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Pandey A, Mohseni A, Shaghaghi M, Pandey P, Rezvani Habibabadi R, Hazhirkarzar B, Ly A, Panid Madani S, Borhani A, Kamel IR. Incremental value of volumetric multiparametric MRI over Fudan score for prognosis of unresectable intrahepatic cholangiocarcinoma treated with systemic chemotherapy. Eur J Radiol 2024; 170:111196. [PMID: 38029705 DOI: 10.1016/j.ejrad.2023.111196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/25/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Individualized patient care requires prognostic models customized to a tumor and an individual's disease profile for reliable survival prediction. MRI has prognostic value for intrahepatic cholangiocarcinoma (ICCA). Existing prognostic models for ICCA exclude imaging-based information about an individual's tumor that may reflect important aspects of tumor's biology. Fudan score, a prognostic model applicable to unresectable ICCA, is limited by subjective morphologic imaging parameters. OBJECTIVES To assess the prognostic value of baseline volumetric multiparametric MRI in unresectable intrahepatic cholangiocarcinoma (ICCA) treated with systemic chemotherapy and the incremental value of MRI over the Fudan score. METHODS This retrospective study included 114 ICCA patients treated with systemic chemotherapy between 2007 and 2021 after a baseline MRI. The single largest tumor was volumetrically assessed for anatomic (total tumor volume and diameter) and functional parameters (viable tumor volume, percentage-viable tumor volume, viable tumor burden, and ADC). A derivation cohort of 30 patients was utilized to identify MRI parameters associated with overall survival (OS) using Cox regression analysis. The incremental value of MRI over Fudan score was assessed on an independent sub-cohort of 84 patients using Kaplan-Meier analysis and C-index. RESULTS 114 patients (64 years +/- 11; 61 women) were evaluated. Pre-treatment high (>1350x10-6 mm2/sec) ADC was the only independent predictor of OS (HR, 8.07; P < 0.001). Replacing subjective tumor boundary with objective ADC value, and using modified biochemical thresholds increased the prognostic stratification for the risk groups in the modified ADC-Fudan model compared to the original Fudan model (median survival 12 and 4.5 months; P = 0.055; vs. 11 and 3 months; P < 0.001). The modified ADC-Fudan model demonstrated an 11 % improvement over the original Fudan model (c-index: 0.80 vs. 0.69; P = 0.044) for survival prediction. CONCLUSIONS High pre-treatment volumetric ADC was associated with unfavorable prognosis in patients with unresectable intrahepatic cholangiocarcinoma treated with systemic chemotherapy. Supplementing the original Fudan model with ADC and modified serum marker thresholds improved the survival prediction performance by 11% in the resulting modified ADC-Fudan model. CLINICAL IMPACT Volumetric MRI could improve the survival prediction among ICCA patients prior to receiving potentially toxic and expensive palliative chemotherapies. This could potentially guide individualized therapy for this patient cohort.
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Affiliation(s)
- Ankur Pandey
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA; Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, USA.
| | - Alireza Mohseni
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA.
| | - Mohammadreza Shaghaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA.
| | - Pallavi Pandey
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA
| | - Roya Rezvani Habibabadi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA.
| | - Bita Hazhirkarzar
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA.
| | - Andrew Ly
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA.
| | - Seyedeh Panid Madani
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA.
| | - Ali Borhani
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA.
| | - Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA.
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Thormann M, Surov A, Pech M, March C, Hass P, Damm R, Omari J. Local ablation of hepatocellular carcinoma by interstitial brachytherapy: prediction of outcome by diffusion-weighted imaging. Acta Radiol 2022; 64:1331-1340. [PMID: 36262039 DOI: 10.1177/02841851221129714] [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: 11/16/2022]
Abstract
BACKGROUND Interstitial brachytherapy (iBT) has become a viable treatment option in the therapy of early and intermediate stage hepatocellular carcinoma (HCC). Prognostic imaging tools to predict patient outcome are missing. PURPOSE To assess the predictive value of baseline diffusion-weighted imaging in HCC before iBT with regard to local tumor control and overall survival (OS). MATERIAL AND METHODS We retrospectively identified 107 patients who underwent iBT for HCC from 2011 to 2018 from our database. Apparent diffusion coefficient (ADC) values for each treated lesion were analyzed in region of interest measurements. Additionally, explorative combined ratios adjusting total measured lesion area and mean measured lesion area per patient by ADC values were calculated. Measurements underwent a univariate and multivariate Cox regression analysis. The log rank test was then used to verify prognostic cutoff levels for median survival time. RESULTS A total of 189 lesions in 81 patients were measured. Median survival of patients was 46.0 months. Neither ADC parameter was indicative of local tumor control. Lesion size >5 cm was associated with lower local tumor control (hazard ratio [HR]=4.292, 95% confidence interval [CI]=1.285-14.331; P = 0.018). Average measured lesion area divided by ADCmin (ADCarea mean, min) was identified to independently predict OS (HR=1.994, 95% CI=1.172-3.392; P = 0.011). A cutoff based on the variable's median (0.29 × 10-4 AU) identified patients with poor outcome (OS 36 vs. 61 months) for lower ADCarea mean, min values as verified by the log-rank test (P = 0.040). CONCLUSION Pre-treatment ADCarea mean, min may serve as an independent predictor of OS in patients with HCC undergoing iBT.
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Affiliation(s)
- Maximilian Thormann
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Christine March
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Peter Hass
- Clinic for Radiation Oncology, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Robert Damm
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
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3
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Drewes R, Heinze C, Pech M, Powerski M, Woidacki K, Wienke A, Surov A, Omari J. Apparent Diffusion Coefficient Can Predict Therapy Response of Hepatocellular Carcinoma to Transcatheter Arterial Chemoembolization. Dig Dis 2022; 40:596-606. [PMID: 34749359 PMCID: PMC9501788 DOI: 10.1159/000520716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/14/2021] [Indexed: 02/02/2023]
Abstract
AIM The goal of this meta-analysis was to assess the apparent diffusion coefficient (ADC) as a pre- and posttreatment (ADC value changes [ΔADC]) predictive imaging biomarker of response to transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). METHODS Scopus database, Embase database, and MEDLINE library were scanned for connections between pre- and posttreatment ADC values of HCC and response to TACE. Six studies qualified for inclusion. The following parameters were collected: authors, publication year, study design, number of patients, drugs for TACE, mean ADC value, standard deviation, measure method, b values, and Tesla strength. The Quality Assessment of Diagnostic Studies 2 instrument was employed to check the methodological quality of each study. The meta-analysis was performed by utilizing RevMan 5.3 software. DerSimonian and Laird random-effects models with inverse-variance were used to regard heterogeneity. The mean ADC values and 95% confidence intervals were computed. RESULTS Six studies (n = 271 patients with 293 HCC nodules) were included. The pretreatment mean ADC in the responder group was 1.20 × 10-3 mm2/s (0.98, 1.42) and 1.14 × 10-3 mm2/s (0.89, 1.39) in the nonresponder group. The analysis of post-TACE ΔADC revealed a threshold of ≥20% to identify treatment responders. No suitable pretreatment ADC threshold to predict therapy response or discriminate between responders and nonresponders before therapy could be discovered. CONCLUSION ΔADC can facilitate early objective response evaluation through post-therapeutic ADC alterations ≥20%. Pretreatment ADC cannot predict response to TACE.
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Affiliation(s)
- Ralph Drewes
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Constanze Heinze
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany,*Constanze Heinze,
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany,2nd Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Katja Woidacki
- Section Experimental Radiology, Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Andreas Wienke
- Institute for Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle Wittenberg, Halle, Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany,**Alexey Surov,
| | - Jazan Omari
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
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Preoperative estimation of the survival of patients with unresectable hepatocellular carcinoma achieving complete response after conventional transcatheter arterial chemoembolization: assessments of clinical and LI-RADS MR features. Radiol Med 2022; 127:939-949. [DOI: 10.1007/s11547-022-01517-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/13/2022] [Indexed: 10/15/2022]
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5
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Wang H, Guo W, Yang W, Liu G, Cao K, Sun Y, Liang ZN, Bai XM, Wang S, Wu W, Yan K, Goldberg SN. Computer-Aided Color Parameter Imaging of Contrast-Enhanced Ultrasound Evaluates Hepatocellular Carcinoma Hemodynamic Features and Predicts Radiofrequency Ablation Outcome. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1555-1566. [PMID: 35597704 DOI: 10.1016/j.ultrasmedbio.2022.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/21/2022] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
Computer-aided color parameter imaging (CPI) is a novel technique for contrast-enhanced ultrasound (CEUS) that can highlight hemodynamic features of focal lesions. The purpose of the study was to investigate the role of CPI in evaluation of hepatocellular carcinoma (HCC) hemodynamic features and prognosis after radiofrequency ablation (RFA). One hundred twenty-one patients with HCC underwent CEUS with CPI analysis before RFA. Eighty-nine patients had pathologically proven well- to moderately differentiated HCC (WM-HCC), and 32 patients had poorly differentiated or undifferentiated HCC (PU-HCC). Perfusion features of CEUS and contrast-enhanced computed tomography/magnetic resonance imaging were compared with CPI parameters for WM-HCC and PU-HCC. The results indicated that 67.4% of WM-HCC had a centrifugal perfusion CPI pattern, whereas 84.4% of PU-HCC tumors had a centripetal pattern (p < 0.001, odds ratio = 11.2). The specificity, sensitivity and accuracy of the CPI perfusion pattern regarding HCC pathological grade were higher than those with routine CEUS (84.4% vs. 9.4%, p < 0.001; 67.4% vs. 3.4%, p < 0.001; 71.9% vs. 5.0%, p < 0.001). Moreover, multivariable analysis revealed that the CPI perfusion pattern was an independent risk factor for progression-free survival post-RFA (centripetal group: 28.3 ± 4.1 mo vs. centrifugal group: 45.8 ± 4.4 mo, p = 0.002). A novel CPI technique for CEUS could non-invasively provide valuable hemodynamic information and predict prognosis for HCC patients treated by RFA.
