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Patel R, Aslam A, Parikh ND, Mervak B, Mubarak E, Higgins L, Lala K, Conner JF, Khaykin V, Bashir M, Do RKG, Burke LMB, Smith EN, Kim CY, Shampain KL, Owen D, Mendiratta-Lala M. Updates on LI-RADS Treatment Response Criteria for Hepatocellular Carcinoma: Focusing on MRI. J Magn Reson Imaging 2023; 57:1641-1654. [PMID: 36872608 PMCID: PMC11078141 DOI: 10.1002/jmri.28659] [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: 12/16/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 03/07/2023] Open
Abstract
As the incidence of hepatocellular carcinoma (HCC) and subsequent treatments with liver-directed therapies rise, the complexity of assessing lesion response has also increased. The Liver Imaging Reporting and Data Systems (LI-RADS) treatment response algorithm (LI-RADS TRA) was created to standardize the assessment of response after locoregional therapy (LRT) on contrast-enhanced CT or MRI. Originally created based on expert opinion, these guidelines are currently undergoing revision based on emerging evidence. While many studies support the use of LR-TRA for evaluation of HCC response after thermal ablation and intra-arterial embolic therapy, data suggest a need for refinements to improve assessment after radiation therapy. In this manuscript, we review expected MR imaging findings after different forms of LRT, clarify how to apply the current LI-RADS TRA by type of LRT, explore emerging literature on LI-RADS TRA, and highlight future updates to the algorithm. EVIDENCE LEVEL: 3. TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Richa Patel
- Department of Radiology, Stanford, California, USA
| | - Anum Aslam
- Department of Radiology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Neehar D Parikh
- Department of Internal Medicine, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Benjamin Mervak
- Department of Radiology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Eman Mubarak
- Department of Radiology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Lily Higgins
- Department of Radiology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kayli Lala
- Department of Radiology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jack F Conner
- Department of Radiology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Valerie Khaykin
- Department of Radiology and Hepatology, University of Michigan Medicine, Michigan, USA
| | - Mustafa Bashir
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Richard Kinh Gian Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lauren M B Burke
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Elainea N Smith
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles Y Kim
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Kimberly L Shampain
- Department of Radiology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Fan XL, Wang YH, Chen YH, Chen BX, Cai JN, Yang JS, Sun X, Yan FR, He BS. Computed tomography texture analysis combined with preoperative clinical factors serve as a predictor of early efficacy of transcatheter arterial chemoembolization in hepatocellular carcinoma. Abdom Radiol (NY) 2023; 48:2008-2018. [PMID: 36943423 DOI: 10.1007/s00261-023-03868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/23/2023]
Abstract
AIM To investigate a pre-therapeutic radiomics nomogram to accurately predict hepatocellular carcinoma (HCC) lesion responses to transcatheter arterial chemoembolization (TACE). METHODS This retrospective study from January 2012 to 2022 included 92 TACE-treated patients who underwent liver contrast-enhanced CT scan 7 days before treatment, having complete clinical information. We extracted quantitative texture parameters and clinical factors for the largest tumors on the baseline arterial and portal venous phase CT images. An adaptive least absolute shrinkage and selection operator (LASSO)-penalized logistic regression identified independent predictors of tumor activity after TACE. RESULTS We fitted an adaptive LASSO regression model to narrow down the texture features and clinical risk factors of the tumor activity status. The selected texture features were used to construct radiomic scores (RadScore), which demonstrated superior performance in predicting tumor activity on both the training (area under the curve (AUC): 0.881, 95% CI: 0.799-0.963) and testing sets (AUC: 0.88, 95% CI: 0.726-1). A logistic regression-based nomogram was developed using RadScore and four selected clinical features. In the testing set, nomogram total points were significant predictors (P = 0.034), and the training set showed no departure from perfect fit (P = 0.833). Internal validation of the nomogram was obtained for the training (AUC: 0.91, 95% CI: 0.837-0.984) and testing (AUC: 0.889, 95% CI: 0.746-1) sets. CONCLUSION We propose a nomogram to predict the early response of HCC lesions to TACE treatment with high accuracy, which may serve as an additional criterion in multidisciplinary decision-making treatment.
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Affiliation(s)
- Xiao Le Fan
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People's Republic of China
| | - Yu Hang Wang
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 211198, People's Republic of China
| | - Yu Hao Chen
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People's Republic of China
| | - Bai Xu Chen
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People's Republic of China
| | - Jia Nan Cai
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People's Republic of China
| | - Ju Shun Yang
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People's Republic of China
| | - Xu Sun
- Université Paris Cité, 75013, Paris, France
| | - Fang Rong Yan
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 211198, People's Republic of China
| | - Bo Sheng He
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People's Republic of China.
- Clinical Medicine Research Center, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People's Republic of China.
