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Brunson C, Struycken L, Schaub D, Ref J, Goldberg D, Hannallah J, Woodhead G, Young S. Comparative outcomes of trans-arterial radioembolization in patients with non-alcoholic steatohepatitis/non-alcoholic fatty liver disease-induced HCC: a retrospective analysis. Abdom Radiol (NY) 2024; 49:2714-2725. [PMID: 38709344 PMCID: PMC11300538 DOI: 10.1007/s00261-024-04295-8] [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: 12/12/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE Tumorigenesis in NAFLD/NASH-induced HCC is unique and may affect the effectiveness of trans-arterial radioembolization in this population. The purpose of this study was to retrospectively compare the effectiveness of trans-arterial radioembolization for the treatment of hepatocellular carcinoma (HCC) between patients with non-alcoholic steatohepatitis (NASH)/non-alcoholic fatty liver disease (NAFLD) and non-NASH/NAFLD liver disease. MATERIALS AND METHODS Consecutive patients with HCC who underwent TARE at a single academic institution were retrospectively reviewed. Outcome measures including overall survival (OS), local progression-free survival (PFS), and hepatic PFS as assessed by modified response evaluation criteria in solid tumors (mRECIST) were recorded. Kaplan-Meier and Cox proportional hazard models were utilized to compare progression-free survival and overall survival. RESULTS 138 separate HCCs in patients treated with TARE between July 2013 and July 2022 were retrospectively identified. Etiologies of HCC included NASH/NAFLD (30/122, 22%), HCV (52/122, 43%), alcoholic liver disease (25/122, 21%), and combined ALD/HCV (14/122, 11%). NASH/NAFLD patients demonstrated a significantly higher incidence of type 2 diabetes mellitus (p < 0.0001). There was no significant difference in overall survival (p = 0.928), local progression-free survival (p = 0.339), or hepatic progression-free survival between the cohorts (p = 0.946) by log-rank analysis. When NASH/NAFLD patients were compared to all combined non-NASH/NAFLD patients, there was no significant difference in OS (HR 1.1, 95% C.I. 0.32-3.79, p = 0.886), local PFS (HR 1.2, 95% C.I. 0.58-2.44, p = 0.639), or hepatic PFS (HR 1.3, 95% C.I. 0.52-3.16, p = 0.595) by log-rank analysis. CONCLUSION TARE appears to be an equally effective treatment for NASH/NAFLD-induced HCC when compared to other causes of HCC. Further studies in a larger cohort with additional subgroup analyses are warranted.
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Affiliation(s)
- Christopher Brunson
- University of California, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143-0628, USA.
| | - Lucas Struycken
- Department of Medical Imaging, University of Arizona Health Sciences, Tucson, USA
| | - David Schaub
- University of Arizona Health Sciences, Tucson, USA
| | - Jacob Ref
- University of Arizona Health Sciences, Tucson, USA
| | - Daniel Goldberg
- Department of Medical Imaging, University of Arizona Health Sciences, Tucson, USA
| | - Jack Hannallah
- Department of Medical Imaging, University of Arizona Health Sciences, Tucson, USA
| | - Gregory Woodhead
- Department of Medical Imaging, University of Arizona Health Sciences, Tucson, USA
| | - Shamar Young
- Department of Medical Imaging, University of Arizona Health Sciences, Tucson, USA
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Derbel H, Galletto Pregliasco A, Mulé S, Calderaro J, Zaarour Y, Saccenti L, Ghosn M, Reizine E, Blain M, Laurent A, Brustia R, Leroy V, Amaddeo G, Luciani A, Tacher V, Kobeiter H. Should Hypervascular Incidentalomas Detected on Per-Interventional Cone Beam Computed Tomography during Intra-Arterial Therapies for Hepatocellular Carcinoma Impact the Treatment Plan in Patients Waiting for Liver Transplantation? Cancers (Basel) 2024; 16:2333. [PMID: 39001395 PMCID: PMC11240509 DOI: 10.3390/cancers16132333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Current guidelines do not indicate any comprehensive management of hepatic hypervascular incidentalomas (HVIs) discovered in hepatocellular carcinoma (HCC) patients during intra-arterial therapies (IATs). This study aims to evaluate the prognostic value of HVIs detected on per-interventional cone beam computed tomography (CBCT) during IAT for HCC in patients waiting for liver transplantation (LT). MATERIAL AND METHODS In this retrospective single-institutional study, all liver-transplanted HCC patients between January 2014 and December 2018 who received transarterial chemoembolization (TACE) or radioembolization (TARE) before LT were included. The number of ≥10 mm HCCs diagnosed on contrast-enhanced pre-interventional imaging (PII) was compared with that detected on per-interventional CBCT with a nonparametric Wilcoxon test. The correlation between the presence of an HVI and histopathological criteria associated with poor prognosis (HPP) on liver explants was investigated using the chi-square test. Tumor recurrence (TR) and TR-related mortality were investigated using the chi-square test. Recurrence-free survival (RFS), TR-related survival (TRRS), and overall survival (OS) were assessed according to the presence of HVI using Kaplan-Meier analysis. RESULTS Among 63 included patients (average age: 59 ± 7 years, H/F = 50/13), 36 presented HVIs on per-interventional CBCT. The overall nodule detection rate of per-interventional CBCT was superior to that of PII (median at 3 [Q1:2, Q3:5] vs. 2 [Q1:1, Q3:3], respectively, p < 0.001). No significant correlation was shown between the presence of HVI and HPP (p = 0.34), TR (p = 0.095), and TR-related mortality (0.22). Kaplan-Meier analysis did not show a significant impact of the presence of HVI on RFS (p = 0.07), TRRS (0.48), or OS (p = 0.14). CONCLUSIONS These results may indicate that the treatment plan during IAT should not be impacted or modified in response to HVI detection.