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Affiliation(s)
- Hong Wang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Wen Guo
- Department of Ultrasound, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Wei Yang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China.
| | - Gang Liu
- GE Healthcare China-Ultrasound R&D, Jiangsu, China
| | - Kun Cao
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yu Sun
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Zi-Nan Liang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiu-Mei Bai
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Song Wang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Wei Wu
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Kun Yan
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - S Nahum Goldberg
- Division of Image-Guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Lee MD, Elsayed M, Chopra S, Lui YW. A No-Math Primer on the Principles of Machine Learning for Radiologists. Semin Ultrasound CT MR 2022; 43:133-141. [PMID: 35339253 DOI: 10.1053/j.sult.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Machine learning is becoming increasingly important in both research and clinical applications in radiology due to recent technological developments, particularly in deep learning. As these technologies are translated toward clinical practice, there is a need for radiologists and radiology trainees to understand the basic principles behind them. This primer provides an accessible introduction to the vocabulary and concepts that are central to machine learning and relevant to the radiologist.
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Affiliation(s)
- Matthew D Lee
- Department of Radiology, NYU Grossman School of Medicine, New York, NY
| | - Mohammed Elsayed
- Department of Radiology, NYU Grossman School of Medicine, New York, NY
| | - Sumit Chopra
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; Courant Institute of Mathematical Sciences, New York University, New York, NY
| | - Yvonne W Lui
- Department of Radiology, NYU Grossman School of Medicine, New York, NY.
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7
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Li B, Zhou L, Xu A, Li Q, Xiang H, Huang Y, Peng L, Xiang K, Zhang M, Wang N. Apparent Diffusion Coefficient as a Noninvasive Biomarker for the Early Response in Hepatocellular Carcinoma after Transcatheter Arterial Chemoembolization using Drug-Eluting Beads. Curr Med Imaging 2022; 18:1186-1194. [PMID: 35249499 DOI: 10.2174/1573405618666220304141632] [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: 11/08/2021] [Revised: 12/03/2021] [Accepted: 12/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prognostic evaluation for hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) using drug-eluting beads (DEBs) is essential for guiding the personalized treatment and follow-up strategy. Apparent diffusion coefficient (ADC) has been reported as a biomarker in conventional TACE. OBJECTIVE To evaluate the diagnostic value of ADCbaseline, ADC change, and ADCratio in predicting the early objective response for HCC after DEB-TACE. METHODS This prospective single-center study included 32 consecutive patients undergoing dynamic contrast-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging before and 1 month after DEB-TACE. After DEB-TACE, patients were grouped based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria into responders (complete response [CR], partial response [PR] ) and nonresponders (stable disease [SD], progressive disease [PD]). The Mann-Whitney U test and receiver operating characteristic (ROC) curves were performed to assess the statistical differences in ADCbaseline, ADC change, and ADCratio between responders and nonresponders. RESULTS At post-DEB-TACE follow-up MRI, 62.5% (n = 20, 11 CRs, and 9 PRs) of patients showed objective response, and 37.5% (n = 12, 7 SDs, and 5 PDs) did not respond to chemoembolization. Nonresponders had a significantly higher ADCbaseline value than responders (p < 0.001). The ROC for identifying the response to chemoembolization demonstrated that the threshold ADCbaseline value of 0.920 × 10-3 mm2/s had 100% sensitivity and 70% specificity. The ADC change and ADCratio of responders were higher than that of nonresponders (p < 0.001). CONCLUSION ADCbaseline, ADC change, and ADCratio may be utilized as a noninvasive biomarker for predicting the early response of HCC to DEB-TACE.
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Affiliation(s)
- Basen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Anhui Xu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qin Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huihua Xiang
- Department of Radiology, Minda Hospital of Hubei Minzu University, Enshi, China
| | - Yanrong Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Peng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Xiang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingfeng Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nan Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Diffusion-weighted imaging of the abdomen using echo planar imaging with compressed SENSE: Feasibility, image quality, and ADC value evaluation. Eur J Radiol 2021; 142:109889. [PMID: 34388627 DOI: 10.1016/j.ejrad.2021.109889] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the feasibility, image quality, and apparent diffusion coefficient (ADC) values of diffusion-weighted imaging (DWI) using echo planar imaging (EPI) with Compressed SENSE (EPICS-DWI) of the abdomen and to compare them with conventional single-shot EPI with parallel imaging (PI) technique (PI-DWI). MATERIALS AND METHODS This prospective study included 46 participants with known or suspected upper abdominal diseases (19 men and 27 women, mean age, 68 years) who underwent MRI. DWI acquisition was performed using free-breathing two-dimensional fat-suppressed PI-DWI and EPICS-DWI with SENSE or compressed sensing (CS) factor, 3.0. Moreover, image noise and contour of liver and pancreas were qualitatively evaluated using a five-point scale. The mean ADC value and standard deviation (SD) of the liver, pancreas, and spleen were measured, and the coefficient of variation (CV) was calculated. Qualitative and quantitative parameters were compared between PI-DWI and EPICS-DWI using the Wilcoxon test. RESULTS The mean image quality scores for image noise and contour of liver and pancreas were higher in EPICS-DWI compared with PI-DWI (P < 0.0001). Moreover, the mean ADC values of the liver and pancreas were higher in EPICS-DWI compared with PI-DWI (P < 0.0001), but that of spleen was not significantly different. The mean SD and CV of the liver, pancreas, and spleen were lower in EPICS-DWI compared with PI-DWI (P < 0.0001-0.032). CONCLUSION EPICS-DWI could be feasible in MRI of the abdomen and significantly improve image quality compared with PI-DWI in aggressive setting. ADC value measurements were higher in EPICS-DWI compared with PI-DWI.
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Cannella R, Sartoris R, Grégory J, Garzelli L, Vilgrain V, Ronot M, Dioguardi Burgio M. Quantitative magnetic resonance imaging for focal liver lesions: bridging the gap between research and clinical practice. Br J Radiol 2021; 94:20210220. [PMID: 33989042 PMCID: PMC8173689 DOI: 10.1259/bjr.20210220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Magnetic resonance imaging (MRI) is highly important for the detection, characterization, and follow-up of focal liver lesions. Several quantitative MRI-based methods have been proposed in addition to qualitative imaging interpretation to improve the diagnostic work-up and prognostics in patients with focal liver lesions. This includes DWI with apparent diffusion coefficient measurements, intravoxel incoherent motion, perfusion imaging, MR elastography, and radiomics. Multiple research studies have reported promising results with quantitative MRI methods in various clinical settings. Nevertheless, applications in everyday clinical practice are limited. This review describes the basic principles of quantitative MRI-based techniques and discusses the main current applications and limitations for the assessment of focal liver lesions.
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Affiliation(s)
- Roberto Cannella
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Section of Radiology - BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127 Palermo, Italy.,Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy
| | | | - Jules Grégory
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France
| | - Lorenzo Garzelli
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France
| | - Valérie Vilgrain
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Maxime Ronot
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Marco Dioguardi Burgio
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,INSERM U1149, CRI, Paris, France
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Xu L, Wang S, Wang S, Wang Y, Li W, Lin G, Yuan Z. Baseline apparent diffusion coefficients: Validation study of new predictor of survival in patients with unresectable hepatocellular carcinoma following chemoembolization. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:507-516. [PMID: 33814481 DOI: 10.3233/xst-200827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate whether the baseline apparent diffusion coefficient (ADC) can predict survival in the hepatocellular carcinoma (HCC) patients receiving chemoembolization. MATERIALS AND METHODS Diffusion-weighted MR imaging of HCC patients is performed within 2 weeks before chemoembolization. The ADC of the largest index lesion is recorded. Responses are assessed by mRECIST after the start of the second course of chemoembolization. Receiver operating characteristic (ROC) curve analysis is performed to evaluate the diagnostic performance and determine optimal cut-off values. Cox regression and Kaplan-Meier survival analyses are used to explore the differences in overall survival (OS) between the responders and non-responders. RESULTS The difference is statistically significant in the baseline ADC between the responders and non-responders (P < 0.001). ROC analyses indicate that the baseline ADC value is a good predictor of response to treatment with an area under the ROC curve (AUC) of 0.744 and the optimal cut-off value of 1.22×10-3 mm2/s. The Cox regression model shows that the baseline ADC is an independent predictor of OS, with a 57.2% reduction in risk. CONCLUSION An optimal baseline ADC value is a functional imaging response biomarker that has higher discriminatory power to predict tumor response and prolonged survival following chemoembolization in HCC patients.