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Saleh GA, Elmokadem AH, Razek AA, El-Morsy A, Hamdy O, Eleraky ES, Saleh M. Utility of diffusion tensor imaging in differentiating benign from malignant hepatic focal lesions. Eur Radiol 2023; 33:1400-1411. [PMID: 35982336 DOI: 10.1007/s00330-022-09091-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To assess the diagnostic accuracy of diffusion tensor imaging (DTI) in the characterization of hepatic focal lesions (HFLs) and compare it to diffusion-weighted imaging (DWI). METHODS Prospective analysis was done for 49 patients (23 male and 26 female) with 74 HFLs who underwent dynamic MRI, DWI, and DTI. Apparent diffusion coefficient (ADC) values from DWI, fractional anisotropy (FA) values, and mean diffusivity (MD) values from DTI were measured by two independent radiologists. HFLs were classified into benign and malignant HFLs; the latter were subdivided into HCC and non-HCC lesions. Binary logistic regression was performed to analyze the associations between the DTI parameters and the distinction of malignant lesions. RESULTS The ADC, MD, and FA at cutoff values of ≤ 1.17 × 10-3 mm2/s, ≤ 1.71 × 10-3 mm2/s, and > 0.29, respectively, are excellent discriminators for differentiating malignant and benign HFLs. The mean ADC and MD values of hemangiomas were significantly higher than HCC and non-HCC malignant lesions. In contrast, the mean FA values of hemangiomas were significantly lower than those of non-HCC malignant lesions and HCCs. The ADC and MD were very good discriminators at cutoff values of > 1.03 × 10-3 mm2/s and > 1.12 × 10-3 mm2/s, respectively. The FA at a cutoff value > 0.38 is an excellent discriminator for HCC versus non-HCC malignant lesions. Only FA value > 0.38 was a statistically significant independent predictor of HCC versus non-HCC lesions among the three parameters. There was an excellent inter-observer agreement with ICC > 0.9. CONCLUSION MD and FA of DTI are non-invasive, very good, and excellent discriminators superior to ADC measured by DWI for the differentiation of HFLs. KEY POINTS • The ADC, MD, and FA at cutoff values of ≤ 1.17 × 10-3 mm2/s, ≤ 1.71 × 10-3 mm2/s, and > 0.29, respectively, are excellent discriminators for differentiating malignant and benign HFLs. • The mean ADC and MD values of hemangiomas were significantly higher than those of HCC and non-HCC malignant lesions. In contrast, the mean FA values of hemangiomas were significantly lower than those of non-HCC malignant lesions and HCCs, respectively. • Multivariate regression analysis revealed that only FA value > 0.38 was a statistically significant independent predictor of HCC vs. non-HCC lesions. A lesion with FA > 0.38 has 34 times higher odds of being HCC rather than non-HCC lesions.
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Affiliation(s)
- Gehad A Saleh
- Department of Radiology, Mansoura University, El Gomhoria St., Mansoura, 35516, Egypt
| | - Ali H Elmokadem
- Department of Radiology, Mansoura University, El Gomhoria St., Mansoura, 35516, Egypt.
| | - Ahmed Abdel Razek
- Department of Radiology, Mansoura University, El Gomhoria St., Mansoura, 35516, Egypt
| | - Ahmed El-Morsy
- Department of Radiology, Mansoura University, El Gomhoria St., Mansoura, 35516, Egypt
| | - Omar Hamdy
- Department of Surgical Oncology, Mansoura University, Mansoura, Egypt
| | | | - Marwa Saleh
- Department of Internal Medicine, Mansoura University, Mansoura, Egypt
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Jin H, Huang J, Zhang M, Yang Y, Huang H, Feng X, Long B, Huang L, Zeng Y. Efficacy of LR-5 and LR-4/5 by Liver Imaging Reporting and Data System (MRI) for hepatocellular carcinoma: A meta-analysis. Asian J Surg 2023; 46:82-88. [PMID: 35431127 DOI: 10.1016/j.asjsur.2022.03.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/14/2022] [Accepted: 03/24/2022] [Indexed: 02/05/2023] Open
Abstract
To comprehensive investigate the diagnostic efficacy of LR-5 and LR-4/5 by MRI LI-RADS of suspected liver nodules. A comprehensive search of authenticated international databases including PubMed/Medline, Ovid, Embase, Web of Science as well as a series of nation-level databases, including China National Knowledge Infrastructure was carried out to look for related studies with respect to the diagnostic performance of MRI LR-5 or LR-4/5 for HCC. Subsequently, main data including the basic information of the articles incorporated as well as main outcomes, including diagnostic sensitivity, specificity, accuracy, or original data like true positive, false positive, true negative and false negative values were extracted. Next, forest plots were generated to reveal the pooled diagnostic sensitivity, specificity. The diagnostic sensitivity, specificity of LR-5 and LR-4/5 by LI-RADS were comparatively satisfactory. The pooled diagnostic sensitivity and specificity of MRI LR-5 with respect to pathologically diagnosed HCC were 0.73 [95% CI 0.7-0.75] and 0.88 [95% CI 0.86-0.90] respectively. The pooled sensitivity and specificity of MRI LR-4/5 were 0.77 [95% CI 0.75-0.80] and 0.82 [95% CI 0.79-0.85] respectively. Through this systematic review and meta-analysis, we found a promisingly satisfactory diagnostic efficacy of LR-5 and LR-4/5 by MRI LI-RADS of suspected malignant liver nodules, manifested by optimal diagnostic sensitivity, specificity, and accuracy.
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Affiliation(s)
- Hongyu Jin
- Department of Liver Surgery & Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, 610041, China
| | - Jiwei Huang
- Department of Liver Surgery & Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, 610041, China
| | - Man Zhang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Key Laboratory of Obstetric & Gynecologic and Pediatric Disease and Birth Defects of Ministry of Education, Chengdu, 610041, China
| | - Yujia Yang
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hao Huang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xuping Feng
- Department of Liver Surgery & Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, 610041, China
| | - Boyu Long
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Libin Huang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yong Zeng
- Department of Liver Surgery & Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, 610041, China.
