mark A Ahlman
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Chia-Ying Liu
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | | | - David A Bluemke
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA.
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Stroehl YW, Letzen BS, van Breugel JMM, Geschwind JF, Chapiro J. Intra-arterial therapies for liver cancer: assessing tumor response. Expert Rev Anticancer Ther 2016; 17:119-127. [PMID: 27983883 DOI: 10.1080/14737140.2017.1273775] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Intra-arterial therapies (IATs) play an integral role in the management of unresectable hepatocellular carcinoma and liver metastases. The ability to accurately assess tumor response to intra-arterial therapies is crucial for clinical management. Several one- and two-dimensional manual imaging-based response assessment techniques, based both on tumor size or enhancement, have shown to be highly subjective and merely surrogate for the actual tumor as a whole. Areas covered: Given the currently existing literature, we will discuss all available tumor assessment techniques and criteria for liver cancer with a strong emphasis on 3D quantitative imaging biomarkers of tumor response in this review. Expert commentary: The growing role of information technology in medicine has brought about the advent of software-assisted, segmentation-based assessment techniques that address the outstanding issues of a subjective reader and provide for more accurate assessment techniques for the locally treated lesions. Three-dimensional quantitative tumor assessment techniques are superior to one- and two-dimensional measurements. This allows for treatment alterations and more precise targeting, potentially resulting in improved patient outcome.
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Affiliation(s)
- Yasmin W Stroehl
- a Department of Diagnostic and Interventional Radiology , Charité , Berlin , Germany.,b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
| | - Brian S Letzen
- b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
| | - Johanna M M van Breugel
- b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
| | - Jean-Francois Geschwind
- b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
| | - Julius Chapiro
- b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
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Fleckenstein FN, Schernthaner RE, Duran R, Sohn JH, Sahu S, Zhao Y, Hamm B, Gebauer B, Lin M, Geschwind JF, Chapiro J. 3D Quantitative tumour burden analysis in patients with hepatocellular carcinoma before TACE: comparing single-lesion vs. multi-lesion imaging biomarkers as predictors of patient survival. Eur Radiol 2016; 26:3243-52. [PMID: 26762942 PMCID: PMC4942412 DOI: 10.1007/s00330-015-4168-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/25/2015] [Accepted: 12/14/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To compare the ability of single- vs. multi-lesion assessment on baseline MRI using 1D- and 3D-based measurements to predict overall survival (OS) in patients with hepatocellular carcinoma (HCC) before transarterial chemoembolization (TACE). METHODS This retrospective analysis included 122 patients. A quantitative 3D analysis was performed on baseline MRI to calculate enhancing tumour volume (ETV [cm(3)]) and enhancing tumour burden (ETB [%]) (ratio between ETV [cm(3)] and liver volume). Furthermore, enhancing and overall tumour diameters were measured. Patients were stratified into two groups using thresholds derived from the BCLC staging system. Statistical analysis included Kaplan-Meier plots, uni- and multivariate cox proportional hazard ratios (HR) and concordances. RESULTS All methods achieved good separation of the survival curves (p < 0.05). Multivariate analysis showed an HR of 5.2 (95 % CI 3.1-8.8, p < 0.001) for ETV [cm(3)] and HR 6.6 (95 % CI 3.7-11.5, p < 0.001) for ETB [%] vs. HR 2.6 (95 % CI 1.2-5.6, p = 0.012) for overall diameter and HR 3.0 (95 % CI 1.5-6.3, p = 0.003) for enhancing diameter. Concordances were highest for ETB [%], with no added predictive power for multi-lesion assessment (difference between concordances not significant). CONCLUSION 3D quantitative assessment is a stronger predictor of survival as compared to diameter-based measurements. Assessing multiple lesions provides no substantial improvement in predicting OS than evaluating the dominant lesion alone. KEY POINTS • 3D quantitative tumour assessment on baseline MRI predicts survival in HCC patients. • 3D quantitative tumour assessment predicts survival better than any current radiological method. • Multiple lesion assessment provides no improvement than evaluating the dominant lesion alone. • Measuring enhancing tumour volume in proportion to liver volume reflects tumour burden.
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Affiliation(s)
- Florian N Fleckenstein
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA
- Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany
| | - Rüdiger E Schernthaner
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rafael Duran
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA
- Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Jae Ho Sohn
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sonia Sahu
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Yan Zhao
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Bernd Hamm
- Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany
| | - Bernhard Gebauer
- Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany
| | - MingDe Lin
- U/S Imaging and Interventions, Philips Research North America, Cambridge, MA, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Jean-François Geschwind
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
| | - Julius Chapiro
- Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
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Savic LJ, Lin MD, Duran R, Schernthaner RE, Hamm B, Geschwind JF, Hong K, Chapiro J. Three-dimensional quantitative assessment of lesion response to MR-guided high-intensity focused ultrasound treatment of uterine fibroids. Acad Radiol 2015; 22:1199-205. [PMID: 26160057 PMCID: PMC4546360 DOI: 10.1016/j.acra.2015.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 04/03/2015] [Accepted: 05/18/2015] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the response after magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) treatment of uterine fibroids (UF) using a three-dimensional (3D) quantification of total and enhancing lesion volume (TLV and ELV, respectively) on contrast-enhanced MRI (ceMRI) scans. METHODS AND MATERIALS In a total of 24 patients, ceMRI scans were obtained at baseline and 24 hours, and 6, 12, and 24 months after MRgHIFU treatment. The dominant lesion was assessed using a semiautomatic quantitative 3D segmentation technique. Agreement between software-assisted and manual measurements was then analyzed using a linear regression model. Patients were classified as responders (R) or nonresponders (NR) on the basis of their symptom report after 6 months. Statistical analysis included the paired t-test and Mann-Whitney test. RESULTS Preprocedurally, the median TLV and ELV were 263.74 cm(3) (30.45-689.56 cm(3)) and 210.13 cm(3) (14.43-689.53 cm(3)), respectively. The 6-month follow-up demonstrated a reduction of TLV in 21 patients (87.5%) with a median TLV of 171.7 cm(3) (8.5-791.2 cm(3); P < .0001). TLV remained stable with significant differences compared to baseline (P < .001 and P = .047 after 12 and 24 months). A reduction of ELV was apparent in 16 patients (66.6%) with a median ELV of 158.91 cm(3) (8.55-779.61 cm(3)) after 6 months (P = .065). Three-dimensional quantification and manual measurements showed strong intermethod agreement for fibroid volumes (R(2) = .889 and .917) but greater discrepancy for enhancement calculations (R(2) = .659 and .419) at baseline and 6 months. No significant differences in TLV or ELV were observed between clinical R (n = 15) and NR (n = 3). CONCLUSIONS The 3D assessment has proven feasible and accurate in the quantification of fibroid response to MRgHIFU. Contrary to ELV, changes in TLV may be representative of the clinical outcome.