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Affiliation(s)
- Lichao Xu
- Department of Interventional Radiology and Image Guided Medicine, Shanghai Cancer Hospital, Fudan University, Shanghai, China
| | - Shiqin Wang
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Shengping Wang
- Department of Radiology, Shanghai Cancer Hospital, Fudan University, Shanghai, China
| | - Ying Wang
- Department of Interventional Radiology and Image Guided Medicine, Shanghai Cancer Hospital, Fudan University, Shanghai, China
| | - Wentao Li
- Department of Interventional Radiology and Image Guided Medicine, Shanghai Cancer Hospital, Fudan University, Shanghai, China
| | - Guangwu Lin
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Zheng Yuan
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
- Department of Radiology, Shanghai No. 85 Hospital, Shanghai, China
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Tang J, Liu F, Yuan H, Li X, Tian X, Ji K, Li X, Wang W. Pretreatment Apparent Diffusion Coefficient as a Predictor of Response to Transcatheter Arterial Chemoembolization Immediately Combined with Radiofrequency Ablation for Treatment of Solitary Large Hepatocellular Carcinoma. Cancer Manag Res 2020; 12:10127-10138. [PMID: 33116868 PMCID: PMC7569047 DOI: 10.2147/cmar.s270470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/08/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose To evaluate whether the pretreatment apparent diffusion coefficient (ADC) measured with diffusion weighted imaging (DWI) of tumor can be used as an imaging biomarker for predicting prognosis in solitary large hepatocellular carcinomas (HCCs) treated with transcatheter arterial chemoembolization (TACE) immediately combined with radiofrequency ablation (RFA). Patients and Methods In this single institution retrospective study, 40 solitary large HCCs that underwent treatment with TACE immediately combined with RFA were analyzed. All patients underwent abdominal dynamic contrast-enhanced magnetic resonance imaging within one month before treatment with DWI, and ADC values in the lesions were measured by two independent radiologists. Associations among patients’ preoperative ADC values and objective response (OR), progression-free survival (PFS) and overall survival (OS) were examined. Survival curves were drawn with the Kaplan–Meier method, and differences were determined with the Log rank test. The Cox proportional-hazards model was used for univariate and multivariate analyses of PFS and OS. Results Forty solitary large HCCs (mean 9.54 cm, range 5.04–16.06 cm) were successfully treated with TACE in immediate combination with RFA (OR 75%). The ADC values were significantly higher in the response group than the non-response group (1.51±0.32×10−3 mm2/s vs 1.09±0.17×10−3 mm2/s; P<0.001). As predicted on the basis of the ADC values, the optimal cutoff value for the efficacy of TACE combined with RFA was 1.32×10−3 mm2/s, with a predictive sensitivity of 0.63 and a specificity of 1.00. Patients with high ADC had longer PFS than those with low ADC (14.9 months vs 5.3 months; P<0.001) and had significantly longer survival rates (22.6 months vs 12.1 months; P=0.004). Conclusion Preoperative ADC values <1.32×10−3 mm2/s are an independent predictor of poorer prognosis in patients with solitary large HCCs who have undergone TACE immediately combined with RFA.
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Affiliation(s)
- Jing Tang
- Medical School of Chinese PLA, Beijing, People's Republic of China.,Department of Interventional Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Fengyong Liu
- Department of Interventional Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hongjun Yuan
- Department of Interventional Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xin Li
- Department of Interventional Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiaomei Tian
- Department of Interventional Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Kan Ji
- Department of Interventional Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xueping Li
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wei Wang
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
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Gregory J, Dioguardi Burgio M, Corrias G, Vilgrain V, Ronot M. Evaluation of liver tumour response by imaging. JHEP Rep 2020; 2:100100. [PMID: 32514496 PMCID: PMC7267412 DOI: 10.1016/j.jhepr.2020.100100] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 12/12/2022] Open
Abstract
The goal of assessing tumour response on imaging is to identify patients who are likely to benefit - or not - from anticancer treatment, especially in relation to survival. The World Health Organization was the first to develop assessment criteria. This early score, which assessed tumour burden by standardising lesion size measurements, laid the groundwork for many of the criteria that followed. This was then improved by the Response Evaluation Criteria in Solid Tumours (RECIST) which was quickly adopted by the oncology community. At the same time, many interventional oncology treatments were developed to target specific features of liver tumours that result in significant changes in tumours but have little effect on tumour size. New criteria focusing on the viable part of tumours were therefore designed to provide more appropriate feedback to guide patient management. Targeted therapy has resulted in a breakthrough that challenges conventional response criteria due to the non-linear relationship between response and tumour size, requiring the development of methods that emphasize the appearance of tumours. More recently, research into functional and quantitative imaging has created new opportunities in liver imaging. These results have suggested that certain parameters could serve as early predictors of response or could predict later tumour response at baseline. These approaches have now been extended by machine learning and deep learning. This clinical review focuses on the progress made in the evaluation of liver tumours on imaging, discussing the rationale for this approach, addressing challenges and controversies in the field, and suggesting possible future developments.
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Key Words
- (c)TACE, (conventional) transarterial chemoembolisation
- (m)RECIST, (modified) Response Evaluation Criteria in Solid Tumours
- 18F-FDG, 18F-fluorodeoxyglucose
- 90Y, yttrium-90
- ADC, apparent diffusion coefficient
- APHE, arterial phase hyperenhancement
- CEUS, contrast-enhanced ultrasound
- CRLM, colorectal liver metastases
- DWI, diffusion-weighted imaging
- EASL
- EASL, European Association for the Study of the Liver criteria
- GIST, gastrointestinal stromal tumours
- HCC, hepatocellular carcinoma
- HU, Hounsfield unit
- Imaging
- LI-RADS
- LI-RADS, Liver Imaging Reporting And Data System
- Liver
- Metastases
- PD, progressive disease
- PET, positron emission tomography
- PR, partial response
- RECIST
- SD, stable disease
- SIRT, selective internal radiotherapy
- TR, treatment response
- Tumours
- WHO, World Health Organization
- mRECIST
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Affiliation(s)
- Jules Gregory
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Marco Dioguardi Burgio
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Giuseppe Corrias
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
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Diffusion-weighted imaging of hepatocellular carcinoma before and after transarterial chemoembolization: role in survival prediction and response evaluation. Abdom Radiol (NY) 2019; 44:2740-2750. [PMID: 31069479 DOI: 10.1007/s00261-019-02030-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Survival outcomes of patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) are heterogeneous. Measuring the apparent diffusion coefficient (ADC) using diffusion-weighted imaging (DWI) may improve overall survival prediction. AIM To assess the value of measuring the ADC before and after TACE in predicting overall survival. METHODS A retrospective analysis was performed in HCC patients treated with TACE at a tertiary referral center between 2008 and 2017. The ADC values and changes in ADC value (ΔADC) of HCC lesions (≥ 1 cm) and liver parenchyma were assessed by DWI ≤ 3 months before and after first TACE. Pre- and post-TACE ADC values were compared with tumor response according to mRECIST and correlated with overall survival (OS) in a univariable and multivariable Cox-regression analysis. RESULTS A total of 89 patients were included, mostly Child-Pugh A (85%) and BCLC stage B (53%) with a median OS of 21.7 months (95% CI 17.6-25.9). Tumor ADC increased from 1081 mm2/s before (IQR 964-1225) to 1328 mm2/s (IQR 1197-1560) after TACE (p < 0.001). Responders according to mRECIST showed a higher ΔADC after first TACE than non-responders (26 vs. 14%, p = 0.048). Pre-TACE ADC and ΔADC were not significantly associated with OS in both univariable and multivariable analysis, whereas response according to mRECIST remained an independent predictor of OS. CONCLUSION mRECIST was confirmed as an independent prognostic factor of OS, but pre- or post-TACE ADC measurements were not. Response according to mRECIST was associated with a higher increase in ADC than non-response.
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Luo Y, Pandey A, Ghasabeh MA, Pandey P, Varzaneh FN, Zarghampour M, Khoshpouri P, Ameli S, Li Z, Hu D, Kamel IR. Prognostic value of baseline volumetric multiparametric MR imaging in neuroendocrine liver metastases treated with transarterial chemoembolization. Eur Radiol 2019; 29:5160-5171. [DOI: 10.1007/s00330-019-06100-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 12/17/2022]
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15
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Fang Y, Zhang Y, Zhou J, Cao K. Adipose-derived mesenchymal stem cell exosomes: a novel pathway for tissues repair. Cell Tissue Bank 2019; 20:153-161. [PMID: 30852701 DOI: 10.1007/s10561-019-09761-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/04/2019] [Indexed: 12/11/2022]
Abstract
The well-characterized curative effect of transplanted mesenchymal stem cells has been mainly attributed to their homing and subsequent differentiation for the repair and regeneration of damaged tissue. Adipose-derived mesenchymal stem cells (ADMSCs) are not only multipotent and plastic, but also abundant as they can be easily harvested with minimally invasive surgical techniques. This makes ADMSCs conducive for clinical applications. Recently, the secretory function of ADMSCs has been regarded as the primary mediator of MSC-based therapy. Exosomes are one kind of small cell extracellular membrane vesicles, which are primarily used to deliver cell-specific proteins, as well as nucleic acids secreted by various cell types. This review will introduce and characterize exosomes-derived ADMSCs (ADMSCs-Exo) and look at new therapies and prospective, including the limitations and outlook for therapeutic strategy. We will describe the latest research progress on myocardial repair, neuroprotection and neurotrophic effects, hepatic repair, renal repair, cutaneous repair, regeneration and other aspects using these cells.
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Affiliation(s)
- Yuan Fang
- The Third Xiangya Hospital of Central South University, No.138.Tongzipo Road, 410013, Changsha, Hunan, People's Republic of China
| | - Yufang Zhang
- Anyang Tumor Hospital, No. 1 Huanbin North Road, 455000, Anyang, Henan, People's Republic of China
| | - Jianda Zhou
- The Third Xiangya Hospital of Central South University, No.138.Tongzipo Road, 410013, Changsha, Hunan, People's Republic of China.
| | - Ke Cao
- The Third Xiangya Hospital of Central South University, No.138.Tongzipo Road, 410013, Changsha, Hunan, People's Republic of China.