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Affiliation(s)
- Haytham Derbel
- Medical Imaging Department, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France (H.K.)
- Institut Mondor de Recherche Biomédicale, Inserm U955, Team n° 18, 94010 Creteil, France
- Faculty of Medicine, University of Paris Est Creteil, 94010 Creteil, France
| | - Athena Galletto Pregliasco
- Medical Imaging Department, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France (H.K.)
| | - Sébastien Mulé
- Medical Imaging Department, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France (H.K.)
- Institut Mondor de Recherche Biomédicale, Inserm U955, Team n° 18, 94010 Creteil, France
- Faculty of Medicine, University of Paris Est Creteil, 94010 Creteil, France
| | - Julien Calderaro
- Institut Mondor de Recherche Biomédicale, Inserm U955, Team n° 18, 94010 Creteil, France
- Faculty of Medicine, University of Paris Est Creteil, 94010 Creteil, France
- Laboratory of Pathology, Henri Mondor University Hospital, 94010 Creteil, France
| | - Youssef Zaarour
- Medical Imaging Department, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France (H.K.)
| | - Laetitia Saccenti
- Medical Imaging Department, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France (H.K.)
- Institut Mondor de Recherche Biomédicale, Inserm U955, Team n° 18, 94010 Creteil, France
- Faculty of Medicine, University of Paris Est Creteil, 94010 Creteil, France
| | - Mario Ghosn
- Medical Imaging Department, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France (H.K.)
- Faculty of Medicine, University of Paris Est Creteil, 94010 Creteil, France
| | - Edouard Reizine
- Medical Imaging Department, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France (H.K.)
- Institut Mondor de Recherche Biomédicale, Inserm U955, Team n° 18, 94010 Creteil, France
- Faculty of Medicine, University of Paris Est Creteil, 94010 Creteil, France
| | - Maxime Blain
- Medical Imaging Department, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France (H.K.)
- Faculty of Medicine, University of Paris Est Creteil, 94010 Creteil, France
| | - Alexis Laurent
- Institut Mondor de Recherche Biomédicale, Inserm U955, Team n° 18, 94010 Creteil, France
- Faculty of Medicine, University of Paris Est Creteil, 94010 Creteil, France
- Department of Visceral Surgery, Henri Mondor University Hospital, 94010 Creteil, France
| | - Raffaele Brustia
- Institut Mondor de Recherche Biomédicale, Inserm U955, Team n° 18, 94010 Creteil, France
- Faculty of Medicine, University of Paris Est Creteil, 94010 Creteil, France
- Department of Visceral Surgery, Henri Mondor University Hospital, 94010 Creteil, France
| | - Vincent Leroy
- Institut Mondor de Recherche Biomédicale, Inserm U955, Team n° 18, 94010 Creteil, France
- Faculty of Medicine, University of Paris Est Creteil, 94010 Creteil, France
- Department of Hepatology, Henri Mondor University Hospital, 94010 Creteil, France
| | - Giuliana Amaddeo
- Institut Mondor de Recherche Biomédicale, Inserm U955, Team n° 18, 94010 Creteil, France
- Faculty of Medicine, University of Paris Est Creteil, 94010 Creteil, France
- Department of Hepatology, Henri Mondor University Hospital, 94010 Creteil, France
| | - Alain Luciani
- Medical Imaging Department, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France (H.K.)