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Abdelrahman AS, Ekladious MEY, Badran EM, Madkour SS. Liver imaging reporting and data system (LI-RADS) v2018: Reliability and agreement for assessing hepatocellular carcinoma locoregional treatment response. Diagn Interv Imaging 2022; 103:524-534. [PMID: 35787988 DOI: 10.1016/j.diii.2022.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of this study was to determine the reliability and interobserver agreement of the liver imaging reporting and data system (LI-RADS) treatment response algorithm (LR-TR) v2018 using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and the added value of diffusion-weighted imaging (DWI). MATERIALS AND METHODS A total of 54 patients who underwent DCE-MRI and DWI after locoregional treatment of 81 hepatocellular carcinoma (HCC) lesions from September 2020 to July 2021 were included. There were 47 men and 7 women, with a mean age of 63.9 ± 9.2 (SD) years (age range: 23-77 years). Locoregional treatments included transarterial chemoembolization (TACE) (53/81; 65.4%), radiofrequency ablation (RFA) (25/81; 30.9%) and microwave ablation (MWA) (3/81; 3.7%). Two independent radiologists retrospectively evaluated DCE-MRI examinations obtained after locoregional treatment using LR-TR, and then three months later both radiologists reevaluated DCE-MRI examinations with DWI. Interobserver agreement was assessed using intraclass correlation coefficient (ICC) and Kappa test. Diagnostic performances were evaluated in term of sensitivity, specificity, and area under ROC curve (AUC) using a composite standard of reference that included results of histopathological examinations and follow-up findings. RESULTS Using DCE-MRI alone, observer 1 had 83.9% sensitivity (26/31; 95% confidence interval [CI]: 66-95%), 88% specificity (44/50; 95% CI: 76-95%) and 86.4% accuracy (70/81; 95%CI: 77-93%), and observer 2 had 71% sensitivity (22/31; 95% CI: 52-86%), 92% specificity (46/50; 95% CI: 81-98%) and 83.9% accuracy (68/81; 95% CI: 74-91%). For the diagnosis of viable tumors using DCE-MRI with DWI, observer 1 and observer 2 had 87.1% (27/31; 95% CI: 70-96%) and 74.2% (23/31; 95% CI: 55-88%) sensitivity, respectively. The diagnostic performance of DCE-MRI with DWI yielded an AUC (0.875; 95% CI: 0.789-0.962) not different from that of DCE-MRI without DWI (0.859; 95% CI: 0.768-0.951) (P = 0.317). Interobserver agreement for arterial phase hyperenhancement, washout, enhancement similar to pretreatment and DWI findings in all treated HCCs was almost perfect (kappa = 0.815, 0.837, 0.826 and 0.81 respectively). Agreement between observers for LR-TR category was substantial (kappa = 0.795; 95% CI: 0.665-0.924). Interobserver agreement for size of viable HCC was excellent (ICC = 0.938; 95% CI: 0.904-0.960). CONCLUSION LR-TR using DCE-MRI alone or DCE-MRI with DWI are both accurate for detecting viable HCC lesions after locoregional treatment, with no differences in diagnostic performance and excellent interobserver agreement.
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Affiliation(s)
- Ahmed S Abdelrahman
- Radiology Department, Faculty of Medicine, Ain Shams University, 11591 Cairo, Egypt.
| | - Mena E Y Ekladious
- Radiology Department, Faculty of Medicine, Ain Shams University, 11591 Cairo, Egypt
| | - Ethar M Badran
- Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, 11591 Cairo, Egypt
| | - Sherihan S Madkour
- Radiology Department, Faculty of Medicine, Ain Shams University, 11591 Cairo, Egypt
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Dohan A, Barat M, Coriat R, Soyer P. A step toward a better understanding of hepatocellular progression after transarterial embolization. Diagn Interv Imaging 2022; 103:125-126. [DOI: 10.1016/j.diii.2022.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 01/01/2023]
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Aujay G, Etchegaray C, Blanc JF, Lapuyade B, Papadopoulos P, Pey MA, Bordenave L, Trillaud H, Saut O, Pinaquy JB. Comparison of MRI-based response criteria and radiomics for the prediction of early response to transarterial radioembolization in patients with hepatocellular carcinoma. Diagn Interv Imaging 2022; 103:360-366. [DOI: 10.1016/j.diii.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 02/07/2023]
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Local recurrence following complete radiologic response in patients treated with transarterial chemoembolization for hepatocellular carcinoma. Diagn Interv Imaging 2022; 103:143-149. [PMID: 35115276 DOI: 10.1016/j.diii.2022.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/16/2021] [Accepted: 01/17/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to determine the local progression rate and identify factors that may predict local progression, in patients who achieve a complete response (CR) radiologically after undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS One-hundred-forty-seven patients, who achieved CR of 224 HCCs after TACE, were retrospectively reviewed. There were 109 men and 38 women with a mean age of 61.6 ± 6.8 (SD) years (range: 45.4-86.9 years). Logistic mixed-effects and Cox regression models were used to evaluate associations between clinical factors and local progression. RESULTS A total of 75 patients (75/147; 51%) and 99 (99/224,44.2%) lesions showed local progression at a median of 289.5 days (Q1: 125, Q3: 452; range: 51-2245 days). Pre-treatment, international normalization ratio (INR) (1.17 ± 0.15 [SD] vs. 1.25 ± 0.16 [SD]; P <0.001), model for end-stage liver disease (9.4 ± 2.6 [SD] vs. 10.6 ± 3.2 [SD]; P = 0.010) and Child-Pugh score (6 ± 1 [SD] vs. 6.4 ± 1.3 [SD]; P = 0.012) were significantly lower while albumin serum level (3.4 ± 0.62 [SD] vs. 3.22 ± 0.52 [SD]; P = 0.033) was significantly greater in those who showed local progression as compared to those who did not. In terms of local-recurrence free survival, the number of TACE treatments (hazard ratio [HR]: 2.05 [95% CI: 1.57-2.67]; P<0.001), INR (HR: 0.13 [95% CI: 0.03-0.61]; P = 0.010) and type of TACE (P = 0.003) were significant. Patients with local progression on any tumor did not differ from those who did in terms of overall survival (P = 0.072), however, were less likely to be transplanted (20/75, 26.7%) than those who did not (33/72; 36.1%) (P = 0.016). CONCLUSION A significant number of patients who achieve CR of HCC after TACE have local progression. This emphasizes the importance of long-term follow up.