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Hussein RS, Tantawy W, Abbas YA. MRI assessment of hepatocellular carcinoma after locoregional therapy. Insights Imaging 2019; 10:8. [PMID: 30694398 PMCID: PMC6352610 DOI: 10.1186/s13244-019-0690-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 01/03/2019] [Indexed: 12/16/2022] Open
Abstract
Liver cirrhosis and hepatocellular carcinoma (HCC) constitute one of the major causes of morbidity, mortality, and high health care costs worldwide. Multiple treatment options are available for HCC depending on the clinical status of the patient, size and location of the tumor, and available techniques and expertise. Locoregional treatment options are multiple. The most challenging part is how to assess the treatment response by different imaging modalities, but our scope will be assessing the response to locoregional therapy for HCC by MRI. This will be addressed by conventional MR methods using LI-RADS v2018 and by functional MR using diffusion-weighted imaging, perfusion, and highlighting the value of the novel intravoxel incoherent motion (IVIM).
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Affiliation(s)
- Rasha S Hussein
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt.
| | - Wahid Tantawy
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt
| | - Yasser A Abbas
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt
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Ma X, Ouyang H, Wang S, Wang M, Zhou C, Zhao X. Histogram analysis of apparent diffusion coefficient predicts response to radiofrequency ablation in hepatocellular carcinoma. Chin J Cancer Res 2019; 31:366-374. [PMID: 31156307 PMCID: PMC6513745 DOI: 10.21147/j.issn.1000-9604.2019.02.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective The aim of this study was to predict tumor progression in patients with hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA) using histogram analysis of apparent diffusion coefficients (ADC). Methods Breath-hold diffusion weighted imaging (DWI) was performed in 64 patients (33 progressive and 31 stable) with biopsy-proven HCC prior to RFA. All patients had pre-treatment magnetic resonance imaging (MRI) and follow-up computed tomography (CT) or MRI. The ADC values (ADC10, ADC30, ADCmedian and ADCmax) were obtained from the histogram’s 10th, 30th, 50th and 100th percentiles. The ratios of ADC10, ADC30, ADCmedian and ADCmax to the mean non-lesion area-ADC (RADC10, RADC30, RADCmedian, and RADCmax) were calculated. The two patient groups were compared. Key predictive factors for survival were determined using the univariate and multivariate analysis of the Cox model. The Kaplan-Meier survival analysis was performed, and pairs of survival curves based on the key factors were compared using the log-rank test.
Results The ADC30, ADCmedian, ADCmax, RADC30, RADCmedian, and RADCmax were significantly larger in the progressive group than in the stable group (P<0.05). The median progression-free survival (PFS) was 22.9 months for all patients. The mean PFS for the stable and progressive groups were 47.7±1.3 and 9.8±1.3 months, respectively. Univariate analysis indicated that RADC10, RADC30, and RADCmedian were significantly correlated with the PFS [hazard ratio (HR)=31.02, 43.84, and 44.29, respectively, P<0.05 for all]. Multivariate analysis showed that RADCmedian was the only independent predictor of tumor progression (P=0.04). And the cutoff value of RADCmedian was 0.71.
Conclusions Pre-RFA ADC histogram analysis might serve as a useful biomarker for predicting tumor progression and survival in patients with HCC treated with RFA.
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Affiliation(s)
- Xiaohong Ma
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Han Ouyang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Shuang Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Meng Wang
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Chunwu Zhou
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
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18
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Pandey A, Pandey P, Ghasabeh MA, Zarghampour M, Khoshpouri P, Ameli S, Luo Y, Kamel IR. Baseline Volumetric Multiparametric MRI: Can It Be Used to Predict Survival in Patients with Unresectable Intrahepatic Cholangiocarcinoma Undergoing Transcatheter Arterial Chemoembolization? Radiology 2018; 289:843-853. [DOI: 10.1148/radiol.2018180450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Ankur Pandey
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Pallavi Pandey
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Mounes Aliyari Ghasabeh
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Manijeh Zarghampour
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Pegah Khoshpouri
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Sanaz Ameli
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Yan Luo
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
| | - Ihab R. Kamel
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287
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19
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Wu LF, Rao SX, Xu PJ, Yang L, Chen CZ, Liu H, Huang JF, Fu CX, Halim A, Zeng MS. Pre-TACE kurtosis of ADC total derived from histogram analysis for diffusion-weighted imaging is the best independent predictor of prognosis in hepatocellular carcinoma. Eur Radiol 2018; 29:213-223. [PMID: 29922932 DOI: 10.1007/s00330-018-5482-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the feasibility of pre-TACE IVIM imaging based on histogram analysis for predicting prognosis in the treatment of unresectable hepatocellular carcinoma (HCC). MATERIALS AND METHODS Fifty-five patients prospectively underwent 1.5T MRI 1 week before TACE. Histogram metrics for IVIM parameters and ADCs maps between responders and non-responders with mRECIST assessment were compared. Kaplan-Meier, log-rank tests and Cox proportional hazard regression model were used to correlate variables with time to progression (TTP). RESULTS Mean (p = 0.022), median (p = 0.043), and 25th percentile (p < 0.001) of perfusion fraction (PF), mean (p < 0.001), median (p < 0.001), 25th percentile (p < 0.001) and 75th percentile (p = 0.001) of ADC(0,500), mean (p = 0.005), median (p = 0.008) and 25th percentile (p = 0.039) of ADCtotal were higher, while skewness and kurtosis of PF (p = 0.001, p = 0.005, respectively), kurtosis of ADC(0,500) and ADCtotal (p = 0.005, p = 0.001, respectively) were lower in responders compared to non-responders. Multivariable analysis demonstrated that mRECIST was associated with TTP independently, and kurtosis of ADCtotal had the best predictive performance for disease progression. CONCLUSION Pre-TACE kurtosis of ADCtotal is the best independent predictor for TTP. KEY POINTS • mRECIST was associated with TTP independently. • Lower kurtosis and higher mean for ADCs tend to have good response. • Pre-TACE kurtosis of ADC total is the best independent predictor for TTP.
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Affiliation(s)
- Li-Fang Wu
- Shanghai Institute of Medical Imaging, Department of Radiology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Sheng-Xiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Peng-Ju Xu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Li Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Cai-Zhong Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Hao Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Jian-Feng Huang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Cai-Xia Fu
- Siemens Healthcare, Siemens MR Center, Gaoxin C. Ave., 2nd, Hi-Tech Industrial Park, Shenzhen, 518057, China
| | - Alice Halim
- Fudan University, No. 130, Dongan Road, Xuhui District, Shanghai, 200032, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.
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Transarterial Radioembolization Following Chemoembolization for Unresectable Hepatocellular Carcinoma: Response Based on Apparent Diffusion Coefficient Change is an Independent Predictor for Survival. Cardiovasc Intervent Radiol 2018; 41:1716-1726. [DOI: 10.1007/s00270-018-1991-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/19/2018] [Indexed: 12/22/2022]
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21
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Cao QY, Zou ZM, Wang Q, He CN, Zou Q, Wang B. MRI manifestations of hepatic perfusion disorders. Exp Ther Med 2018; 15:5199-5204. [PMID: 29805544 PMCID: PMC5958701 DOI: 10.3892/etm.2018.6090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/06/2017] [Indexed: 12/25/2022] Open
Abstract
The present study aimed to analyze the magnetic resonance imaging (MRI) results from patients with hepatic perfusion disorders (HPD) and liver diseases, in order to assess the pathogenetic mechanisms. This was completed byanalyzing the causes of HPD in 35 patients to assess if they were associated with arterioportal shunt, and classify the patients according to results from the MRI scans. Of the 35 patients, 26 (74.3%) with HPD presented with hepatocellular carcinoma, a major cause of HPD. The HPD phenomenon in 35 patients was not identified as obvious abnormal lesions on T2WI and T1WI according to the isointensity on diffusion weighted images. Enhanced scanning showed hyperintense signals on the arterial phase images, isointense or hyperintense signals on portal phase and delayed phase images. According to their MRI findings, hepatic perfusion disorders may be divided into different types, as follows: Diffuse, lobe or segment type, wedge type and platy. The HPD phenomenon may herald an underlying abnormality of liver disease and MRI may accurately diagnose HPDs in liver diseases.
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Affiliation(s)
- Qing-Yong Cao
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Zhi-Meng Zou
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Qi Wang
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Chun-Ni He
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Qing Zou
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Bin Wang
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China.,Medical Imaging Center, Binzhou Medical University, Yantai, Shandong 264100, P.R. China
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22
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Baseline Apparent Diffusion Coefficient as a Predictor of Response to Liver-Directed Therapies in Hepatocellular Carcinoma. J Clin Med 2018; 7:jcm7040083. [PMID: 29661994 PMCID: PMC5920457 DOI: 10.3390/jcm7040083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 12/28/2022] Open
Abstract
Predicting outcomes in patients with hepatocellular carcinoma (HCC) who undergo locoregional therapies remains a substantial clinical challenge. The purpose of this study was to investigate pre-procedure diffusion weighted magnetic resonance imaging (DW-MRI) as an imaging biomarker for tumoral response to therapy for patients with HCC undergoing drug eluting embolic (DEE) chemoembolization and radioembolization. A retrospective review of HCC patients who underwent DEE chemoembolization or radioembolization was performed. Of the 58 patients who comprised the study population, 32 underwent DEE chemoembolization and 26 underwent radioembolization. There was no significant difference in median apparent diffusion coefficient (ADC) values across the two treatment groups (1.01 × 10-3 mm²/s, P = 0.25). The immediate objective response (OR) rate was 71% (40/56). Tumors with high ADC values were found to have a higher probability of OR within 90 days (odds ratio 4.4, P = 0.03). Moreover, index lesion specific progression free survival (PFS) was greater for high ADC tumors, independent of conventional predictors of treatment response (hazard ratio 0.44, P = 0.01). Low ADC was associated with poorer PFS (P = 0.02). Pre-procedure ADC < 1.01 × 10-3 mm²/s is an independent predictor of poorer immediate OR and index lesion specific PFS in patients with HCC undergoing DEE chemoembolization or radioembolization.