- Institut Mondor de Recherche Biomédicale, Inserm U955, Team n° 18, 94010 Creteil, France
- Faculty of Medicine, University of Paris Est Creteil, 94010 Creteil, France
| | - Vania Tacher
- Medical Imaging Department, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France (H.K.)
- Institut Mondor de Recherche Biomédicale, Inserm U955, Team n° 18, 94010 Creteil, France
- Faculty of Medicine, University of Paris Est Creteil, 94010 Creteil, France
| | - Hicham Kobeiter
- Medical Imaging Department, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France (H.K.)
- Faculty of Medicine, University of Paris Est Creteil, 94010 Creteil, France
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Young S, Sanghvi T, Ragulojan R, Torkian P, Todatry S, D'Souza D, Flanagan S, Golzarian J. Local recurrence following a complete radiologic response in hepatocellular carcinoma patients: comparison of transarterial chemoembolisation and transarterial radioembolisation. Clin Radiol 2024; 79:371-377. [PMID: 38341344 DOI: 10.1016/j.crad.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024]
Abstract
AIM To evaluate and compare the rates of local recurrence in hepatocellular carcinoma (HCC) patients who undergo selective transarterial radioembolisation (TARE) or transarterial chemoembolisation (TACE) and achieve a complete response (CR) radiologically. MATERIALS AND METHODS All patients undergoing treatment with TARE or TACE at a single academic institution were reviewed retrospectively. Those who had been treated previously, presented with multifocal disease, had non-selective TARE or TACE, or did not achieve a complete response (CR) radiologically were excluded. RESULTS In total 110 patients were included (TACE n=60 [54.5%]; TARE n=50 [45.5%]). TARE patients were older (66.4 ± 9.4 versus 61.2 ± 5.6 years, p<0.001) and had larger tumours (4.4 ± 2.2 versus 3 ± 1.4 cm, p=0.002). TACE patients were significantly more likely to suffer a local recurrence (31/60, 51.7% versus 9/50, 18%, p<0.001) and had a significantly shorter time to recurrence (median 8.3 {interquartile range [IQR]}: 12 versus median 17.9 [IQR: 23.5] months, p=0.001). A local time to progression (TTP) Kaplan-Meier curve demonstrated TACE patients had a significantly shorter local TTP (hazard ratio [HR]: 7.2; 95% confidence interval [CI]: 3.64-14.24; p<0.001) and treatment modality (TACE or TARE; HR: 0.05; 95% CI: 0.005-0.5; p=0.01) was found to be associated with local recurrences on multivariate Cox proportional HR analysis. When overall TTP was evaluated, again TACE patients were found to have a significantly shorter TTP (HR: 2.13 [1.28-3.53], p=0.004). CONCLUSION In HCC patients undergoing selective treatment who achieve a CR radiologically, those treated with TARE may be less likely to suffer recurrence, either local or general, than those treated with TACE.
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Affiliation(s)
- S Young
- Department of Radiology, University of Arizona, Division of Interventional Radiology, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724, USA.
| | - T Sanghvi
- Minneapolis VA Hospital, 1 Veterans Dr, Minneapolis, MN 55417, USA
| | - R Ragulojan
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - P Torkian
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - S Todatry
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - D D'Souza
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - S Flanagan
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - J Golzarian
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
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Pescatori LC, Galletto Pregliasco A, Derbel H, Saccenti L, Ghosn M, Blain M, Chalayea J, Luciani A, Mulé S, Amaddeo G, Kobeiter H, Tacher V. Combination of intrahepatic TARE and extrahepatic TACE to treat HCC patients with extrahepatic artery supply: A case series. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2024; 9:100042. [PMID: 39076578 PMCID: PMC11265365 DOI: 10.1016/j.redii.2024.100042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/24/2024] [Indexed: 07/31/2024]
Abstract
Purpose The aim of this study was to report the safety and tumor response rate of combined transarterial radioembolization (TARE) through the intrahepatic arteries and transarterial chemoembolization (TACE) through the extrahepatic feeding arteries (EHFA) in patients with hepatocellular carcinoma (HCC). Methods Patients with HCC, who had both intrahepatic and extrahepatic arterial supply visible on preinterventional multiphase CT and were treated between 2016 and 2021 with a combination of TACE and TARE on the same nodule, were retrospectively included. Epidemiological, clinical, biological, and radiological characteristics were recorded. Safety and tumor response were assessed at 6 months. Results Nine patients (8 men, median age 62 years [IQR: 54-72 years]) were included. Seven patients had previous treatments on the target nodule (TARE: 5; TACE: 2). The median longest axis (LA) of the lesion was 70 mm (IQR: 60-79 mm). Three patients had portal vein invasion (VP3). The EHFA originated from the right diaphragmatic artery (n = 6), the right adrenal artery (n = 2), and the left gastric artery (n = 1). The LA of the tumor portion treated with TACE was 47 mm (range: 35-64 mm). The ratio between the LA of the entire lesion and the LA treated with TACE was 1.44 (range: 1.27-1.7). One major complication occurred: acute on chronic liver failure. Median follow-up was 23 months (range: 16-29 months). Seven patients underwent further treatment: on the same lesion (n = 2), on newly appeared nodules (n = 2), and systemic treatment (n = 3). At 6-month follow-up, seven patients showed a local objective response. Time-to-progression was 13 (3.5-19) months. Conclusion The combination of TARE and extrahepatic TACE for HCC with both intrahepatic and extrahepatic arterial supplies seems feasible and safe. Further studies are needed to validate the effectiveness of these preliminary results.