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Affiliation(s)
- Lynn J Savic
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Department of Diagnostic and Interventional Radiology, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Ming De Lin
- U/S Imaging and Interventions (UII), Philips Research North America, Briarcliff Manor, New York
| | - Rafael Duran
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287
| | - Rüdiger E Schernthaner
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287
| | - Bernd Hamm
- Department of Diagnostic and Interventional Radiology, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Jean-François Geschwind
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287
| | - Kelvin Hong
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287.
| | - Julius Chapiro
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Department of Diagnostic and Interventional Radiology, Charité, Universitätsmedizin Berlin, Berlin, Germany
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Cone Beam Computed Tomography (CBCT) in the Field of Interventional Oncology of the Liver. Cardiovasc Intervent Radiol 2015; 39:8-20. [DOI: 10.1007/s00270-015-1180-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/27/2015] [Indexed: 12/21/2022]
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Xu C, Lv PH, Huang XE, Wang SX, Sun L, Wang FA. Radiofrequency Ablation for Liver Metastases after Transarterial Chemoembolization: A Systemic Analysis. Asian Pac J Cancer Prev 2015; 16:5101-6. [PMID: 26163649 DOI: 10.7314/apjcp.2015.16.12.5101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This systemic analysis was conducted to evaluate tumor recurrence rate and one-year survival rate for patients with liver metastases received radiofrequency ablation after transarterial chemoembolization and introduce a new method of radiofrequency ablation by puncture navigation technology for single liver metastases after transarterial chemoembolization. MATERIALS AND METHODS Clinical studies evaluating tumor recurrence rate and one-year survival rate. Appling the innova trackvision software to process one liver metastases received transarterial chemoembolization and using radiofrequency ablation by puncture navigation technology to treat the liver metastases. RESULTS 3 clinical studies which including 235 patients with liver metastases after transaeterial chemoembolization were considered eligible for inclusion. Systemic analysis suggested that tumor recurrence rate was 23% (54/235), one-year survival rate was 76% (178/235). The new procedure was performed successfully and the patient received a good prognosis. CONCLUSIONS This systemic analysis suggests that radiofrequency ablation is a good method for liver metastases after transarterial chemoembolization and could receive a relatively good prognosis.
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Affiliation(s)
- Chuan Xu
- Department of Interventional Radiology, Subei People's Hospital of Jiangsu Province, Clinical Hospital of Yangzhou University, Yangzhou, China E-mail : why77sina.com;
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3D quantitative assessment of response to fractionated stereotactic radiotherapy and single-session stereotactic radiosurgery of vestibular schwannoma. Eur Radiol 2015; 26:849-57. [PMID: 26139318 DOI: 10.1007/s00330-015-3895-9] [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: 02/28/2015] [Revised: 05/19/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine clinical outcome of patients with vestibular schwannoma (VS) after treatment with fractionated stereotactic radiotherapy (FSRT) and single-session stereotactic radiosurgery (SRS) by using 3D quantitative response assessment on MRI. MATERIALS This retrospective analysis included 162 patients who underwent radiation therapy for sporadic VS. Measurements on T1-weighted contrast-enhanced MRI (in 2-year post-therapy intervals: 0-2, 2-4, 4-6, 6-8, 8-10, 10-12 years) were taken for total tumour volume (TTV) and enhancing tumour volume (ETV) based on a semi-automated technique. Patients were considered non-responders (NRs) if they required subsequent microsurgical resection or developed radiological progression and tumour-related symptoms. RESULTS Median follow-up was 4.1 years (range: 0.4-12.0). TTV and ETV decreased for both the FSRT and SRS groups. However, only the FSRT group achieved significant tumour shrinkage (p < 0.015 for TTV, p < 0.005 for ETV over time). The 11 NRs showed proportionally greater TTV (median TTV pre-treatment: 0.61 cm(3), 8-10 years after: 1.77 cm(3)) and ETV despite radiation therapy compared to responders (median TTV pre-treatment: 1.06 cm(3); 10-12 years after: 0.81 cm(3); p = 0.001). CONCLUSION 3D quantification of VS showed a significant decrease in TTV and ETV on FSRT-treated patients only. NR had significantly greater TTV and ETV over time. KEY POINTS Only FSRT not GK-treated patients showed significant tumour shrinkage over time. Clinical non-responders showed significantly less tumour shrinkage when compared to responders. 3D volumetric assessment of vestibular schwannoma shows advantages over unidimensional techniques.