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Abstract
Diffusion-weighted imaging (DWI) is increasingly incorporated into routine body magnetic resonance imaging protocols. DWI can assist with lesion detection and even in characterization. Quantitative DWI has exhibited promise in the discrimination between benign and malignant pathology, in the evaluation of the biologic aggressiveness, and in the assessment of the response to treatment. Unfortunately, inconsistencies in DWI acquisition parameters and analysis have hampered widespread clinical utilization. Focusing primarily on liver applications, this article will review the basic principles of quantitative DWI. In addition to standard mono-exponential fitting, the authors will discuss intravoxel incoherent motion and diffusion kurtosis imaging that involve more sophisticated approaches to diffusion quantification.
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Affiliation(s)
- Myles T Taffel
- Department of Radiology, New York University School of Medicine, New York, NY
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Wu L, Xu P, Rao S, Yang L, Chen C, Liu H, Fu C, Zeng M. ADC total ratio and D ratio derived from intravoxel incoherent motion early after TACE are independent predictors for survival in hepatocellular carcinoma. J Magn Reson Imaging 2017; 46:820-830. [PMID: 28276105 DOI: 10.1002/jmri.25617] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 12/15/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To explore the threshold of intravoxel incoherent motion (IVIM) parameters, apparent diffusion coefficient [ADCtotal and ADC(0,500) ] ratios 24-48 hours after transarterial chemoembolization (TACE) to assess early response in patients with unresectable hepatocellular carcinoma (HCC) and to compare the association between diffusion-weighted imaging with the intravoxel incoherent motion (IVIM-DWI) and mRECIST with survival. MATERIALS AND METHODS Institutional Review Board approval and informed consent were obtained for this prospective study. There were 30 patients undergoing 1.5T magnetic resonance imaging (MRI) with IVIM-DWI of 12 b values (0, 10, 20, 30, 40, 50, 70, 100, 200, 300, 500, 800 s/mm2 ) 1 week before and 24-48 hours after TACE. Response was assessed with the change of true diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (PF), ADCtotal , and ADC(0,500) values relative to baseline and with mRECIST. Receiver operating characteristic (ROC) curve analysis was used to explore the threshold of these parameters ratios. Kaplan-Meier, log-rank tests, and the Cox hazard model were used to correlate the response variables with progression-free survival (PFS) and to assess the incidence and potential clinical risk factors for PFS. Mann-Whitney U-test was used to compare the difference in parameters between different groups with progression within and beyond median PFS prior to TACE. RESULTS Median PFS was 99 days, within which 16 patients progressed. The threshold of ADCtotal ratio, D ratio, and ADC(0,500) ratio were 13.1% (P = 0.001), 7.0% (P = 0.011), and 3.6% (P = 0.018) with sensitivity and specificity of 78.6% and 87.5%, 85.7% and 62.5%, 78.6% and 75%, respectively. The predictive utility of ADCtotal ratio, D ratio, and ADC(0,500) ratio for PFS were 0.848, 0.772, and 0.754, respectively. Survival analyses showed ADCtotal ratio, D ratio, ADC(0,500) ratio, liver cirrhosis, and mRECIST had a significant effect on PFS (P < 0.05). ADCtotal ratio and D ratio were independent predictors for 99-day PFS (P = 0.025, P = 0.036). There were no significant differences in pretreatment IVIM-DWI parameters between PFS > 99-day group and PFS ≤ 99-day group with P values of 0.547 for D, 0.394 for D*, 0.575 for PF, 0.901 for ADC(0,500) , and 0.506 for ADCtotal , respectively. CONCLUSION The ADCtotal ratio and D ratio 24-48 hours after TACE were independent predictors for response to TACE for HCC, and showed stronger association with PFS than mRECIST. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:820-830.
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Affiliation(s)
- Lifang Wu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, P.R. China
| | - Pengju Xu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, P.R. China.,Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Shengxiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, P.R. China.,Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Li Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, P.R. China
| | - Caizhong Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Hao Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Caixia Fu
- Siemens Healthcare, Shanghai, P.R. China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, P.R. China.,Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
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Ye XD, Yuan Z, Zhang J, Yuan Z. Radiological biomarkers for assessing response to locoregional therapies in hepatocellular carcinoma: From morphological to functional imaging (Review). Oncol Rep 2017; 37:1337-1346. [PMID: 28184942 DOI: 10.3892/or.2017.5420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/16/2017] [Indexed: 11/05/2022] Open
Abstract
Many hepatocellular carcinoma (HCC) patients do not qualify for curative surgical intervention and are instead treated with locoregional therapies (LRTs) including ablative and endovascular therapies. Assessment of imaging response is essential in the management of HCC for determining efficacy of therapy and as a surrogate marker for improved survival. The established morphological image biomarkers for tumor burden measurement continue to be applied, as size measurement can easily be used in clinical practice. However, in the setting of liver-directed LRTs for HCC, simple tumor morphological changes can be less informative and usually appear later than biologic changes. Functional imaging (such as perfusion and diffusion imaging, PET-CT/MR and MR spectroscopy) has the potential to be a promising technique for assessment of HCC response to LRTs. Although promising, none of these functional imaging biomarkers have gone through all the required steps of standardization and validation and established accepted criteria for clinical practice.
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Affiliation(s)
- Xiao-Dan Ye
- Department of Radiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200030, P.R. China
| | - Zuguo Yuan
- Radiation Oncology Center, The 1st Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Jian Zhang
- Department of Nuclear Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Zheng Yuan
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China
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Ronot M, Clift AK, Vilgrain V, Frilling A. Functional imaging in liver tumours. J Hepatol 2016; 65:1017-1030. [PMID: 27395013 DOI: 10.1016/j.jhep.2016.06.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 02/08/2023]
Abstract
Functional imaging encompasses techniques capable of assessing physiological parameters of tissues, and offers useful clinical information in addition to that obtained from morphological imaging. Such techniques may include magnetic resonance imaging with diffusion-weighted sequences or hepatobiliary contrast agents, perfusion imaging, or molecular imaging with radiolabelled tracers. The liver is of major importance in oncological practice; not only is hepatocellular carcinoma one of the malignancies with steadily rising incidence worldwide, but hepatic metastases are regularly observed with a range of solid neoplasms. Within the realm of hepatic oncology, different functional imaging modalities may occupy pivotal roles in lesion characterisation, treatment selection and follow-up, depending on tumour size and type. In this review, we characterise the major forms of functional imaging, discuss their current application to the management of patients with common primary and secondary liver tumours, and anticipate future developments within this field.
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Affiliation(s)
- Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, Centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| | | | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, Centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Andrea Frilling
- Department of Surgery and Cancer, Imperial College London, London, UK
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Mürtz P, Penner AH, Pfeiffer AK, Sprinkart AM, Pieper CC, König R, Block W, Schild HH, Willinek WA, Kukuk GM. Intravoxel incoherent motion model-based analysis of diffusion-weighted magnetic resonance imaging with 3 b-values for response assessment in locoregional therapy of hepatocellular carcinoma. Onco Targets Ther 2016; 9:6425-6433. [PMID: 27799790 PMCID: PMC5079699 DOI: 10.2147/ott.s113909] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose The aim of this study was to evaluate an intravoxel incoherent motion (IVIM) model–based analysis of diffusion-weighted imaging (DWI) for assessing the response of hepatocellular carcinoma (HCC) to locoregional therapy. Patients and methods Respiratory-gated DWI (b=0, 50, and 800 s/mm2) was retrospectively analyzed in 25 patients who underwent magnetic resonance imaging at 1.5 T before and 6 weeks following the first cycle of transarterial chemoembolization therapy, transarterial ethanol-lipiodol embolization therapy, and transarterial radioembolization therapy. In addition to the determination of apparent diffusion coefficient, ADC(0,800), an estimation of the diffusion coefficient, D′, and the perfusion fraction, f′, was performed by using a simplified IVIM approach. Parameters were analyzed voxel-wise. Tumor response was assessed in a central slice by using a region of interest (ROI) covering the whole tumor. HCCs were categorized into two groups, responders and nonresponders, according to tumor size changes on first and second follow ups (if available) and changes of contrast-enhanced region on the first follow up. Results In total, 31 HCCs were analyzed: 17 lesions were assigned to responders and 14 were to nonresponders. In responders, ADC(0,800) and D′ were increased after therapy by ~30% (P=0.00004) and ~42% (P=0.00001), respectively, whereas f′ was decreased by ~37% (P=0.00094). No significant changes were found in nonresponders. Responders and nonresponders were better differentiated by changes in D′ than by changes in ADC(0,800) (area under the curve =0.878 vs 0.819 or 0.714, respectively). Conclusion In patients with HCCs undergoing embolization therapy, diffusion changes were better reflected by D′ than by conventional ADC(0,800), which is influenced by counteracting perfusion changes as assessed by f′.