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Affiliation(s)
| | | | - Haytham Derbel
- Inserm IMRB U955, équipe 18, université Paris-Est Créteil, Créteil, France
| | - Laetitia Saccenti
- Department of Radiology, hôpital Henri-Mondor (AP-HP), Créteil, France
- Inserm IMRB U955, équipe 18, université Paris-Est Créteil, Créteil, France
| | - Mario Ghosn
- Department of Radiology, hôpital Henri-Mondor (AP-HP), Créteil, France
| | - Maxime Blain
- Department of Radiology, hôpital Henri-Mondor (AP-HP), Créteil, France
| | - Julia Chalayea
- Department of Nuclear Medicine, hôpital Henri-Mondor (AP-HP), Créteil, France
| | - Alain Luciani
- Inserm IMRB U955, équipe 18, université Paris-Est Créteil, Créteil, France
| | - Sebastien Mulé
- Inserm IMRB U955, équipe 18, université Paris-Est Créteil, Créteil, France
| | - Giuliana Amaddeo
- Inserm IMRB U955, équipe 18, université Paris-Est Créteil, Créteil, France
- Department of Hepatology, hôpital Henri-Mondor (AP-HP), Créteil, France
| | - Hicham Kobeiter
- Inserm IMRB U955, équipe 18, université Paris-Est Créteil, Créteil, France
- Inserm IMRB U955, équipe 8, université Paris-Est Créteil, Créteil, France
| | - Vania Tacher
- Inserm IMRB U955, équipe 18, université Paris-Est Créteil, Créteil, France
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Barat M, Pellat A, Hoeffel C, Dohan A, Coriat R, Fishman EK, Nougaret S, Chu L, Soyer P. CT and MRI of abdominal cancers: current trends and perspectives in the era of radiomics and artificial intelligence. Jpn J Radiol 2024; 42:246-260. [PMID: 37926780 DOI: 10.1007/s11604-023-01504-0] [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: 09/13/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
Abdominal cancers continue to pose daily challenges to clinicians, radiologists and researchers. These challenges are faced at each stage of abdominal cancer management, including early detection, accurate characterization, precise assessment of tumor spread, preoperative planning when surgery is anticipated, prediction of tumor aggressiveness, response to therapy, and detection of recurrence. Technical advances in medical imaging, often in combination with imaging biomarkers, show great promise in addressing such challenges. Information extracted from imaging datasets owing to the application of radiomics can be used to further improve the diagnostic capabilities of imaging. However, the analysis of the huge amount of data provided by these advances is a difficult task in daily practice. Artificial intelligence has the potential to help radiologists in all these challenges. Notably, the applications of AI in the field of abdominal cancers are expanding and now include diverse approaches for cancer detection, diagnosis and classification, genomics and detection of genetic alterations, analysis of tumor microenvironment, identification of predictive biomarkers and follow-up. However, AI currently has some limitations that need further refinement for implementation in the clinical setting. This review article sums up recent advances in imaging of abdominal cancers in the field of image/data acquisition, tumor detection, tumor characterization, prognosis, and treatment response evaluation.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
| | - Anna Pellat
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
| | - Christine Hoeffel
- Department of Radiology, Hopital Robert Debré, CHU Reims, Université Champagne-Ardennes, 51092, Reims, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
| | - Romain Coriat
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Stéphanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, 34000, Montpellier, France
- PINKCC Lab, IRCM, U1194, 34000, Montpellier, France
| | - Linda Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France.