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Inter-observer agreement using the LI-RADS version 2018 CT treatment response algorithm in patients with hepatocellular carcinoma treated with conventional transarterial chemoembolization. Abdom Radiol (NY) 2022; 47:115-122. [PMID: 34581927 PMCID: PMC8776670 DOI: 10.1007/s00261-021-03272-9] [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: 06/27/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/06/2022]
Abstract
Aim To determine inter-reader agreement in categorization of imaging features using the Liver Imaging Reporting and Data System (LI-RADS) treatment response (LR-TR) algorithm in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE). Methods Two radiologists used the LR-TR algorithm to assess 112 computed tomography (CT) examinations of 102 patients treated with cTACE. The inter-observer agreement in categorization of LR-TR features was assessed using kappa (κ) statistics. Results There was substantial inter-observer agreement between the two reviewers using the LR-TR algorithm (κ = 0.70; 95% CI 0.58–0.81). The two reviewers categorized tumors as non-viable in 37 (33.0%) and 39 (34.8%) of 112 examinations, viable in 58 (51.8%) and 62 (55.4%) examinations, and equivocal in 18 (16.1%) and 11 (9.8%) examinations, respectively. There was almost perfect inter-observer agreement for the LR-TR non-viable category (κ = 0.80; 95% CI 0.68–0.92), substantial agreement for the viable category (κ = 0.78 95% CI 0.67–0.90), and fair agreement for the equivocal category (κ = 0.25; 95% CI 0.02–0.49). Conclusion The LR-TR algorithm conveys high degrees of inter-observer agreement for the assessment of CT imaging features in the viable and non-viable categories. Further refinement of indeterminate features may be necessary to improve the correct categorization of equivocal lesions. Graphic abstract ![]()
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Tada T, Kumada T, Toyoda H, Nakamura S, Endo Y, Kaneoka Y, Hiraoka A, Joko K, Hirooka M, Hiasa Y. A validation study of combined resection and ablation therapy for multiple hepatocellular carcinoma. Clin Radiol 2021; 77:114-120. [PMID: 34789396 DOI: 10.1016/j.crad.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022]
Abstract
AIM To validate the utility of hepatic resection combined with complementary radiofrequency ablation (RFA) compared with resection alone for patients with multiple hepatocellular carcinoma (HCC), and to compare these results with those of a previous report. MATERIALS AND METHODS A total of 78 HCC patients with multiple (≤5) tumours who were initially treated with hepatic resection only (Resection group) or with combined hepatic resection and RFA (Combination group) were included. Overall and disease-free survival were analysed. RESULTS There were 21 women and 57 men with a median age of 72.5 (64.3-76.8) years. Fifty-three patients were treated with resection alone and 25 received combination therapy. The 3-, 5-, and 7-year cumulative overall survival rates were 81.2%, 68.2%, and 57.1%, respectively, in the Resection group, and 81.3%, 59.6%, and 42.4%%, respectively, in the Combination group (hazard ratio [HR], 1.462; 95% confidence interval [CI], 0.682-3.136; p=0.329). The 1-, 3-, and 5-year cumulative disease-free survival rates were 61.4%, 45.7%, and 39.8%, respectively, in the Resection group, and 53.1%, 18.6%, and 0%, respectively, in the Combination group (HR, 2.080; 95% CI, 1.157-3.737; p=0.014). The overall survival rate was not significantly different between the Resection and Combination groups in patients within the up-to-seven HCC criteria (n=56; HR, 2.101; 95% CI, 0.805-5.486; p=0.130) or those beyond these criteria (n=22; HR, 0.804; 95% CI, 0.197-3.286; p=0.761). CONCLUSIONS The combination of hepatic resection and RFA therapy may be an effective strategy for HCC patients with multiple tumours.
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Affiliation(s)
- T Tada
- Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Himeji, Japan; Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
| | - T Kumada
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - H Toyoda
- Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Japan
| | - S Nakamura
- Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Himeji, Japan
| | - Y Endo
- Department of Surgery, Japanese Red Cross Himeji Hospital, Himeji, Japan
| | - Y Kaneoka
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - A Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - K Joko
- Hepato-biliary Center, Japanese Red Cross Matsuyama Hospital, Matsuyama, Japan
| | - M Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Y Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
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Interobserver agreement of interstitial lung fibrosis Reporting and Data System (ILF-RADS) at high-resolution CT. Emerg Radiol 2021; 29:115-123. [PMID: 34705193 DOI: 10.1007/s10140-021-01993-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the interobserver agreement of interstitial lung fibrosis Reporting and Data System (ILF-RADS) in interpretation and categorization of interstitial lung disease (ILD) at high-resolution CT (HRCT). METHODS Retrospective analysis was performed on 65 consecutive patients (36 male and 29 female), median age 53 years, who were referred to the Radiology Department, Mansoura University, in the period from July 2016 to February 2020. They were expected clinically to have diffuse lung disease and underwent HRCT of the chest. Patients had some investigations like serology, and when required surgical lung biopsy. Image analysis was done by two independent and blinded readers for the pulmonary and extra-pulmonary finding of ILF-RADS. The pulmonary findings were 13 items and extrapulmonary findings were 5 items. The score was 5 types according to ILF-RADS: ILF-RADS 0 (incomplete assessment), ILF-RADS 1 (typical UIP), ILF-RADS 2 (probable UIP), ILF-RADS 3 (indeterminate UIP), ILF-RADS 4 (CT features most consistent with non-UIP diagnosis). RESULTS There was an excellent interobserver agreement of both reviewers for overall ILF-RADS (K = 0.88, P = 0.001) with 95.4% agreement. There was an excellent interobserver agreement for overall pulmonary findings (K = 0.901, 95% CI = 0.877-0.926, P = 0.001), excellent interobserver agreement for seven items including lung volume, traction bronchiectasis, nodules, cysts, consolidation, emphysema, and complications and moderate interobserver agreement for six items including reticulations, honeycomb, ground glass, mosaic attenuation, and axial and zonal distribution. There was excellent interobserver agreement for overall extra-pulmonary findings (K = 0.902, 95% CI = 0.852-0.952, P = 0.001), excellent interobserver agreement for four items including mediastinum, pleura, visible abdomen, and soft tissue and bone and moderate interobserver agreement for trachea and main bronchi. There was excellent interobserver agreement for ILF-RADS score: ILF-RADS 1 (K = 0.84, P = 0.001), ILF-RADS 3 (K = 0.881, P = 0.001), and ILF-RADS 4 (K = 0.878, 95% CI = 0.743-1.0, P = 0.001) and moderate interobserver agreement for ILF-RADS 2 (K = 0.784, P = 0.001). CONCLUSION ILF-RADS is a reliable reporting system which can be routinely performed for standard interpretation of ILD.