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Affiliation(s)
- Petra Mürtz
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | | | | | - Claus C Pieper
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Roy König
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Wolfgang Block
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Hans H Schild
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | - Guido M Kukuk
- Department of Radiology, University of Bonn, Bonn, Germany
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28
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Kokabi N, Ludwig JM, Camacho JC, Xing M, Mittal PK, Kim HS. Baseline and Early MR Apparent Diffusion Coefficient Quantification as a Predictor of Response of Unresectable Hepatocellular Carcinoma to Doxorubicin Drug-Eluting Bead Chemoembolization. J Vasc Interv Radiol 2016; 26:1777-86. [PMID: 26603497 DOI: 10.1016/j.jvir.2015.08.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/10/2015] [Accepted: 08/18/2015] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To investigate baseline and early apparent diffusion coefficients (ADC) derived from diffusion-weighted imaging (DWI) as a predictor of objective response (OR) and survival in unresectable hepatocellular carcinoma (HCC) treated with doxorubicin drug-eluting bead (DEB) transcatheter arterial chemoembolization. MATERIALS AND METHODS In a prospective study, 57 patients underwent DEB chemoembolization. Dynamic contrast-enhanced magnetic resonance imaging and DWI were performed at baseline and 1 and 3 months after DEB chemoembolization. OR was evaluated per modified Response Evaluation Criteria In Solid Tumors (mRECIST) and European Association for the Study of the Liver (EASL) guidelines. Baseline ADCs of tumors that showed OR at 1 and 3 months were compared with nonresponding tumor ADCs by two-sample t test and receiver operating characteristic curves. Additionally, ADC changes at 30 days were correlated with OR. Finally, Kaplan–Meier analysis was used to compare survival between patients with lesions demonstrating more restricted baseline diffusion and others. RESULTS At 1 month, 33 patients (60%) showed OR (21 complete responses and 12 partial responses). At baseline, tumors with OR at 1 month showed significantly more restricted diffusion (0.731 × 10(−3) mm2/s) compared with others (1.057 × 10(−3) mm2/s; P = .031). No difference between response rates at 1 and 3 months according to mRECIST and EASL was observed. For an area under the curve of 0.965, the sensitivity and specificity of predicting objective tumor response at 1 month using a baseline HCC ADC of 0.83 × 10(−3) mm2/s were 91% and 96%, respectively. In addition, patients with lesions with a baseline ADC < 0.83 × 10(−3) mm2/s showed prolonged survival compared with others (P < .001). CONCLUSIONS In unresectable HCC, a baseline ADC < 0.83 × 10(−3) mm2/s is a predictor of survival and treatment response at 1 and 3 months after DEB chemoembolization with high sensitivity and specificity.
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29
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Gluskin JS, Chegai F, Monti S, Squillaci E, Mannelli L. Hepatocellular Carcinoma and Diffusion-Weighted MRI: Detection and Evaluation of Treatment Response. J Cancer 2016; 7:1565-70. [PMID: 27471573 PMCID: PMC4964141 DOI: 10.7150/jca.14582] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/22/2016] [Indexed: 12/11/2022] Open
Abstract
Differentiating between cancerous tissue and healthy liver parenchyma could represent a challenge with the only conventional Magnetic Resonance (MR) imaging. Diffusion weighted imaging (DWI) exploits different tissue characteristics to conventional Magnetic Resonance Imaging (MRI) sequences that enhance hepatocellular carcinoma (HCC) detection, characterization, and post-treatment evaluation. Detection of HCC is improved by DWI, infact this technology increases conspicuity of lesions that might otherwise not be identified due to obscuration by adjacent vessels or due to low contrast between the lesion and background liver. It is important to remember that DWI combined with contrast-enhanced MRI has higher sensitivity than DWI alone, and that some patients are not eligible for use of contrast on CT and MRI; in these patients DWI has a prominent role. MRI has advanced beyond structural anatomic imaging to now showing pathophysiologic processes. DWI is a promising way to characterize lesions utilizing the inherent contrast within the liver and has the benefit of not requiring contrast injection. DWI improves detection and characterization of HCC. Proposed clinical uses for DWI include: assessing prognosis, predicting response, monitoring response to therapy, and distinguishing tumor recurrence from treatment effect. Ideally, DWI will help risk stratify patients and will participate in prognostic modeling.
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Affiliation(s)
- Jill S Gluskin
- 1. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C276, New York, NY 10065, USA
| | - Fabrizio Chegai
- 2. Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology, University Hospital Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | | | - Ettore Squillaci
- 2. Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology, University Hospital Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Lorenzo Mannelli
- 1. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C276, New York, NY 10065, USA
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30
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Zhang Y, Zhang Q, Wang XX, Deng XF, Zhu YZ. Value of pretherapeutic DWI in evaluating prognosis and therapeutic effect in immunocompetent patients with primary central nervous system lymphoma given high-dose methotrexate-based chemotherapy: ADC-based assessment. Clin Radiol 2016; 71:1018-1029. [PMID: 27341986 DOI: 10.1016/j.crad.2016.05.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/30/2016] [Accepted: 05/24/2016] [Indexed: 01/18/2023]
Abstract
AIM To investigate apparent diffusion coefficient (ADC) as a prognostic indicator in primary central nervous system lymphoma (PCNSL) by analysing patient clinical characteristics and pretherapeutic diffusion-weighted imaging (DWI). MATERIALS AND METHODS Clinical characteristics and pretherapeutic DWI were studied retrospectively in 28 patients receiving high-dose methotrexate (HD-MTX)-based chemotherapy. Mean (ADCmean), 95th percentile (ADC95%), and 5th percentile (ADC5%) ADC values of the enhancing tumour volume were measured. The influence of prognostic parameters on progression-free survival (PFS) was investigated by log-rank test and Cox regression analysis. Correlations between the variables and PFS or the level of Ki-67 expression were analysed. ADC and clinical features were analysed using an independent sample t-test between the complete response (CRi) and partial response (PRi) groups after initial four cycles of chemotherapy. Receiver operating characteristic (ROC) curves were constructed using ADC parameters. RESULTS Patients with CRi, lower Ki-67 level, higher Karnofsky performance status (KPS), ADC5%, or ADCmean showed better PFS. The level of Ki-67 expression and ADC5% were independent risk factors. There was a positive correlation between KPS, ADC5%, and PFS, and negative correlation between ADC5%, PFS, and the level of Ki-67 expression. There was a significant difference for PFS, KPS, ADCmean, and ADC5% between CRi and non-CRi; however, ADC5% outperformed ADCmean because the area under the ROC curve (AUC) using ADC5% (0.983) was higher than the AUC using ADCmean (0.822). CONCLUSION ADC measurements, especially ADC5%, are useful predictors for PFS and response to HD-MTX in PCNSL.
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Affiliation(s)
- Y Zhang
- Department of Radiology, The 105th Hospital of Chinese PLA, Hefei 230031, People's Republic of China
| | - Q Zhang
- Department of Radiology, The 105th Hospital of Chinese PLA, Hefei 230031, People's Republic of China
| | - X-X Wang
- Department of Pathology, The 105th Hospital of Chinese PLA, Hefei 230031, People's Republic of China
| | - X-F Deng
- Basic Medicine College, Anhui Medical University, Hefei 230032, People's Republic of China
| | - Y-Z Zhu
- Department of Radiology, The 105th Hospital of Chinese PLA, Hefei 230031, People's Republic of China.
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31
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Ludwig JM, Camacho JC, Kokabi N, Xing M, Kim HS. The Role of Diffusion-Weighted Imaging (DWI) in Locoregional Therapy Outcome Prediction and Response Assessment for Hepatocellular Carcinoma (HCC): The New Era of Functional Imaging Biomarkers. Diagnostics (Basel) 2015; 5:546-63. [PMID: 26854170 PMCID: PMC4728474 DOI: 10.3390/diagnostics5040546] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 11/12/2015] [Accepted: 11/19/2015] [Indexed: 12/12/2022] Open
Abstract
Reliable response criteria are critical for the evaluation of therapeutic response in hepatocellular carcinoma (HCC). Current response assessment is mainly based on: (1) changes in size, which is at times unreliable and lag behind the result of therapy; and (2) contrast enhancement, which can be difficult to quantify in the presence of benign post-procedural changes and in tumors presenting with a heterogeneous pattern of enhancement. Given these challenges, functional magnetic resonance imaging (MRI) techniques, such as diffusion-weighted imaging (DWI) have been recently investigated, aiding specificity to locoregional therapy response assessment and outcome prediction. Briefly, DWI quantifies diffusion of water occurring naturally at a cellular level (Brownian movement), which is restricted in multiple neoplasms because of high cellularity. Disruption of cellular integrity secondary to therapy results in increased water diffusion across the injured membranes. This review will provide an overview of the current literature on DWI therapy response assessment and outcome prediction in HCC following treatment with locoregional therapies.
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Affiliation(s)
- Johannes M Ludwig
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT 06510, USA.
| | - Juan C Camacho
- Division of Interventional Radiology and Image-guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | - Nima Kokabi
- Division of Interventional Radiology and Image-guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | - Minzhi Xing
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT 06510, USA.
| | - Hyun S Kim
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT 06510, USA.
- Yale Cancer Center, Yale School of Medicine, New Haven, CT 06519, USA.
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Yuan Z, Zhang J, Yang H, Ye XD, Xu LC, Li WT. Diffusion-Weighted MR Imaging of Hepatocellular Carcinoma: Current Value in Clinical Evaluation of Tumor Response to Locoregional Treatment. J Vasc Interv Radiol 2015; 27:20-30; quiz 31. [PMID: 26621785 DOI: 10.1016/j.jvir.2015.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 02/07/2023] Open
Abstract
The established size-based image biomarkers for tumor burden measurement continue to be applied to solid tumors, as size measurement can easily be used in clinical practice. However, in the setting of novel targeted therapies and liver-directed locoregional treatments for hepatocellular carcinoma (HCC), simple tumor anatomic changes can be less informative and usually appear later than biologic changes. Functional magnetic resonance (MR) imaging has the potential to be a promising technique for assessment of HCC response to therapy. Diffusion-weighted MR imaging is now widely used as a standard imaging modality to evaluate the liver. This review discusses the current clinical value of diffusion-weighted MR imaging in the evaluation of tumor response after nonsurgical locoregional treatment of HCC.