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France.
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Young S, Abamyan A, Goldberg D, Hannallah J, Schaub D, Kalarn S, Fitzgerald Z, Woodhead G. Cryoablation in the liver: how accurately does the iceball predict the ablation zone? Abdom Radiol (NY) 2024; 49:625-630. [PMID: 38036773 DOI: 10.1007/s00261-023-04117-3] [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: 08/02/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE To evaluate the accuracy with which the iceball predicts the realized ablation zone in patients undergoing cryoablation of the liver. MATERIALS AND METHODS Continuous patients who underwent cryoablation of primary or secondary malignancies of the liver were retrospectively reviewed. Iceball and ablation zone dimensions on 1 month follow up imaging were collected in three orientations, the long axis (LA), perpendicular transverse (PTR), and perpendicular craniocaudal (PCC). Factors which may predict differences in the measurements were evaluated with regression analysis. Oncologic outcomes were also collected. RESULTS The mean size of the iceball was 5.5 ± 1.1 cm, 3.9 ± 1.1 cm, and 4.4 ± 1.4 cm in the LA, PTR, and PCC orientations, respectively. The mean size of the one-month ablation cavity was 4.3 ± 1.3 cm, 3 ± 1.1 cm, and 3 ± 1.3 cm in the LA, PTR, and PCC orientations, respectively. The iceball was significantly larger than the ablation zone in all orientations (p < 0.001). When comparing HCC and non-HCC patients the Kaplan-Meier analysis of TTLP, the Kaplan Meier curves deviated significantly (p = 0.015, HR 2.26 (95%CI 1.17-4.37)). When a similar analysis was performed looking at TTP again the curves diverged significantly (p = 0.002, HR 2.4 (95%CI 1.37-4.19)). CONCLUSION The iceball seems to overestimate the realized ablation zone by about 1 cm in all orientations during hepatic cryoablation.
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Affiliation(s)
- Shamar Young
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA.
| | - Art Abamyan
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Dan Goldberg
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Jack Hannallah
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - David Schaub
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Salil Kalarn
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Zachary Fitzgerald
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Gregory Woodhead
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
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Hedjoudje M, Barat M, Dohan A, Lucas A, Dautry R, Coriat R, Marchese U, Pol S, Parlati L, Soyer P. Comparison Between Radial and Femoral Artery Access for Transarterial Chemoembolisation in Patients With Hepatocellular Carcinoma. Can Assoc Radiol J 2024; 75:178-186. [PMID: 37563785 DOI: 10.1177/08465371231186524] [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: 08/12/2023] Open
Abstract
PURPOSE The purpose of this study was to compare the technical success rate, the selectivity of transarterial chemoembolisation (TACE), the complication rate, the radiation dose given to the patients and the hospitalization stay between TACE performed using femoral artery approach (FAA) and TACE performed using radial artery approach (RAA) in patients with hepatocellular carcinoma (HCC). METHODS Between June 2020 and April 2022, 49 patients with HCC who underwent 116 TACEs (75 using FAA and 41 using RAA) were included. Differences in technical success rate, selectivity of micro-catheterization, radiation dose given to the patients, fluoroscopy time, hospitalization stay duration, and complication rate were compared between FAA and RAA using Fisher exact or Student t tests. RESULTS No differences in technical success rates were found between RAA (93%; 39/41 TACEs) and FAA (100%; 75/75 TACEs) (P = .12). There were no differences between the two groups in terms of selectivity of catheterization, radiation dose, fluoroscopy time and hospitalization stay duration. Five patients had Grade 2 complications (hematoma) after FAA vs. one patient with one Grade 1 complication (radial artery occlusion) after RAA (5/75 [7%] vs. 1/41 [2%], respectively; P = .42). No major arterial access site complications occurred with FAA or RAA. CONCLUSIONS This study confirms that RAA is a safe approach that does not compromise the technical efficacy and the selectivity of TACE compared to FAA in patients with HCC.