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Chapiro J, Duran R, Lin M, Schernthaner R, Lesage D, Wang Z, Savic LJ, Geschwind JF. Early survival prediction after intra-arterial therapies: a 3D quantitative MRI assessment of tumour response after TACE or radioembolization of colorectal cancer metastases to the liver. Eur Radiol 2015; 25:1993-2003. [PMID: 25636420 PMCID: PMC4458393 DOI: 10.1007/s00330-015-3595-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 12/22/2014] [Accepted: 01/12/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVES This study evaluated the predictive role of 1D, 2D and 3D quantitative, enhancement-based MRI regarding overall survival (OS) in patients with colorectal liver metastases (CLM) following intra-arterial therapies (IAT). METHODS This retrospective analysis included 29 patients who underwent transarterial chemoembolization (TACE) or radioembolization and received MRI within 6 weeks after therapy. Tumour response was assessed using 1D and 2D criteria (such as European Association for the Study of the Liver guidelines [EASL] and modified Response Evaluation Criteria in Solid Tumors [mRECIST]). In addition, a segmentation-based 3D quantification of overall (volumetric [v] RECIST) and enhancing lesion volume (quantitative [q] EASL) was performed on portal venous phase MRI. Accordingly, patients were classified as responders (R) and non-responders (NR). Survival was evaluated using Kaplan-Meier analysis and compared using Cox proportional hazard ratios (HR). RESULTS Only enhancement-based criteria identified patients as responders. EASL and mRECIST did not predict patient survival (P = 0.27 and P = 0.44, respectively). Using uni- and multivariate analysis, qEASL was identified as the sole predictor of patient survival (9.9 months for R, 6.9 months for NR; P = 0.038; HR 0.4). CONCLUSION The ability of qEASL to predict survival early after IAT provides evidence for potential advantages of 3D quantitative tumour analysis. KEY POINTS • Volumetric assessment of colorectal liver metastases after intra-arterial therapy is feasible. • Early 3D quantitative tumour analysis after intra-arterial therapy may predict patient survival. • Volumetric tumour response assessment shows advantages over 1D and 2D techniques. • Enhancement-based MR response assessment is preferable to size-based measurements.
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Affiliation(s)
- Julius Chapiro
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, 21287, USA
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Wang Z, Chapiro J, Schernthaner R, Duran R, Chen R, Geschwind JF, Lin M. Multimodality 3D Tumor Segmentation in HCC Patients Treated with TACE. Acad Radiol 2015; 22:840-5. [PMID: 25863795 DOI: 10.1016/j.acra.2015.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 02/12/2015] [Accepted: 03/08/2015] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To validate the concordance of a semiautomated multimodality lesion segmentation technique between contrast-enhanced magnetic resonance imaging (CE-MRI), cone-beam computed tomography (CBCT), and multidetector CT (MDCT) in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). MATERIALS AND METHODS This retrospective analysis included 45 patients with unresectable HCC who underwent baseline CE-MRI within 1 month before the treatment, intraprocedural CBCT during conventional TACE, and MDCT within 24 hours after TACE. Fourteen patients were excluded because of atypical lesion morphology, portal vein invasion, or small lesion size which precluded sufficient lesion visualization. Thirty-one patients with a total of 40 target lesions were included into the analysis. A tumor segmentation software, based on non-Euclidean geometry and theory of radial basis functions, was used to allow for the segmentation of target lesions in 3D on all three modalities. The algorithm created image-based masks located in a 3D region whose center and size were defined by the user, yielding the nomenclature "semiautomatic". On the basis of that, tumor volumes on all three modalities were calculated and compared using a linear regression model (R(2) values). Residual plots were used to analyze drift and variance of the values. RESULTS The mean value of tumor volumes was 18.72 ± 19.13 cm(3) (range, 0.41-59.16 cm(3)) on CE-MRI, 21.26 ± 21.99 cm(3) (range, 0.62-86.82 cm(3)) on CBCT, and 19.88 ± 20.88 cm(3) (range, 0.45-75.24 cm(3)) on MDCT. The average volumes of the tumor were not significantly different between CE-MRI and DP-CBCT, DP-CBCT and MDCT, MDCT and CE-MRI (P = .577, .770, and .794, respectively). A strong correlation between volumes on CE-MRI and CBCT, CBCT and MDCT, MDCT and CE-MRI was observed (R(2) = 0.974, 0.992 and 0.983, respectively). When plotting the residuals, no drift was observed for all methods showing deviations of no >10% of absolute volumes (in cm(3)). CONCLUSIONS A semiautomated 3D segmentation of HCC lesions treated with TACE provides high volumetric concordance across all tested imaging modalities.
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Tacher V, Lin M, Duran R, Yarmohammadi H, Lee H, Chapiro J, Chao M, Wang Z, Frangakis C, Sohn JH, Maltenfort MG, Pawlik T, Geschwind JF. Comparison of Existing Response Criteria in Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization Using a 3D Quantitative Approach. Radiology 2015; 278:275-84. [PMID: 26131913 DOI: 10.1148/radiol.2015142951] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare currently available non-three-dimensional methods (Response Evaluation Criteria in Solid Tumors [RECIST], European Association for Study of the Liver [EASL], modified RECIST [mRECIST[) with three-dimensional (3D) quantitative methods of the index tumor as early response markers in predicting patient survival after initial transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS This was a retrospective single-institution HIPAA-compliant and institutional review board-approved study. From November 2001 to November 2008, 491 consecutive patients underwent intraarterial therapy for liver cancer with either conventional TACE or TACE with drug-eluting beads. A diagnosis of hepatocellular carcinoma (HCC) was made in 290 of these patients. The response of the index tumor on pre- and post-TACE magnetic resonance images was assessed retrospectively in 78 treatment-naïve patients with HCC (63 male; mean age, 63 years ± 11 [standard deviation]). Each response assessment method (RECIST, mRECIST, EASL, and 3D methods of volumetric RECIST [vRECIST] and quantitative EASL [qEASL]) was used to classify patients as responders or nonresponders by following standard guidelines for the uni- and bidimensional measurements and by using the formula for a sphere for the 3D measurements. The Kaplan-Meier method with the log-rank test was performed for each method to evaluate its ability to help predict survival of responders and nonresponders. Uni- and multivariate Cox proportional hazard ratio models were used to identify covariates that had significant association with survival. RESULTS The uni- and bidimensional measurements of RECIST (hazard ratio, 0.6; 95% confidence interval [CI]: 0.3, 1.0; P = .09), mRECIST (hazard ratio, 0.6; 95% CI: 0.6, 1.0; P = .05), and EASL (hazard ratio, 1.1; 95% CI: 0.6, 2.2; P = .75) did not show a significant difference in survival between responders and nonresponders, whereas vRECIST (hazard ratio, 0.6; 95% CI: 0.3, 1.0; P = .04), qEASL (Vol) (hazard ratio, 0.5; 95% CI: 0.3, 0.9; P = .02), and qEASL (%) (hazard ratio, 0.3; 95% CI: 0.15, 0.60; P < .001) did show a significant difference between these groups. CONCLUSION The 3D-based imaging biomarkers qEASL and vRECIST were tumor response criteria that could be used to predict patient survival early after initial TACE and enabled clear identification of nonresponders.