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Affiliation(s)
- Zheng Yuan
- Department of Radiology, Shanghai 85 Hospital; Department of Interventional Radiology, Shanghai Cancer Hospital, Fudan University.
| | - Jian Zhang
- Department of Nuclear Medicine, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Huan Yang
- Department of Interventional Radiology, Shanghai Cancer Hospital, Fudan University
| | - Xiao-Dan Ye
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Li-Chao Xu
- Department of Interventional Radiology, Shanghai Cancer Hospital, Fudan University
| | - Wen-Tao Li
- Department of Interventional Radiology, Shanghai Cancer Hospital, Fudan University
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Adipose-Derived Mesenchymal Stem Cell Exosomes Suppress Hepatocellular Carcinoma Growth in a Rat Model: Apparent Diffusion Coefficient, Natural Killer T-Cell Responses, and Histopathological Features. Stem Cells Int 2015; 2015:853506. [PMID: 26345219 PMCID: PMC4545422 DOI: 10.1155/2015/853506] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/11/2015] [Accepted: 01/12/2015] [Indexed: 12/15/2022] Open
Abstract
We sought to evaluate the effects of adipose-derived mesenchymal stem cells (ADMSCs) exosomes on hepatocellular carcinoma (HCC) in rats using apparent diffusion coefficient (ADC), natural killer T-cell (NKT-cell) responses, and histopathological features. ADMSC-derived exosomes appeared as nanoparticles (30–90 nm) on electron microscopy and were positive for CD63, tumor susceptibility gene-101, and β-catenin on western blotting. The control (n = 8) and exosome-treated (n = 8) rats with N1S1-induced HCC underwent baseline and posttreatment day 10 and day 20 magnetic resonance imaging and measurement of ADC. Magnetic resonance imaging showed rapidly enlarged HCCs with low ADCs in the controls. The exosome-treated rats showed partial but nonsignificant tumor reduction, and significant ADC and ADC ratio increases on day 10. On day 20, the exosome-treated rats harbored significantly smaller tumors and volume ratios, higher ADC and ADC ratios, more circulating and intratumoral NKT-cells, and low-grade HCC (P < 0.05 for all comparisons) compared to the controls. The ADC and volume ratios exhibited significant inverse correlations (P < 0.001, R2 = 0.679). ADMSC-derived exosomes promoted NKT-cell antitumor responses in rats, thereby facilitating HCC suppression, early ADC increase, and low-grade tumor differentiation. ADC may be an early biomarker of treatment response.
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Corona-Villalobos CP, Zhang Y, Zhang WD, Kamel IR. Magnetic resonance imaging of the liver after loco-regional and systemic therapy. Magn Reson Imaging Clin N Am 2015; 22:353-72. [PMID: 25086934 DOI: 10.1016/j.mric.2014.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Assessment of tumor response is crucial in determining the effectiveness of loco-regional and systemic therapy, and for determining the need for subsequent treatment. The ultimate goal is to improve patient's survival. Changes in tumor size and enhancement after therapy may not be detected early by the traditional response criteria. Tumor response is better assessed in the entire tumor volume rather than in a single axial plane. The purpose of this article is to familiarize the reader with early treatment response assessed by anatomic and volumetric functional magnetic resonance imaging metrics of the liver after loco-regional and systemic therapy.
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Affiliation(s)
- Celia Pamela Corona-Villalobos
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, MRI 110B, Baltimore, MD 21287, USA
| | - Yan Zhang
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, 601 North Caroline Street, Room 4240, Baltimore, MD 21287, USA; Department of Radiology, Shandong Medical Imaging Research Institute, 324 Jingwu Road, MRI, Jinan 250021, Republic of China
| | - Wei-Dong Zhang
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, 601 North Caroline Street, Room 4240, Baltimore, MD 21287, USA
| | - Ihab R Kamel
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, MRI 143, Baltimore, MD 21287, USA.
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35
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Kim MN, Kim BK, Han KH, Kim SU. Evolution from WHO to EASL and mRECIST for hepatocellular carcinoma: considerations for tumor response assessment. Expert Rev Gastroenterol Hepatol 2015; 9:335-48. [PMID: 25370168 DOI: 10.1586/17474124.2015.959929] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Radiological response assessment criteria in hepatocellular carcinoma (HCC) have evolved to accurately evaluate tumor responses. The WHO criteria and the subsequent Response Evaluation Criteria in Solid Tumors (RECIST) evaluate change in tumor size; however, these criteria generally ignore tumor necrosis and therefore may underestimate treatment responses. Thus, a panel of experts of the European Association for the Study of Liver (EASL) amended the response criteria to take into account tumor necrosis. In 2010, the modified RECIST (mRECIST) was developed, which consider both the concept of tumor viability based on arterial enhancement and single linear summation, ultimately simplifying EASL criteria. Currently, the mRECIST represents the gold standard for radiologically evaluating tumor response during HCC treatment. Here, the authors review application and performance of mRECIST as well as other HCC response assessment criteria and discuss unmet and open issues regarding response evaluation for HCC treatments.
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Affiliation(s)
- Mi Na Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea
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36
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Kokabi N, Camacho JC, Xing M, Edalat F, Mittal PK, Kim HS. Immediate post-doxorubicin drug-eluting beads chemoembolization Mr Apparent diffusion coefficient quantification predicts response in unresectable hepatocellular carcinoma: A pilot study. J Magn Reson Imaging 2015; 42:981-9. [PMID: 25683022 DOI: 10.1002/jmri.24845] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/18/2014] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To investigate magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) of hepatocellular carcinoma (HCC) immediately post-doxorubicin drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) therapy as an early imaging biomarker of therapy response. MATERIALS AND METHODS In a single-center prospective correlative study, 12 consecutive patients, median age 64 years, underwent DEB-TACE and dynamic contrast-enhanced (DCE) and DWI (b = 50,400,800 s/mm(2)) MRI at baseline with respect to first DEB-TACE, within 3 hours, and at 1 and 3 months posttherapy. DCE imaging response was evaluated according to target mRECIST and EASL. Relative change (RC) in apparent diffusion coefficient (ADC) of treated lesions was measured on follow-ups. Correlation between ADC RC in tumors and anatomical response were evaluated with paired t-test and receiver operator characteristic (ROC) curve. Survival from first DEB-TACE was estimated using Kaplan-Meier and log-rank analysis. RESULTS Compared to baseline, mean ADC increased significantly for responders within 3 hours post-DEB-TACE (0.73 ± 0.20 mm(2) /s vs. 0.99 ± 0.28 mm(2) /s × 10(-3) (P = 0.001)). There was no significant change in ADC within 3 hours for nonresponders. ADC RC threshold of 20% immediately post-DEB-TACE showed 100% sensitivity and specificity in predicting anatomical response at 1 and 3 months with patients with ≥20% ADC increase demonstrated significantly prolonged mean overall survival compared to others (25.4 vs. 13.3 months (P = 0.017)). CONCLUSION ADC relative change of ≥20% immediately post-DEB-TACE is an accurate predictor of objective and quantitative treatment response and prolonged survival in unresectable HCC.
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Affiliation(s)
- Nima Kokabi
- Division of Interventional Radiology & Image Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Juan C Camacho
- Division of Interventional Radiology & Image Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Abdominal Imaging, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Minzhi Xing
- Division of Interventional Radiology & Image Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Faramarz Edalat
- Division of Interventional Radiology & Image Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Pardeep K Mittal
- Division of Abdominal Imaging, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hyun S Kim
- Division of Interventional Radiology & Image Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Ye XD, Li WT, Yuan Z. Apparent Diffusion Coefficients at Diffusion-weighted MR Imaging: Potential Predictors of Survival in Patients with Hepatocellular Carcinoma Treated with Chemoembolization. Radiology 2014; 272:920-1. [DOI: 10.1148/radiol.14141025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
Liver-directed intra-arterial therapies are palliative treatment options for patients with unresectable liver cancer; their use has also resulted in patients being downstaged leading to curative resection and transplantation. These intra-arterial therapies include transarterial embolization, conventional transarterial chemoembolization (TACE), drug-eluting bead TACE and radioembolization. Assessment of imaging response following these liver-directed intra-arterial therapies is challenging but pivotal for patient management. Size measurements based on computed tomography or magnetic resonance imaging (MRI) have been traditionally used to assess tumor response to therapy. However, these anatomic changes lag behind functional changes and may require months to occur. Further, these intra-arterial therapies cause acute tumor necrosis, which may result in a paradoxical increase in tumor size on early follow-up imaging despite complete cell death or necrosis. This concept is unique comparing to changes seen following systemic chemotherapy. The recent development of functional imaging techniques including diffusion-weighted MRI (DW MRI) and positron emission tomography (PET) allow for early assessment of treatment response and even prediction of overall tumor response to intra-arterial therapies. Although the results of DW MRI and PET studies are promising, the impact of these imaging modalities to assess treatment response has been limited without standardized protocols. The aim of this review article is to delineate the best practice for assessing tumor response in patients with primary or secondary hepatic malignancies undergoing intra-arterial therapies.