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Affiliation(s)
| | - Maxime Barat
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Alexandre Lucas
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Raphael Dautry
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
| | - Romain Coriat
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hopital Cochin, AP-HP, Paris, France
| | - Ugo Marchese
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Digestive, Hepatobiliary, and Endocrine Surgery, Hopital Cochin, AP-HP, Paris, France
| | - Stanislas Pol
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Hepatology, Hopital Cochin, AP-HP, Paris, France
| | - Lucia Parlati
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Hepatology, Hopital Cochin, AP-HP, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
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Gradel KO. Interpretations of the Role of Plasma Albumin in Prognostic Indices: A Literature Review. J Clin Med 2023; 12:6132. [PMID: 37834777 PMCID: PMC10573484 DOI: 10.3390/jcm12196132] [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: 07/07/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
This review assesses how publications interpret factors that influence the serum or plasma albumin (PA) level in prognostic indices, focusing on inflammation and nutrition. On PubMed, a search for "albumin AND prognosis" yielded 23,919 results. From these records, prognostic indices were retrieved, and their names were used as search strings on PubMed. Indices found in 10 or more original research articles were included. The same search strings, restricted to "Review" or "Systematic review", retrieved yielded on the indices. The data comprised the 10 latest original research articles and up to 10 of the latest reviews. Thirty indices had 294 original research articles (6 covering two indices) and 131 reviews, most of which were from recent years. A total of 106 articles related the PA level to inflammation, and 136 related the PA level to nutrition. For the reviews, the equivalent numbers were 54 and 65. In conclusion, more publications mention the PA level as a marker of nutrition rather than inflammation. This is in contrast to several general reviews on albumin and nutritional guidelines, which state that the PA level is a marker of inflammation but not nutrition. Hypoalbuminemia should prompt clinicians to focus on the inflammatory aspects in their patients.
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Affiliation(s)
- Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, 5000 Odense, Denmark; ; Tel.: +45-21-15-80-85
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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Vanderbecq Q, Grégory J, Dana J, Dioguardi Burgio M, Garzelli L, Raynaud L, Frémy S, Paulatto L, Bouattour M, Kavafyan-Lasserre J, Vilgrain V, Ronot M. Improving pain control during transarterial chemoembolization for hepatocellular carcinoma performed under local anesthesia with multimodal analgesia. Diagn Interv Imaging 2023; 104:123-132. [PMID: 36805801 DOI: 10.1016/j.diii.2022.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to assess the performance of a reinforced analgesic protocol (RAP) on pain control in patients undergoing conventional trans-arterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS Eighty-one consecutive patients (57 men, 24 women) with a mean age of 69 ± 10 (standard deviation) years (age range: 49-92 years) underwent 103 cTACEs. Standard antalgic protocol (50 mg hydroxyzine, 10 mg oxycodone, 8 mg ondansetron, and lidocaine for local anesthesia) was prospectively compared to a RAP (standard + 40 mg 2-h infusion nefopam and 50 mg tramadol). The individual pain risk was stratified based on age, the presence of cirrhosis and alcoholic liver disease, and patients were assigned to a low-risk group (standard protocol) or high-risk group (RAP). The primary endpoint was severe periprocedural abdominal pain (SAP), defined as a visual analog scale score ≥30/100. A predefined intermediate analysis was performed to monitor the benefit-risk of the RAP. Based on the intermediate analysis, all patients were treated with the RAP. RESULTS The intermediate analysis performed after 52 cTACE showed that 2/17 (12%) high-risk patients (i.e., those receiving the RAP) experienced SAP compared to 15/35 (43%) low-risk patients (odds ratio [OR] = 0.18; 95% confidence interval [CI]: 0.02-0.98; P = 0.03). Analysis of all procedures showed that 12/67 (18%) patients in cTACE receiving the RAP experienced SAP compared to 15/36 (42%) patients who did not receive it (OR = 3.27; 95% CI: 1.32-8.14; P = 0.01). There were no statistical differences in adverse events, particularly for nausea, between groups. CONCLUSION Reinforcing the analgesic protocol by combining non-opioid and opioid molecules reduces perioperative pain in patients undergoing cTACE for HCC.
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Affiliation(s)
- Quentin Vanderbecq
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France
| | - Jules Grégory
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France; Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation", CRI, 75018 Paris, France; FHU MOSAIC, 92110 Clichy, France
| | - Jeremy Dana
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France; Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation", CRI, 75018 Paris, France
| | - Lorenzo Garzelli
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France; Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation", CRI, 75018 Paris, France
| | - Lucas Raynaud
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France
| | - Sébastien Frémy
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France
| | - Luisa Paulatto
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France
| | | | | | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France; Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation", CRI, 75018 Paris, France
| | - Maxime Ronot
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France; Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation", CRI, 75018 Paris, France; Department of Anesthesiology and Intensive Care, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France.