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Affiliation(s)
- Vania Tacher
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - MingDe Lin
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Rafael Duran
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Hooman Yarmohammadi
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Howard Lee
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Julius Chapiro
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Michael Chao
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Zhijun Wang
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Constantine Frangakis
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Jae Ho Sohn
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Mitchell Gil Maltenfort
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Timothy Pawlik
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Jean-François Geschwind
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
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Intraprocedural 3D Quantification of Lipiodol Deposition on Cone-Beam CT Predicts Tumor Response After Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2015; 38:1548-56. [PMID: 26001366 DOI: 10.1007/s00270-015-1129-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/26/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate whether intraprocedural 3D quantification of Lipiodol deposition on cone-beam computed tomography (CBCT) can predict tumor response on follow-up contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE). MATERIALS AND METHODS This IRB approved, retrospective analysis included 36 patients with 51 HCC target lesions, who underwent cTACE with CBCT. CE-MRI was acquired at baseline and 1 month after cTACE. Overall tumor volumes as well as intratumoral Lipiodol volumes on CBCT were measured and compared with the overall and necrotic (non-enhancing) tumor volumes on CE-MRI using the paired student's t test. Tumor response on CE-MRI was assessed using modified response evaluation criteria in solid tumors (mRECIST). A linear regression model was used to correlate tumor volumes, Lipiodol volumes, and the percentage of Lipiodol deposition on CBCT with the corresponding parameters on CE-MRI. Nonparametric spearman rank-order correlation and trend test were used to correlate the percentage of Lipiodol deposition in the tumor with tumor response. RESULT A strong correlation between overall tumor volumes on CBCT and CE-MRI was observed (R(2) = 0.986). In addition, a strong correlation was obtained between the volume of Lipiodol deposition on CBCT and tumor necrosis (in cm(3)) on CE-MRI (R(2) = 0.960), and between the percentage of Lipiodol deposition and tumor necrosis (R(2) = 0.979). Importantly, the extent of Lipiodol deposition (in percentage of total tumor volume) correlated strongly with tumor response on CE-MRI (Spearman rho = 0.84, p < 0.001). CONCLUSIONS Intraprocedural 3D quantification of Lipiodol deposition on CBCT can be used to predict tumor response on follow-up CE-MRI.
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Radiologic-pathologic analysis of quantitative 3D tumour enhancement on contrast-enhanced MR imaging: a study of ROI placement. Eur Radiol 2015; 26:103-13. [PMID: 25994198 DOI: 10.1007/s00330-015-3812-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/13/2015] [Accepted: 04/21/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To investigate the influence of region-of-interest (ROI) placement on 3D tumour enhancement [Quantitative European Association for the Study of the Liver (qEASL)] in hepatocellular carcinoma (HCC) patients treated with transcatheter arterial chemoembolization (TACE). METHODS Phase 1: 40 HCC patients had nine ROIs placed by one reader using systematic techniques (3 ipsilateral to the lesion, 3 contralateral to the lesion, and 3 dispersed throughout the liver) and qEASL variance was measured. Intra-class correlations were computed. Phase 2: 15 HCC patients with histosegmentation were selected. Six ROIs were systematically placed by AC (3 ROIs ipsilateral and 3 ROIs contralateral to the lesion). Three ROIs were placed by 2 radiologists. qEASL values were compared to histopathology by Pearson's correlation, linear regression, and median difference. RESULTS Phase 1: The dispersed method (abandoned in phase 2) had low consistency and high variance. Phase 2: qEASL correlated strongly with pathology in systematic methods [Pearson's correlation coefficient = 0.886 (ipsilateral) and 0.727 (contralateral)] and in clinical methods (0.625 and 0.879). However, ipsilateral placement matched best with pathology (median difference: 5.4 %; correlation: 0.89; regression CI: [0.904, 0.1409]). CONCLUSIONS qEASL is a robust method with comparable values among tested placements. Ipsilateral placement showed high consistency and better pathological correlation. KEY POINTS Ipsilateral and contralateral ROI placement produces high consistency and low variance. Both ROI placement methods produce qEASL values that correlate well with histopathology. Ipsilateral ROI placement produces best correlation to pathology along with high consistency.
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Tacher V, Radaelli A, Lin M, Geschwind JF. How I do it: Cone-beam CT during transarterial chemoembolization for liver cancer. Radiology 2015; 274:320-34. [PMID: 25625741 DOI: 10.1148/radiol.14131925] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cone-beam computed tomography (CBCT) is an imaging technique that provides computed tomographic (CT) images from a rotational scan acquired with a C-arm equipped with a flat panel detector. Utilizing CBCT images during interventional procedures bridges the gap between the world of diagnostic imaging (typically three-dimensional imaging but performed separately from the procedure) and that of interventional radiology (typically two-dimensional imaging). CBCT is capable of providing more information than standard two-dimensional angiography in localizing and/or visualizing liver tumors ("seeing" the tumor) and targeting tumors though precise microcatheter placement in close proximity to the tumors ("reaching" the tumor). It can also be useful in evaluating treatment success at the time of procedure ("assessing" treatment success). CBCT technology is rapidly evolving along with the development of various contrast material injection protocols and multiphasic CBCT techniques. The purpose of this article is to provide a review of the principles of CBCT imaging, including purpose and clinical evidence of the different techniques, and to introduce a decision-making algorithm as a guide for the routine utilization of CBCT during transarterial chemoembolization of liver cancer.
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Affiliation(s)
- Vania Tacher
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287 (V.T., J.F.G.); Department of Interventional X-ray, Philips Healthcare, Best, the Netherlands (A.R.); and Department of Clinical Informatics, Interventional, and Translational Solutions, Philips Research North America, Briarcliff Manor, NY (M.L.)