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Hazhirkarzar B, Tang H, Ghadimi M, Baghdadi A, Motaghi M, Wu Q, Shaghaghi M, Kamel I. Predicting early necrosis of colorectal liver metastases using volumetric enhancement on baseline MRI and oil deposition on post-cTACE unenhanced CT. Abdom Radiol (NY) 2021; 46:4610-4618. [PMID: 34089068 DOI: 10.1007/s00261-021-03133-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/19/2021] [Accepted: 05/21/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE To predict tumor necrosis after conventional TACE (cTACE) in patients with colorectal liver metastasis (CRLM) based on volumetric oil deposition on CT one day after treatment. METHODS Thirty-four lesions in 20 men and 6 women were included in this IRB-approved HIPAA-compliant, retrospective lesion-by-lesion-based study. Semiautomatic volumetric segmentation of target lesions was performed on baseline MRI and post-treatment CT. Predicted percentage of tumor necrosis was defined as 100%-(%baseline MRI enhancement-%CT oil deposition). Necrosis on post-TACE MRI was measured after volumetric segmentation to assess the accuracy of predicting tumor necrosis. The relationship between predicted necrosis percent and post-cTACE measured necrosis percent on MRI was compared using Pearson correlation analysis. Inter-reader agreement was calculated by intraclass correlation coefficient (ICC) after using the same method. RESULTS Patients in this cohort had a mean age of 64 ± 14 years. Mean percentage of the viable tumor on pre-cTACE venous phase MRI was 58.5% ± 23.9%. Mean oil deposition was 19.8% ± 14.6%. Mean percentage of calculated necrosis one month after cTACE was 59.2% ± 22.7% on venous phase MRI, which had a significant correlation with predicted necrotic percentage of 61.3% ± 19.3% (r = 0.89, p < 0.0001). ICC for enhancement percentage on pre-cTACE and post-cTACE venous phase MRIs were 0.93 (95% CI 0.83, 0.97) and 0.86 (95% CI 0.66, 0.94), respectively. ICC for oil deposition was 0.92 (95% CI 0.81, 0.96). CONCLUSION Measuring oil deposition of the whole tumor on CT one day after cTACE can assist to predict post-cTACE tumor necrosis.
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Affiliation(s)
- Bita Hazhirkarzar
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Hao Tang
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Maryam Ghadimi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Azarakhsh Baghdadi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mina Motaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Qingxia Wu
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mohammadreza Shaghaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ihab Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA.
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Coronary artery disease imaging reporting and data system (CAD-RADS): what radiologists need to know? Emerg Radiol 2021; 28:1185-1203. [PMID: 34387783 DOI: 10.1007/s10140-021-01973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/16/2021] [Indexed: 11/09/2022]
Abstract
The aim of this work is to review Coronary Artery Disease Imaging Reporting and Data System (CAD-RADS) that was designed to standardize reporting language and improve the communication of data among radiologists and clinicians. Stenotic lesions are graded into 5 grades ranging from 0 (no stenosis) to 5 (total occlusion), where the highest grade represents the final score. The expert consensus platform has added 4 special modifiers (non-diagnostic, stent, graft, and vulnerability) to aid patient management through linking these scores with decision algorithm and treatment plan. Adherence to standard imaging protocol; knowledge of normal, variant, and anomalous anatomy; and skillful evaluation of stenosis are important for proper utilization of this reporting system. Lastly, radiologists should be aware of the inherited benefits, limitations, and common pitfalls of this classification system.
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LI-RADS treatment response assessment of combination locoregional therapy for HCC. Abdom Radiol (NY) 2021; 46:3634-3647. [PMID: 34120207 DOI: 10.1007/s00261-021-03165-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023]
Abstract
HCC incidence continues to increase worldwide and is most frequently discovered at an advanced stage when limited curative options are available. Combination locoregional therapies have emerged to improve patient survival and quality of life or downstage patients to curative options. The increasing options for locoregional therapy combinations require an understanding of the expected post-treatment imaging appearance in order to assess treatment response. This review aims to describe the synergy between TACE combined with thermal ablation and TACE combined with SBRT. We will also illustrate expected imaging findings that determine treatment efficacy based on the mechanism of tissue injury using the LI-RADS Treatment Response Algorithm.