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Cassinotto C, Nogue E, Durand Q, Panaro F, Assenat E, Dohan A, Malafaye N, Guiu B, Molinari N. Life expectancy of patients with hepatocellular carcinoma according to the upfront treatment: A nationwide analysis. Diagn Interv Imaging 2023; 104:192-199. [PMID: 36682959 DOI: 10.1016/j.diii.2023.01.002] [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: 10/04/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this study was to update the life expectancy of patients with hepatocellular carcinoma (HCC) in an exhaustive nationwide population according to the upfront treatment performed. MATERIALS AND METHODS From the French Program for the Medicalization of Information System database, all patients older than 18 years diagnosed with a de novo HCC from January 2011 to December 2018 were retrospectively selected. Five-year survival rates (95% confidence intervals [CI]) were computed according to the first surgical or interventional radiology procedures performed. RESULTS A total of 63,996 patients (80% men) with a median age of 68 years (Q1, Q3: 61, 77) were selected, including 24,007 patients who underwent at least one procedure (5-year survival of 45.5%; (95% CI: 44.8-46.2), and 39,989 with none (5-year survival, 9.6%; (95% CI: 9.3-10.0). Only 20.5% (13,101/63,996) of patients could undergo an upfront curative procedure. Liver transplantation achieved the best outcome, whether performed upfront (n = 791; 5-year survival, 79.0% [95% CI: 76.1-82.1]) or during subsequent steps (n = 2217; 5-year survival 80.9% [95% CI: 79.2-82.7]). Tumor ablation (n = 5306), open resection (n = 5171), and minimally-invasive resection (n = 1833) achieved 5-year survival rates of 53.8% (95% CI: 52.3-55.4), 54.1% (95% CI: 52.6-55.6), and 66.2% (95% CI: 63.7-68.7), respectively, with more patients with cirrhosis and subsequent procedures in the tumor ablation group. Patients with upfront transarterial (chemo)embolization (n = 10,247) and selective internal radiation therapy (n = 659) had 5-year survival rates of 31.3% (95% CI: 30.3-32.4) and 18.5% (95% CI: 15.2-22.5). CONCLUSION While HCC remains mostly diagnosed at an advanced stage associated with a poor prognosis, all the curative options provide 5-year survival rates above 50%.
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Affiliation(s)
- Christophe Cassinotto
- Department of Diagnostic and Interventional Radiology, Saint-Eloi Hospital, University Hospital of Montpellier, 34090 Montpellier, France; Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, University Hospital of Montpellier, 34090 Montpellier, France.
| | - Erika Nogue
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier, Montpellier University, 34090 Montpellier, France
| | - Quentin Durand
- Department of Diagnostic and Interventional Radiology, Saint-Eloi Hospital, University Hospital of Montpellier, 34090 Montpellier, France
| | - Fabrizio Panaro
- Department of Surgery/ Division of HBP Surgery and Transplantation, Saint-Eloi Hospital, University Hospital of Montpellier, 34090 Montpellier, France
| | - Eric Assenat
- Department of Oncology, Saint-Eloi Hospital, University Hospital of Montpellier, 34090 Montpellier, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Nicolas Malafaye
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier, Montpellier University, 34090 Montpellier, France
| | - Boris Guiu
- Department of Diagnostic and Interventional Radiology, Saint-Eloi Hospital, University Hospital of Montpellier, 34090 Montpellier, France; Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, University Hospital of Montpellier, 34090 Montpellier, France
| | - Nicolas Molinari
- Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, University Hospital of Montpellier, 34090 Montpellier, France; Clinical Research and Epidemiology Unit, University Hospital of Montpellier, Montpellier University, 34090 Montpellier, France
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11
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Ilagan CH, Goldman DA, Gönen M, Aveson VG, Babicky M, Balachandran VP, Drebin JA, Jarnagin WR, Wei AC, Kingham TP, Abou-Alfa GK, Brown KT, D'Angelica MI. Recurrence of Hepatocellular Carcinoma After Complete Radiologic Response to Trans-Arterial Embolization: A Retrospective Study on Patterns, Treatments, and Prognoses. Ann Surg Oncol 2022; 29:6815-6826. [PMID: 35838903 PMCID: PMC9509465 DOI: 10.1245/s10434-022-12036-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/30/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is limited information about the long-term outcomes and patterns of progression in patients who have unresectable, liver-confined hepatocellular carcinoma (HCC) with complete response (CR) to transarterial embolization and do not undergo resection or transplantation (LT). METHODS A retrospective review analyzed participants in a randomized trial comparing hepatic artery embolization (HAE) and drug-eluting bead transarterial chemoembolization (DEB-TACE) with doxorubicin who had CR according to modified response evaluation criteria in solid tumors (mRECIST). The overall survival (OS), incidence and patterns of progression, and factors associated with progression were assessed. RESULTS Of the 101 patients in the trial, 37 with CR were included in this study. This cohort had 17 patients treated with HAE (46 %), and 20 patients managed