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Brodin NP, Tang J, Skalina K, Quinn TJ, Basu I, Guha C, Tomé WA. Semi-automatic cone beam CT segmentation of in vivo pre-clinical subcutaneous tumours provides an efficient non-invasive alternative for tumour volume measurements. Br J Radiol 2015; 88:20140776. [PMID: 25823502 DOI: 10.1259/bjr.20140776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and accuracy of using cone beam CT (CBCT) scans obtained in radiation studies using the small-animal radiation research platform to perform semi-automatic tumour segmentation of pre-clinical tumour volumes. METHODS Volume measurements were evaluated for different anatomical tumour sites, the flank, thigh and dorsum of the hind foot, for a variety of tumour cell lines. The estimated tumour volumes from CBCT and manual calliper measurements using different volume equations were compared with the "gold standard", measured by weighing the tumours following euthanasia and tumour resection. The correlation between tumour volumes estimated with the different methods, compared with the gold standard, was estimated by the Spearman's rank correlation coefficient, root-mean-square deviation and the coefficient of determination. RESULTS The semi-automatic CBCT volume segmentation performed favourably compared with manual calliper measures for flank tumours ≤2 cm(3) and thigh tumours ≤1 cm(3). For tumours >2 cm(3) or foot tumours, the CBCT method was not able to accurately segment the tumour volumes and manual calliper measures were superior. CONCLUSION We demonstrated that tumour volumes of flank and thigh tumours, obtained as a part of radiation studies using image-guided small-animal irradiators, can be estimated more efficiently and accurately using semi-automatic segmentation from CBCT scans. ADVANCES IN KNOWLEDGE This is the first study evaluating tumour volume assessment of pre-clinical subcutaneous tumours in different anatomical sites using on-board CBCT imaging. We also compared the accuracy of the CBCT method to manual calliper measures, using various volume calculation equations.
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Affiliation(s)
- N P Brodin
- 1 Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
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Chapiro J, Duran R, Lin M, Werner JD, Wang Z, Schernthaner R, Savic LJ, Lessne ML, Geschwind JF, Hong K. Three-Dimensional Quantitative Assessment of Uterine Fibroid Response after Uterine Artery Embolization Using Contrast-Enhanced MR Imaging. J Vasc Interv Radiol 2015; 26:670-678.e2. [PMID: 25638750 DOI: 10.1016/j.jvir.2014.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 10/31/2014] [Accepted: 11/10/2014] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To evaluate the clinical feasibility and diagnostic accuracy of three-dimensional (3D) quantitative magnetic resonance (MR) imaging for the assessment of total lesion volume (TLV) and enhancing lesion volume (ELV) before and after uterine artery embolization (UAE). MATERIALS AND METHODS This retrospective study included 25 patients with uterine fibroids who underwent UAE and received contrast-enhanced MR imaging before and after the procedure. TLV was calculated using a semiautomated 3D segmentation of the dominant lesion on contrast-enhanced MR imaging, and ELV was defined as voxels within TLV where the enhancement exceeded the value of a region of interest placed in hypoenhancing soft tissue (left psoas muscle). ELV was expressed in relative (% of TLV) and absolute (in cm(3)) metrics. Results were compared with manual measurements and correlated with symptomatic outcome using a linear regression model. RESULTS Although 3D quantitative measurements of TLV demonstrated a strong correlation with the manual technique (R(2) = 0.93), measurements of ELV after UAE showed significant disagreement between techniques (R(2) = 0.72; residual standard error, 15.8). Six patients (24%) remained symptomatic and were classified as nonresponders. When stratified according to response, no difference in % ELV between responders and nonresponders was observed. When assessed using cm(3) ELV, responders showed a significantly lower mean ELV compared with nonresponders (4.1 cm(3) [range, 0.3-19.8 cm(3)] vs 77 cm(3) [range, 11.91-296 cm(3)]; P < .01). CONCLUSIONS The use of segmentation-based 3D quantification of lesion enhancement is feasible and diagnostically accurate and could be considered as an MR imaging response marker for clinical outcome after UAE.
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Affiliation(s)
- Julius Chapiro
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287; Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Berlin, Germany
| | - Rafael Duran
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287
| | - MingDe Lin
- Clinical Informatics, Interventional, and Translational Solutions, Philips Research North America, Briarcliff Manor, New York
| | - John D Werner
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287
| | - Zhijun Wang
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287
| | - Rüdiger Schernthaner
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287
| | - Lynn Jeanette Savic
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287; Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Berlin, Germany
| | - Mark L Lessne
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287
| | - Jean-François Geschwind
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287
| | - Kelvin Hong
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287.
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Chapiro J, Duran R, Lin M, Schernthaner RE, Wang Z, Gorodetski B, Geschwind JF. Identifying Staging Markers for Hepatocellular Carcinoma before Transarterial Chemoembolization: Comparison of Three-dimensional Quantitative versus Non-three-dimensional Imaging Markers. Radiology 2014; 275:438-47. [PMID: 25531387 DOI: 10.1148/radiol.14141180] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose To test and compare the association between radiologic measurements of lesion diameter, volume, and enhancement on baseline magnetic resonance (MR) images with overall survival and tumor response in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Materials and Methods This HIPAA-compliant retrospective, single-institution analysis was approved by the institutional review board, with waiver of informed consent. It included 79 patients with unresectable HCC who were treated with TACE. Baseline arterial phase contrast material-enhanced (CE) MR imaging was used to measure the overall and enhancing tumor diameters. A segmentation-based three-dimensional quantification of the overall and enhancing tumor volumes was performed in each patient. Numeric cutoff values (5 cm for diameters and 65 cm(3) for volumes) were used to stratify the patient cohort in two groups. Tumor response rates according to Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) guidelines were recorded for all groups. Survival was evaluated by using Kaplan-Meier analysis and was compared by using Cox proportional hazard ratios (HRs) after univariate and multivariate analysis. Results Stratification according to overall and enhancing tumor diameters did not result in a significant separation of survival curves (HR, 1.4; 95% confidence interval [CI]: 0.7, 2.5; P = .234; and HR, 1.6; 95% CI: 0.9, 2.8; P = .08, respectively). The stratification according to overall and enhancing tumor volume achieved significance (HR, 1.8; 95% CI: 0.9, 3.4; P = .022; and HR, 1.8; 95% CI: 1.1, 3.1; P = .017, respectively). As for tumor response, higher response rates were observed in smaller lesions compared with larger lesions, when the 5-cm threshold (27% vs 15% for mRECIST and 45% vs 24% for EASL) was used. Conclusion As opposed to anatomic tumor diameter as the most commonly used staging marker, volumetric assessment of lesion size and enhancement on baseline CE MR images is strongly associated with survival of patients with HCC who were treated with TACE.