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Spieler B, Sabottke C, Moawad AW, Gabr AM, Bashir MR, Do RKG, Yaghmai V, Rozenberg R, Gerena M, Yacoub J, Elsayes KM. Artificial intelligence in assessment of hepatocellular carcinoma treatment response. Abdom Radiol (NY) 2021; 46:3660-3671. [PMID: 33786653 DOI: 10.1007/s00261-021-03056-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 02/08/2023]
Abstract
Artificial Intelligence (AI) continues to shape the practice of radiology, with imaging of hepatocellular carcinoma (HCC) being of no exception. This article prepared by members of the LI-RADS Treatment Response (TR LI-RADS) work group and associates, presents recent trends in the utility of AI applications for the volumetric evaluation and assessment of HCC treatment response. Various topics including radiomics, prognostic imaging findings, and locoregional therapy (LRT) specific issues will be discussed in the framework of HCC treatment response classification systems with focus on the Liver Reporting and Data System treatment response algorithm (LI-RADS TRA).
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Kampalath R, Tran-Harding K, Do RKG, Mendiratta-Lala M, Yaghmai V. Evaluation of Hepatocellular Carcinoma Treatment Response After Locoregional Therapy. Magn Reson Imaging Clin N Am 2021; 29:389-403. [PMID: 34243925 DOI: 10.1016/j.mric.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Locoregional therapy (LRT) for hepatocellular carcinoma can be used alone or with other treatment modalities to reduce rates of progression, improve survival, or act as a bridge to cure. As the use of LRT expands, so too has the need for systems to evaluate treatment response, such as the World Health Organization and modified Response Evaluation Criteria In Solid Tumors systems and more recently, the Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (TRA). Early validation results for LI-RADS TRA have been promising, and as research accrues, the TRA is expected to evolve in the near future.
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Affiliation(s)
- Rony Kampalath
- Department of Radiological Sciences, University of California Irvine, 101 The City Drive South, Orange, CA 92868, USA
| | - Karen Tran-Harding
- Department of Radiological Sciences, University of California Irvine, 101 The City Drive South, Orange, CA 92868, USA
| | - Richard K G Do
- Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Radiology, Weill Medical College of Cornell University, New York, NY, USA.
| | - Mishal Mendiratta-Lala
- Radiology, University of Michigan School of Medicine, 1500 East Medical Center Drive, UH B2A209R, Ann Arbor, MI 48109-5030, USA
| | - Vahid Yaghmai
- University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA
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Razek AAKA, El-Diasty T, Elhendy A, Fahmy D, El-Adalany MA. Prostate Imaging Reporting and Data System (PI-RADS): What the radiologists need to know? Clin Imaging 2021; 79:183-200. [PMID: 34098371 DOI: 10.1016/j.clinimag.2021.05.026] [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] [Received: 12/16/2020] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 01/14/2023]
Abstract
We aim to review the new modifications in MR imaging technique, image interpretation, lexicon, and scoring system of the last version of Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) in a simple and practical way. This last version of PI-RADS v2.1 describes the new technical modifications in the protocol of Multiparametric MRI (MpMRI) including T2, diffusion-weighted imaging (DWI), and dynamic contrast enhancement (DCE) parameters. It includes also; new guidelines in the image interpretation specifications in new locations (lesions located in the central zone and anterior fibromuscular stroma), clarification of T2 scoring of lesions of the transition zone, the distinction between DWI score 2 and 3 lesions in the transition zone and peripheral zone, as well as between positive and negative enhancement in DCE. Biparametric MRI (BpMRI) along with simplified PI-RADS is gaining more acceptances in the assessment of clinically significant prostatic cancer.
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Affiliation(s)
| | - Tarek El-Diasty
- Department of Diagnostic Radiology, Mansoura Urology and Nephrology Center, Mansoura, Egypt
| | - Ahmed Elhendy
- Department of Diagnostic Radiology, Mansoura Urology and Nephrology Center, Mansoura, Egypt
| | - Dalia Fahmy
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
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Vogl TJ, Langenbach MC, Hammerstingl R, Albrecht MH, Chatterjee AR, Gruber-Rouh T. Evaluation of two different transarterial chemoembolization protocols using Lipiodol and degradable starch microspheres in therapy of hepatocellular carcinoma: a prospective trial. Hepatol Int 2021; 15:685-694. [PMID: 34043158 PMCID: PMC8286929 DOI: 10.1007/s12072-021-10193-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/17/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND This prospective randomized trial is designed to compare the performance of conventional transarterial chemoembolization (cTACE) using Lipiodol-only with additional use of degradable starch microspheres (DSM) for hepatocellular carcinoma (HCC) in BCLC-stage-B based on metric tumor response. METHODS Sixty-one patients (44 men; 17 women; range 44-85) with HCC were evaluated in this IRB-approved HIPPA compliant study. The treatment protocol included three TACE-sessions in 4-week intervals, in all cases with Mitomycin C as a chemotherapeutic agent. Multiparametric magnetic resonance imaging (MRI) was performed prior to the first and 4 weeks after the last TACE. Two treatment groups were determined using a randomization sheet: In 30 patients, TACE was performed using Lipiodol only (group 1). In 31 cases Lipiodol was combined with DSMs (group 2). Response according to tumor volume, diameter, mRECIST criteria, and the development of necrotic areas were analyzed and compared using the Mann-Whitney-U, Kruskal-Wallis-H-test, and Spearman-Rho. Survival data were analyzed using the Kaplan-Meier estimator. RESULTS A mean overall tumor volume reduction of 21.45% (± 62.34%) was observed with an average tumor volume reduction of 19.95% in group 1 vs. 22.95% in group 2 (p = 0.653). Mean diameter reduction was measured with 6.26% (± 34.75%), for group 1 with 11.86% vs. 4.06% in group 2 (p = 0.678). Regarding mRECIST criteria, group 1 versus group 2 showed complete response in 0 versus 3 cases, partial response in 2 versus 7 cases, stable disease in 21 versus 17 cases, and progressive disease in 3 versus 1 cases (p = 0.010). Estimated overall survival was in mean 33.4 months (95% CI 25.5-41.4) for cTACE with Lipiosol plus DSM, and 32.5 months (95% CI 26.6-38.4), for cTACE with Lipiodol-only (p = 0.844), respectively. CONCLUSIONS The additional application of DSM during cTACE showed a significant benefit in tumor response according to mRECIST compared to cTACE with Lipiodol-only. No benefit in survival time was observed.