with DEB-TACE (54 %). The median age was 67 years (range, 42-82 years). Most of the cohort were male (86.5 %) and Caucasian (78 %). The median pre-treatment Model for End-Stage Liver Disease (MELD) score was 10, and 70 % of the cohort had Barcelona Clinic Liver Cancer (BCLC) stage B or C. The median follow-up period was 49 months (95 % confidence interval [CI], 9-108 months), and the median OS was 25 months (95 % CI, 18.9-30.9 months). The 3- and 5-year survival rates were respectively 31 % (95 % CI, 16.7-45.9 %) and 18 % (95 % CI, 6.8-32.1 %). The 1- and 2-year cumulative incidences of progression were respectively 76 % (95 % CI, 57.7-86.8 %) and 92 % (95 % CI, 74.5-97.6 %). The most common first site of progression was the previously treated hepatic site or local site (32 %, 12/37). The 3-year cumulative incidence of progression was 65 % (95 % CI, 46.4-78.4 %) for the local site. CONCLUSION Patients with advanced-stage HCC and CR to embolization do not have durable responses and experience inevitable disease progression. Most patients with progression have liver-confined disease and should be evaluated for additional consolidative treatments.
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Affiliation(s)
- Crisanta H Ilagan
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debra A Goldman
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gönen
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victoria G Aveson
- Department of Surgery, New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA
| | - Michelle Babicky
- The Oregon Clinic Gastrointestinal and Minimally Invasive Surgery, Portland, OR, USA
| | - Vinod P Balachandran
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College at Cornell University, New York, NY, USA
| | - Jeffrey A Drebin
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College at Cornell University, New York, NY, USA
| | - William R Jarnagin
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College at Cornell University, New York, NY, USA
| | - Alice C Wei
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College at Cornell University, New York, NY, USA
| | - T Peter Kingham
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College at Cornell University, New York, NY, USA
| | - Ghassan K Abou-Alfa
- Weill Medical College at Cornell University, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karen T Brown
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Michael I D'Angelica
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Weill Medical College at Cornell University, New York, NY, USA.
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12
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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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Messmer F, Zgraggen J, Kobe A, Chaykovska L, Puippe G, Reiner CS, Pfammatter T. Quantitative and qualitative evaluation of liver metastases with intraprocedural cone beam CT prior to transarterial radioembolization as a predictor of treatment response. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2022; 1:100005. [PMID: 39077371 PMCID: PMC11265323 DOI: 10.1016/j.redii.2022.100005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/21/2022] [Indexed: 07/31/2024]
Abstract
Purpose To investigate, by quantitative and qualitative enhancement measurements, the correlation between tumor enhancement on cone beam computed tomography (CBCT) images and treatment response at 6 months in patients undergoing transarterial radioembolization (TARE) for liver metastases. Materials and Methods 36 patients (56% male; median age 62.5 years) with 104 metastases were retrospectively included. Quantitative and qualitative enhancement of liver metastases were evaluated on CBCT images before TARE. Quantitative analysis consisted of lesion enhancement measurements (ROI HU lesion - ROI HU relative to inferior vena cava). Qualitative analysis consisted of subjective enhancement pattern analysis (diffuse, sparse, rim-like or non-enhancing). Morphologic tumor response was evaluated according to RECIST 1.1 criteria on follow-up CT or MR imaging. Results At a mean follow up of 6.5 ± 3.7 months, progressive disease (PD) was found in 4 patients, partial response (PR) in 11 and stable disease (SD) in 21. Relative lesion enhancement was significantly different between these groups (-37.5±154.2 HU vs. 103.8±93.4 vs. 181±144 HU in PD vs. SD vs. PR group, respectively; p<0.01). ROC analysis of relative lesion enhancement to predict progressive disease showed an area under the curve of 0.86 (p<0.01). For qualitative lesion enhancement analysis, no difference between groups was found. Conclusion Quantitative enhancement measurements derived from intraprocedural contrast enhanced CBCT may identify responders to TARE in patients with liver metastases.
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Affiliation(s)
- Florian Messmer
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Juliana Zgraggen
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Adrian Kobe
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Gilbert Puippe
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Caecilia S. Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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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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