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Affiliation(s)
- Julius Chapiro
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, the Johns Hopkins Hospital, 1800 Orleans St, Sheikh Zayed Tower, Suite 7203, Baltimore, MD 21287 (J.C., R.D., M.L., R.E.S., Z.W., B.G., J.F.G.); Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany (J.C., B.G.); and U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.)
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Transarterial chemoembolization in soft-tissue sarcoma metastases to the liver - the use of imaging biomarkers as predictors of patient survival. Eur J Radiol 2014; 84:424-430. [PMID: 25542065 DOI: 10.1016/j.ejrad.2014.11.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 11/14/2014] [Accepted: 11/28/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND The clinical management of patients with metastatic soft-tissue sarcoma of the liver is complicated by the paucity of reliable clinical data. This study evaluated the safety profile, survival outcome as well as the role of imaging biomarkers of tumor response in metastatic soft-tissue sarcoma (mSTS) of the liver treated with conventional transarterial chemoembolization (cTACE). MATERIALS/METHODS This retrospective analysis included 30 patients with mSTS of the liver treated with cTACE. The safety profile, overall survival (OS) and progression-free survival (PFS) after the procedure were evaluated. Tumor response in each patient was assessed using RECIST, modified (m) RECIST and EASL guidelines. In addition, a 3D quantification of the enhancing tumor volume (quantitative [q] EASL) was performed. For each method, patients were classified as responders (R) and non-responders (NR), and evaluated using Kaplan-Meier and multivariate Cox proportional hazard ratio (HR) analysis. RESULTS No Grade III or IV toxicities were reported in a total of 77 procedures (mean, 2.6/patient). Median OS was 21.2 months (95% CI, 13.4-28.9) and PFS was 6.3 months (95% CI, 4.4-8.2). The enhancement-based techniques identified 11 (44%), 12 (48%) and 12 (48%) patients as R according to EASL, mRECIST and qEASL, respectively. No stratification was achieved with RECIST. Multivariate analysis identified tumor response according to mRECIST and qEASL as reliable predictors of improved patient survival (P=0.019; HR 0.3 [0.1-0.8] and P=0.006; HR 0.2 [0.1-0.6], respectively). CONCLUSION This study confirmed the role of cTACE as a safe salvage therapy option in patients with mSTS of the liver. The demonstrated advantages of enhancement-based tumor response assessment techniques over size-based criteria validate mRECIST and qEASL as preferable methods after intraarterial therapy.
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Chapiro J, Lin M, Duran R, Schernthaner RE, Geschwind JF. Assessing tumor response after loco-regional liver cancer therapies: the role of 3D MRI. Expert Rev Anticancer Ther 2014; 15:199-205. [PMID: 25371052 DOI: 10.1586/14737140.2015.978861] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Assessing the tumor response of liver cancer lesions after intraarterial therapies is of major clinical interest. Over the last two decades, tumor response criteria have come a long way from purely size-based, anatomic methods such as the Response Evaluation Criteria in Solid Tumors towards more functional, enhancement- and diffusion-based parameters with a strong emphasis on MRI as the ultimate imaging modality. However, the relatively low reproducibility of those one- and 2D techniques (modified Response Evaluation Criteria in Solid Tumors and the European Association for the Study of the Liver criteria) provided the rationale for the development of new, 3D quantitative assessment techniques. This review will summarize and compare the existing methodologies used for 3D quantitative tumor analysis and provide an overview of the published clinical evidence for the benefits of 3D quantitative tumor response assessment techniques.
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Affiliation(s)
- Julius Chapiro
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower, Suite 7203, Baltimore, MD 21287, USA
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Chapiro J, Wood LD, Lin M, Duran R, Cornish T, Lesage D, Charu V, Schernthaner R, Wang Z, Tacher V, Savic LJ, Kamel IR, Geschwind JF. Radiologic-pathologic analysis of contrast-enhanced and diffusion-weighted MR imaging in patients with HCC after TACE: diagnostic accuracy of 3D quantitative image analysis. Radiology 2014; 273:746-58. [PMID: 25028783 DOI: 10.1148/radiol.14140033] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of three-dimensional ( 3D three-dimensional ) quantitative enhancement-based and diffusion-weighted volumetric magnetic resonance (MR) imaging assessment of hepatocellular carcinoma ( HCC hepatocellular carcinoma ) lesions in determining the extent of pathologic tumor necrosis after transarterial chemoembolization ( TACE transarterial chemoembolization ). MATERIALS AND METHODS This institutional review board-approved retrospective study included 17 patients with HCC hepatocellular carcinoma who underwent TACE transarterial chemoembolization before surgery. Semiautomatic 3D three-dimensional volumetric segmentation of target lesions was performed at the last MR examination before orthotopic liver transplantation or surgical resection. The amount of necrotic tumor tissue on contrast material-enhanced arterial phase MR images and the amount of diffusion-restricted tumor tissue on apparent diffusion coefficient ( ADC apparent diffusion coefficient ) maps were expressed as a percentage of the total tumor volume. Visual assessment of the extent of tumor necrosis and tumor response according to European Association for the Study of the Liver ( EASL European Association for the Study of the Liver ) criteria was performed. Pathologic tumor necrosis was quantified by using slide-by-slide segmentation. Correlation analysis was performed to evaluate the predictive values of the radiologic techniques. RESULTS At histopathologic examination, the mean percentage of tumor necrosis was 70% (range, 10%-100%). Both 3D three-dimensional quantitative techniques demonstrated a strong correlation with tumor necrosis at pathologic examination (R(2) = 0.9657 and R(2) = 0.9662 for quantitative EASL European Association for the Study of the Liver and quantitative ADC apparent diffusion coefficient , respectively) and a strong intermethod agreement (R(2) = 0.9585). Both methods showed a significantly lower discrepancy with pathologically measured necrosis (residual standard error [ RSE residual standard error ] = 6.38 and 6.33 for quantitative EASL European Association for the Study of the Liver and quantitative ADC apparent diffusion coefficient , respectively), when compared with non- 3D three-dimensional techniques ( RSE residual standard error = 12.18 for visual assessment). CONCLUSION This radiologic-pathologic correlation study demonstrates the diagnostic accuracy of 3D three-dimensional quantitative MR imaging techniques in identifying pathologically measured tumor necrosis in HCC hepatocellular carcinoma lesions treated with TACE transarterial chemoembolization .