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Yuan Z, Li WT, Ye XD, Peng WJ, Xiao XS. Utility of diffusion-weighted imaging to assess hepatocellular carcinoma viability following transarterial chemoembolization. Oncol Lett 2014; 8:831-836. [PMID: 25013505 PMCID: PMC4081130 DOI: 10.3892/ol.2014.2228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 05/07/2014] [Indexed: 12/23/2022] Open
Abstract
The purpose of the present study was to evaluate whether diffusion-weighted imaging (DWI) can be used to assess hepatocellular carcinoma (HCC) viability following transarterial chemoembolization (TACE). A total of 41 consecutive patients were treated according to chemoembolization protocols. The follow-up was performed between six and eight weeks post-chemoembolization by multidetector computed tomography [or enhanced magnetic resonance imaging (MRI)] and DW-MRI on the same day. The presence of any residual tumor and the extent of tumor necrosis were evaluated according to the European Association for the Study of the Liver. The apparent diffusion coefficient (ADC) values of the entire area of the treated mass and the vital and necrotic tumor tissues were recorded. Correlation coefficients were also calculated to compare the percentage of necrosis with ADC values. The mean ADC values of the necrotic and vital tumor tissues were 2.22±0.31×10-3 mm2/sec and 1.42±0.25×10-3 mm2/sec, respectively (Mann-Whitney U test, P<0.001). The results from the receiver operating characteristic analysis showed that the threshold ADC value was 1.84×10-3 mm2/sec with 92.3% sensitivity and 100% specificity for identifying the necrotic tumor tissues. A significant linear regression correlation was identified between the ADC value of the entire area of the treated mass and the extent of tumor necrosis (r=0.58; P<0.001). In conclusion, DWI can be used to assess HCC viability following TACE.
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Affiliation(s)
- Zheng Yuan
- Department of Radiology, Shanghai People's Liberation Army No. 85 Hospital, Shanghai 200052, P.R. China ; Department of Radiology, Fudan University, Shanghai Cancer Center, Shanghai 200032, P.R. China
| | - Wen-Tao Li
- Department of Radiology, Fudan University, Shanghai Cancer Center, Shanghai 200032, P.R. China
| | - Xiao-Dan Ye
- Department of Radiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200030, P.R. China
| | - Wei-Jun Peng
- Department of Radiology, Fudan University, Shanghai Cancer Center, Shanghai 200032, P.R. China
| | - Xiang-Sheng Xiao
- Department of Radiology, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, P.R. China
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Ye XD, Li WT, Yuan Z. Is Volumetric Functional MR Imaging Superior to Current Anatomic Imaging Response Criteria for Hepatocellular Carcinoma after Intraarterial Therapy? Radiology 2014; 271:619-620. [DOI: 10.1148/radiol.14132533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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41
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Cao MQ, Suo ST, Zhang XB, Zhong YC, Zhuang ZG, Cheng JJ, Chi JC, Xu JR. Entropy of T2-weighted imaging combined with apparent diffusion coefficient in prediction of uterine leiomyoma volume response after uterine artery embolization. Acad Radiol 2014; 21:437-44. [PMID: 24594413 DOI: 10.1016/j.acra.2013.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/13/2013] [Accepted: 12/15/2013] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES To determine the potential value of entropy of T2-weighted imaging combined with apparent diffusion coefficient (ADC) before uterine artery embolization (UAE) for prediction of uterine leiomyoma volume reduction (VR) after UAE. MATERIALS AND METHODS In this prospective study, 11 patients with uterine leiomyomas who underwent pelvic magnetic resonance imaging including diffusion-weighted imaging before and 6 months after UAE were included. A total number of 16 leiomyomas larger than 2 cm in diameter were evaluated. The volume of each leiomyoma before and after UAE was determined, and the percentage change in volume was calculated. Entropy of T2-weighted imaging and ADC before UAE were assessed. Pearson correction coefficients were calculated between leiomyoma VR after UAE and age, leiomyoma volume, ADC, and entropy, respectively. Multiple regression analysis was performed to investigate the parameters that determine the VR after UAE. Receiver operating characteristic curve analysis was used to determine the sensitivity and specificity of ADC, entropy and the combination of ADC and entropy for predicting volume response. RESULTS The mean leiomyoma VR was 58.9% (range 25.8%-95.0%) in the 6-month follow-up. The mean ADC of leiomyomas was 1.37 × 10(-3) mm(2)/s (range 1.05 × 10(-3)-2.32 × 10(-3) mm(2)/s) and the mean entropy of T2-weighted imaging was 5.36 (range 4.62-5.91) before UAE. ADC and entropy were significantly correlated with leiomyoma VR, respectively (r = 0.61, P = .012; r = 0.73, P = .001). On multiple regression analysis, a combination of ADC and entropy constituted the best model for determining leiomyoma VR using Akaike information criterion. For predicting ≥50% VR, the optimal cutoff value of ADC was 1.39 × 10(-3) mm(2)/s (sensitivity 45.5%, specificity 80.0%) and the optimal cutoff value of entropy was 5.15 (sensitivity 90.9%, specificity 60.0%). The combination of ADC and entropy (area under the curve [AUC] 0.86) provided better classification accuracy than ADC or entropy alone (AUC 0.69 and 0.82, respectively). CONCLUSIONS Pre-UAE entropy of T2-weighted imaging and ADC of leiomyomas were significantly correlated with the leiomyoma VR 6 months after embolization. Higher entropy and higher ADC may be related to greater leiomyoma VR after UAE. A combination of entropy and ADC may have predictive value for leiomyoma VR after UAE.
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Affiliation(s)
- Meng-Qiu Cao
- Department of Diagnostic and Interventional Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160, Pujian Rd, Shanghai 200127, China
| | - Shi-Teng Suo
- Department of Diagnostic and Interventional Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160, Pujian Rd, Shanghai 200127, China
| | - Xue-Bin Zhang
- Department of Diagnostic and Interventional Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160, Pujian Rd, Shanghai 200127, China.
| | - Yi-Cun Zhong
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-Guo Zhuang
- Department of Diagnostic and Interventional Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160, Pujian Rd, Shanghai 200127, China
| | - Jie-Jun Cheng
- Department of Diagnostic and Interventional Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160, Pujian Rd, Shanghai 200127, China
| | - Jia-Chang Chi
- Department of Diagnostic and Interventional Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160, Pujian Rd, Shanghai 200127, China
| | - Jian-Rong Xu
- Department of Diagnostic and Interventional Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160, Pujian Rd, Shanghai 200127, China.
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Novel functional magnetic resonance imaging biomarkers for assessing response to therapy in hepatocellular carcinoma. Clin Transl Oncol 2013; 16:599-605. [PMID: 24356932 DOI: 10.1007/s12094-013-1147-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 11/26/2013] [Indexed: 12/19/2022]
Abstract
The established and adapted image biomarkers based on size for tumor burden measurement continue to be applied to hepatocellular carcinoma (HCC) as size measurement can easily be used in clinical practice. However, in the setting of novel targeted therapies and liver directed treatments, simple tumor anatomical changes can be less informative and usually appear later than biological changes. Functional magnetic resonance imaging (MRI) has a potential to be a promising technique for assessment of HCC response to therapy. In this review, we discuss various functional MRI biomarkers that play an increasingly important role in evaluation of HCC response after treatment.
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Vandecaveye V, Michielsen K, De Keyzer F, Laleman W, Komuta M, Op de beeck K, Roskams T, Nevens F, Verslype C, Maleux G. Chemoembolization for hepatocellular carcinoma: 1-month response determined with apparent diffusion coefficient is an independent predictor of outcome. Radiology 2013; 270:747-57. [PMID: 24475816 DOI: 10.1148/radiol.13130591] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the predictive utility of apparent diffusion coefficient (ADC) changes at diffusion-weighted (DW) magnetic resonance (MR) imaging 1 month after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) compared with the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, European Association for the Study of the Liver (EASL) criteria, and modified RECIST (mRECIST). MATERIALS AND METHODS Institutional review board approval and informed consent were obtained for this prospective study. Thirty-eight patients with inoperable HCC underwent 1.5-T MR imaging, including DW imaging, before and 1 month after TACE. Responses 1 month after TACE were assessed with the ADC change relative to baseline (ADC ratio), RECIST, EASL criteria, and mRECIST. Eight patients underwent transplantation 4 months after TACE, allowing the association between response and histopathologic necrosis ratio to be determined. In 30 patients, Kaplan-Meier and log-rank tests were used to correlate the response variables with progression-free and overall survival. RESULTS Median progression-free survival (PFS) was 5 months, and overall survival was 17.5 months. Survival analyses showed significant effects of pretreatment α-fetoprotein level (P = .03) and ADC ratio (P < .0001) on PFS and substantial effects of mRECIST, RECIST, and EASL criteria (.05 < P < .1). ADC ratio was a significant predictor of 5-month PFS (P < .001), with an accuracy of 93.3% compared with 53.3% with mRECIST and EASL criteria and 66.7% with RECIST. No response variables correlated with overall survival. Only the ADC ratio was significantly associated with histopathologic tumor necrosis (P = .03). CONCLUSION The ADC ratio 1 month after TACE was an independent predictor of PFS, which showed stronger association with tumor response than did RECIST, EASL criteria, or mRECIST.
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Affiliation(s)
- Vincent Vandecaveye
- From the Department of Radiology and Medical Imaging Research Center (V.V., K.M., F.D.K., K.O.d.b., G.M.), Department of Hepatology (W.L., F.N., C.V.), and Department of Morphology and Molecular Pathology (M.K., T.R.), University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Yuan Z, Li WT, Peng WJ. Pre-treatment apparent diffusion coefficient is imaging biomarker for prediction of response to chemoembolization in hepatocellular carcinoma. Eur J Radiol 2013; 82:e901-2. [DOI: 10.1016/j.ejrad.2013.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/02/2013] [Indexed: 01/18/2023]
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Pace L, Nicolai E, Aiello M, Catalano OA, Salvatore M. Whole-body PET/MRI in oncology: current status and clinical applications. Clin Transl Imaging 2013. [DOI: 10.1007/s40336-013-0012-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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