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Affiliation(s)
- T J Vogl
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai, 760590, Frankfurt am Main, Germany
| | - M C Langenbach
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai, 760590, Frankfurt am Main, Germany
| | - R Hammerstingl
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai, 760590, Frankfurt am Main, Germany
| | - M H Albrecht
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai, 760590, Frankfurt am Main, Germany
| | - A R Chatterjee
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - T Gruber-Rouh
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai, 760590, Frankfurt am Main, Germany.
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Efficacy of the association liver partition and portal vein ligation for staged hepatectomy for the treatment of solitary huge hepatocellular carcinoma: a retrospective single-center study. World J Surg Oncol 2021; 19:95. [PMID: 33785022 PMCID: PMC8011225 DOI: 10.1186/s12957-021-02199-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The feasibility of association liver partition and portal vein ligation for staged hepatectomy (ALPPS) for solitary huge hepatocellular carcinoma (HCC, maximal diameter ≥ 10 cm) remains uncertain. This study aims to evaluate the safety and the efficacy of ALPPS for patients with solitary huge HCC. METHODS Twenty patients with solitary huge HCC who received ALPPS during January 2017 and December 2019 were retrospectively analyzed. The oncological characteristics of contemporaneous patients who underwent one-stage resection and transcatheter arterial chemoembolization (TACE) were compared using propensity score matching (PSM). RESULTS All patients underwent complete two-staged ALPPS. The median future liver remnant from the ALPPS-I stage to the ALPPS-II stage increased by 64.5% (range = 22.3-221.9%) with a median interval of 18 days (range = 10-54 days). The 90-day mortality rate after the ALPPS-II stage was 5%. The 1- and 3-year overall survival (OS) rates were 70.0% and 57.4%, respectively, whereas the 1- and 3-year progression-free survival (PFS) rates were 60.0% and 43.0%, respectively. In the one-to-one PSM analysis, the long-term survival of patients who received ALPPS was significantly better than those who received TACE (OS, P = 0.007; PFS, P = 0.011) but comparable with those who underwent one-stage resection (OS, P = 0.463; PFS, P = 0.786). CONCLUSION The surgical outcomes of ALPPS were superior to those of TACE and similar to those of one-stage resection. ALPPS is a safe and effective treatment strategy for patients with unresectable solitary huge HCC.
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Bartnik K, Podgórska J, Rosiak G, Korzeniowski K, Giziński J, Sajdek M, Wróblewski T, Zieniewicz K, Nyckowski P, Rowiński O. Performance of initial LI-RADS 2018 treatment response in predicting survival of patients with hepatocellular carcinoma following TACE: a retrospective, single-center cohort study. J Cancer Res Clin Oncol 2021; 147:3673-3683. [PMID: 33778924 PMCID: PMC8557150 DOI: 10.1007/s00432-021-03603-9] [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] [Received: 01/23/2021] [Accepted: 03/16/2021] [Indexed: 12/17/2022]
Abstract
Purpose Treatment response following transarterial chemoembolization (TACE) is frequently evaluated with Liver Imaging Reporting and Data System Treatment Response (LR-TR) algorithm, but its association with patients’ outcomes is not supported in the literature. The purpose of this study was to provide such data. Methods A retrospective analysis of 99 TACE patients with stage A/B hepatocellular carcinoma according to Barcelona-Clinic Liver Cancer staging system was performed. Two radiologists assessed LR-TR, while a third radiologist re-assessed divergent results. Overall survival (OS) and time to disease progression (TTP) were the primary endpoints of the study, while the Cox proportional hazard model was used for outcome analyses. Results Interobserver agreement was substantial between the two readers with κ = 0.69 (95% CI 0.58–0.81). The median OS in viable, equivocal, and non-viable groups were 27, 27, and 73 months, respectively (p < 0.001). However, after adjustment for confounding factors, there was no significant association between initial viable response and OS (HR 0.98 [95% CI 0.37–2.63], p = 0.97), while equivocal response remained statistically significant (HR 3.52. [95% CI 1.27–9.71], p = 0.015). No significant association was noted when viable and equivocal groups were analyzed in aggregate (HR 1.03 [95% CI 0.4–2.4], p = 0.96). The median TTP did not differ between non-viable and viable groups (23 vs 18 months, respectively; p = 0.98). None of the analyzed predictors was associated with TTP. Conclusion Initial LR-TR response was not an independent predictor for OS nor TTP. The preliminary results suggest the necessity for more aggressive management of equivocal patients.