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Affiliation(s)
- Julius Chapiro
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287 (J.C., M.L., R.D., R.S., Z.W., V.T., L.J.S., I.R.K., J.F.G.); Department of Pathology, The Johns Hopkins Hospital, Baltimore, Md (L.D.W., T.C.); Philips Research, Medisys, Suresnes, France (D.L.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (V.C.)
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Duran R, Chapiro J, Frangakis C, Lin M, Schlachter TR, Schernthaner RE, Wang Z, Savic LJ, Tacher V, Kamel IR, Geschwind JF. Uveal Melanoma Metastatic to the Liver: The Role of Quantitative Volumetric Contrast-Enhanced MR Imaging in the Assessment of Early Tumor Response after Transarterial Chemoembolization. Transl Oncol 2014; 7:447-55. [PMID: 24953419 PMCID: PMC4202794 DOI: 10.1016/j.tranon.2014.05.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/17/2014] [Accepted: 05/21/2014] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To determine whether volumetric changes of enhancement as seen on contrast-enhanced magnetic resonance (MR) imaging can help assess early tumor response and predict survival in patients with metastatic uveal melanoma after one session of transarterial chemoembolization (TACE). MATERIALS AND METHODS Fifteen patients with 59 lesions who underwent MR imaging before and 3 to 4 weeks after the first TACE were retrospectively included. MR analysis evaluated signal intensities, World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), European Association for the Study of the Liver (EASL), modified RECIST (mRECIST), tumor volume [volumetric RECIST (vRECIST)], and volumetric tumor enhancement [quantitative EASL (qEASL)]. qEASL was expressed in cubic centimeters [qEASL (cm3)] and as a percentage of the tumor volume [qEASL (%)]. Paired t test with its exact permutation distribution was used to compare measurements before and after TACE. The Kaplan-Meier method with the log-rank test was used to calculate overall survival for responders and non-responders. RESULTS In target lesions, mean qEASL (%) decreased from 63.9% to 42.6% (P = .016). No significant changes were observed using the other response criteria. In non-target lesions, mean WHO, RECIST, EASL, mRECIST, vRECIST, and qEASL (cm3) were significantly increased compared to baseline. qEASL (%) remained stable (P = .214). Median overall survival was 5.6 months. qEASL (cm3) was the only parameter that could predict survival based on target lesions (3.6 vs 40.5 months, P < .001) or overall (target and non-target lesions) response (4.4 vs 40.9 months, P = .001). CONCLUSION Volumetric tumor enhancement may be used as a surrogate biomarker for survival prediction in patients with uveal melanoma after the first TACE.
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Affiliation(s)
- Rafael Duran
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA.
| | - Julius Chapiro
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA.
| | - Constantine Frangakis
- Ultrasound and Interventions, Philips Research North America, Briarcliff Manor, NY, USA.
| | - MingDe Lin
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Todd R Schlachter
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA.
| | - Rüdiger E Schernthaner
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA.
| | - Zhijun Wang
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA.
| | - Lynn J Savic
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA.
| | - Vania Tacher
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA.
| | - Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA.
| | - Jean-François Geschwind
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA.
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Wang Z, Lin M, Lesage D, Chen R, Chapiro J, Gu T, Tacher V, Duran R, Geschwind JF. Three-dimensional evaluation of lipiodol retention in HCC after chemoembolization: a quantitative comparison between CBCT and MDCT. Acad Radiol 2014; 21:393-9. [PMID: 24507426 PMCID: PMC3979929 DOI: 10.1016/j.acra.2013.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/02/2013] [Accepted: 11/03/2013] [Indexed: 01/04/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the capability of cone-beam computed tomography (CBCT) acquired immediately after transcatheter arterial chemoembolization (TACE) in determining lipiodol retention quantitatively and volumetrically when compared to 1-day postprocedure unenhanced multidetector computed tomography (MDCT). MATERIALS AND METHODS From June to December 2012, 15 patients met the inclusion criteria of unresectable hepatocellular carcinoma (HCC) that was treated with conventional TACE (cTACE) and had intraprocedural CBCT and 1-day post-TACE MDCT. Four patients were excluded because the lipiodol was diffuse throughout the entire liver or lipiodol deposition was not clear on both CBCT and MDCT. Eleven patients with a total of 31 target lesions were included in the analysis. A quantitative three-dimensional software was used to assess complete, localized, and diffuse lipiodol deposition. Tumor volume, lipiodol volume in the tumor, percent lipiodol retention, and lipiodol enhancement in Hounsfield units (HU) were calculated and compared between CBCT and MDCT using two-tailed Student's t test and Bland-Altman plots. RESULTS The mean value of tumor volume, lipiodol-deposited regions, calculated average percent lipiodol retention, and HU value of CBCT were not significantly different from those of MDCT (tumor volume: 9.37 ± 11.35 cm(3) vs 9.34 ± 11.44 cm(3), P = .991; lipiodol volume: 7.84 ± 9.34 cm(3) vs 7.84 ± 9.60 cm(3), P = .998; lipiodol retention: 89.3% ± 14.7% vs. 90.2% ± 14.9%, P = .811; HU value: 307.7 ± 160.1 HU vs. 257.2 ± 120.0 HU, P = .139). Bland-Altman plots showed only minimal difference and high agreement when comparing CBCT to MDCT. CONCLUSIONS CBCT has a similar capability, intraprocedurally, to assess lipiodol deposition in three dimensions for patients with HCC treated with cTACE when compared to MDCT.
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Affiliation(s)
- Zhijun Wang
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - MingDe Lin
- Clinical Informatics, Interventional, and Translational Solutions (CIITS), Philips Research North America, Briarcliff Manor, NY, USA
| | | | - Rongxin Chen
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Julius Chapiro
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Tara Gu
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Vania Tacher
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Rafael Duran
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Jean-François Geschwind
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
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Quantitative tumor segmentation for evaluation of extent of glioblastoma resection to facilitate multisite clinical trials. Transl Oncol 2014; 7:40-7. [PMID: 24772206 DOI: 10.1593/tlo.13835] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 01/15/2014] [Accepted: 01/16/2014] [Indexed: 12/20/2022] Open
Abstract
Standard-of-care therapy for glioblastomas, the most common and aggressive primary adult brain neoplasm, is maximal safe resection, followed by radiation and chemotherapy. Because maximizing resection may be beneficial for these patients, improving tumor extent of resection (EOR) with methods such as intraoperative 5-aminolevulinic acid fluorescence-guided surgery (FGS) is currently under evaluation. However, it is difficult to reproducibly judge EOR in these studies due to the lack of reliable tumor segmentation methods, especially for postoperative magnetic resonance imaging (MRI) scans. Therefore, a reliable, easily distributable segmentation method is needed to permit valid comparison, especially across multiple sites. We report a segmentation method that combines versatile region-of-interest blob generation with automated clustering methods. We applied this to glioblastoma cases undergoing FGS and matched controls to illustrate the method's reliability and accuracy. Agreement and interrater variability between segmentations were assessed using the concordance correlation coefficient, and spatial accuracy was determined using the Dice similarity index and mean Euclidean distance. Fuzzy C-means clustering with three classes was the best performing method, generating volumes with high agreement with manual contouring and high interrater agreement preoperatively and postoperatively. The proposed segmentation method allows tumor volume measurements of contrast-enhanced T 1-weighted images in the unbiased, reproducible fashion necessary for quantifying EOR in multicenter trials.
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Tacher V, Lin M, Bhagat N, Abi Jaoudeh N, Radaelli A, Noordhoek N, Carelsen B, Wood BJ, Geschwind JF. Dual-phase cone-beam computed tomography to see, reach, and treat hepatocellular carcinoma during drug-eluting beads transarterial chemo-embolization. J Vis Exp 2013:50795. [PMID: 24326874 PMCID: PMC3910428 DOI: 10.3791/50795] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 dimensional (3D) diagnostic imaging in the interventional suite and can enhance minimally-invasive therapy beyond the limitations of 2D angiography alone. The role of CBCT has been recognized in transarterial chemo-embolization (TACE) treatment of hepatocellular carcinoma (HCC). The recent introduction of a CBCT technique: dual-phase CBCT (DP-CBCT) improves intra-arterial HCC treatment with drug-eluting beads (DEB-TACE). DP-CBCT can be used to localize liver tumors with the diagnostic accuracy of multi-phasic multidetector computed tomography (M-MDCT) and contrast enhanced magnetic resonance imaging (CE-MRI) (See the tumor), to guide intra-arterially guidewire and microcatheter to the desired location for selective therapy (Reach the tumor), and to evaluate treatment success during the procedure (Treat the tumor). The purpose of this manuscript is to illustrate how DP-CBCT is used in DEB-TACE to see, reach, and treat HCC.
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Affiliation(s)
- Vania Tacher
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital
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Chen R, Geschwind JF, Wang Z, Tacher V, Lin M. Quantitative assessment of lipiodol deposition after chemoembolization: comparison between cone-beam CT and multidetector CT. J Vasc Interv Radiol 2013; 24:1837-44. [PMID: 24094672 PMCID: PMC3840104 DOI: 10.1016/j.jvir.2013.08.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/19/2013] [Accepted: 08/22/2013] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate the ability of cone-beam computed tomography (CBCT) performed directly after transarterial chemoembolization to assess ethiodized oil (Lipiodol) deposition in hepatocellular carcinoma (HCC) and compare it with unenhanced multidetector computed tomography (CT). MATERIALS AND METHODS Conventional transarterial chemoembolization was used to treat 15 patients with HCC, and CBCT was performed to assess Lipiodol deposition directly after transarterial chemoembolization. Unenhanced multidetector CT was performed 24 hours after transarterial chemoembolization. Four patients were excluded because the margin of tumor or area of Lipiodol deposition was unclear. The image enhancement density of the entire tumor and liver parenchyma was measured by ImageJ software, and tumor-to-liver contrast (TLC) was calculated. In addition, volumetric measurement of tumor and Lipiodol was performed by semiautomatic three-dimensional volume segmentation and compared using linear regression to evaluate consistency between the two imaging modalities. RESULTS The mean value of TLC on CBCT was not significantly different from TLC on multidetector CT (337.7 HU ± 233.5 vs 283.0 HU ± 152.1, P = .103).The average volume of the whole tumor and of only the regions with Lipiodol deposition and the calculated average percentage of Lipiodol retention on CBCT were not significantly different compared with multidetector CT (tumor volume, 9.6 cm(3) ± 11.8 vs 10.8 cm(3) ± 14.2, P = .142; Lipiodol volume, 6.3 cm(3) ± 7.7 vs 7.0 cm(3) ± 8.1, P = .214; percentage of Lipiodol retention, 68.9% ± 24.0% vs 72.2% ± 23.1%, P = .578). Additionally, there was a high correlation in the volume of tumor and Lipiodol between CBCT and multidetector CT (R(2) = 0.919 and 0.903). CONCLUSIONS The quantitative image enhancement and volume analyses demonstrate that CBCT is similar to multidetector CT in assessing Lipiodol deposition in HCC after transarterial chemoembolization.
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Affiliation(s)
- Rongxin Chen
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Jean-François Geschwind
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Zhijun Wang
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - Vania Tacher
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, USA 21287
| | - MingDe Lin
- Clinical Informatics, Interventional, and Translational Solutions (CIITS), Philips Research North America, Briarcliff Manor, NY, USA
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