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Affiliation(s)
- Krzysztof Bartnik
- Doctoral School, Medical University of Warsaw, Warsaw, Poland.,Second Department of Radiology, Medical University of Warsaw, Ul. Banacha 1a, 02-097, Warsaw, Poland
| | - Joanna Podgórska
- Second Department of Radiology, Medical University of Warsaw, Ul. Banacha 1a, 02-097, Warsaw, Poland.
| | - Grzegorz Rosiak
- Second Department of Radiology, Medical University of Warsaw, Ul. Banacha 1a, 02-097, Warsaw, Poland
| | - Krzysztof Korzeniowski
- Second Department of Radiology, Medical University of Warsaw, Ul. Banacha 1a, 02-097, Warsaw, Poland
| | - Jakub Giziński
- Second Department of Radiology, Medical University of Warsaw, Ul. Banacha 1a, 02-097, Warsaw, Poland
| | - Michał Sajdek
- Second Department of Radiology, Medical University of Warsaw, Ul. Banacha 1a, 02-097, Warsaw, Poland
| | - Tadeusz Wróblewski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Nyckowski
- Department of General, Gastroenterological and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Olgierd Rowiński
- Second Department of Radiology, Medical University of Warsaw, Ul. Banacha 1a, 02-097, Warsaw, Poland
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Kim DW, Choi SH, Lee JS, Kim SY, Lee SJ, Byun JH. Interreader Reliability of Liver Imaging Reporting and Data System Treatment Response: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11020237. [PMID: 33557040 PMCID: PMC7913820 DOI: 10.3390/diagnostics11020237] [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] [Received: 11/30/2020] [Revised: 01/24/2021] [Accepted: 02/01/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND For a proper management strategy in patients with locoregionally treated hepatocellular carcinoma (HCC), it is essential that the Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (LR-TR) has high interreader reliability. We aimed to systematically evaluate the interreader reliability of LR-TR and sources of any study heterogeneity. METHODS Original studies reporting the interreader reliability of LR-TR were identified in MEDLINE and EMBASE up to 20 September 2020. The pooled kappa coefficient (κ) was calculated using the DerSimonian-Laird random effects model. Subgroup analyses were performed according to imaging modality (magnetic resonance imaging (MRI) or computed tomography (CT)). Meta-regression analyses were performed to explore study heterogeneity. RESULTS Eight studies with 851 HCCs were finally included. Pooled κ was 0.70 (95% CI, 0.58-0.82) for CT/MRI LR-TR, and those of MRI and CT were 0.71 (95% CI, 0.53-0.89) and 0.71 (95% CI, 0.65-0.78), respectively. Study design (p < 0.001) and type of treatment (p = 0.02) were significantly associated with substantial study heterogeneity. CONCLUSION LR-TR showed substantial interreader reliability regardless of the imaging modality. Because of substantial study heterogeneity, which was significantly associated with study design and type of treatment, published values for the interreader reliability of LR-TR should be interpreted with care.
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Affiliation(s)
- Dong Wook Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea; (D.W.K.); (S.Y.K.); (S.J.L.); (J.H.B.)
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea; (D.W.K.); (S.Y.K.); (S.J.L.); (J.H.B.)
- Correspondence: ; Tel.: +82-2-3010-1797
| | - Ji Sung Lee
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea;
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea; (D.W.K.); (S.Y.K.); (S.J.L.); (J.H.B.)
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea; (D.W.K.); (S.Y.K.); (S.J.L.); (J.H.B.)
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea; (D.W.K.); (S.Y.K.); (S.J.L.); (J.H.B.)
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Clinical outcomes of patients with a high alpha-fetoprotein level but without evident recurrence on CT or MRI in surveillance after curative-intent treatment for hepatocellular carcinoma. Abdom Radiol (NY) 2021; 46:597-606. [PMID: 32812065 DOI: 10.1007/s00261-020-02707-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/01/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Multiphasic CT or MRI and serum alpha-fetoprotein (AFP) are widely used for posttreatment surveillance of hepatocellular carcinoma (HCC). This study aimed to investigate the clinical outcomes of patients with high posttreatment AFP but without evident recurrence on CT or MRI after curative-intent treatment of HCC. METHODS We retrospectively analyzed 121 patients presenting with high posttreatment AFP (> 20 ng/mL) without evident recurrence on multiphasic CT or MRI during surveillance after curative-intent surgical resection or radiofrequency ablation (RFA) for HCC. The time interval from the first event of high posttreatment AFP to imaging-evident recurrence (TimeAFP-Imaging recurrence) was estimated using the Kaplan-Meier method. Cox regression analyses were performed to assess the associated factors with TimeAFP-Imaging recurrence. RESULTS The median TimeAFP-Imaging recurrence was 20.0 months (95% CI 13.0-28.0 months), and the estimated 6-month and 1-year cumulative incidences of imaging-evident recurrence were 24.4% and 40.1%, respectively. In multivariate Cox analyses, late onset of AFP elevation (> 3 months after treatment) was an independent predictor of shorter TimeAFP-Imaging recurrence (HR 2.11, P = 0.015) if using variables available at the first event of AFP elevation, while non-normalization of AFP at the next follow-up was an independent predictor of shorter TimeAFP-Imaging recurrence (HR 3.65, P < 0.001) if using variables including the follow-up data. CONCLUSION In the surveillance setting after curative-intent treatment of HCC, patients presenting with high posttreatment AFP without evident recurrence on CT or MRI may frequently progress to imaging-evident recurrence. In high-risk patients, an extensive diagnostic workup or close monitoring is needed to detect HCC recurrence earlier.
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King MJ, Tong A, Dane B, Huang C, Zhan C, Shanbhogue K. Response assessment of hepatocellular carcinoma treated with yttrium-90 radioembolization: inter-reader variability, comparison with 3D quantitative approach, and role in the prediction of clinical outcomes. Eur J Radiol 2020; 133:109351. [DOI: 10.1016/j.ejrad.2020.109351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 12/26/2022]
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