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Stocker D, King MJ, Homsi ME, Gnerre J, Marinelli B, Wurnig M, Schwartz M, Kim E, Taouli B. Early post-treatment MRI predicts long-term hepatocellular carcinoma response to radiation segmentectomy. Eur Radiol 2024; 34:475-484. [PMID: 37540318 PMCID: PMC10791774 DOI: 10.1007/s00330-023-10045-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Radiation segmentectomy using yttrium-90 plays an emerging role in the management of early-stage HCC. However, the value of early post-treatment MRI for response assessment is uncertain. We assessed the value of response criteria obtained early after radiation segmentectomy in predicting long-term response in patients with HCC. MATERIALS AND METHODS Patients with HCC who underwent contrast-enhanced MRI before, early, and 12 months after radiation segmentectomy were included in this retrospective single-center study. Three independent radiologists reviewed images at baseline and 1st follow-up after radiation segmentectomy and assessed lesion-based response according to mRECIST, LI-RADS treatment response algorithm (TRA), and image subtraction. The endpoint was response at 12 months based on consensus readout of two separate radiologists. Diagnostic accuracy for predicting complete response (CR) at 12 months based on the 1st post-treatment MRI was calculated. RESULTS Eighty patients (M/F 60/20, mean age 67.7 years) with 80 HCCs were assessed (median size baseline, 1.8 cm [IQR, 1.4-2.9 cm]). At 12 months, 74 patients were classified as CR (92.5%), 5 as partial response (6.3%), and 1 as progressive disease (1.2%). Diagnostic accuracy for predicting CR was fair to good for all readers with excellent positive predictive value (PPV): mRECIST (range between 3 readers, accuracy: 0.763-0.825, PPV: 0.966-1), LI-RADS TRA (accuracy: 0.700-0.825, PPV: 0.983-1), and subtraction (accuracy: 0.775-0.825, PPV: 0.967-1), with no difference in accuracy between criteria (p range 0.053 to > 0.9). CONCLUSION mRECIST, LI-RADS TRA, and subtraction obtained on early post-treatment MRI show similar performance for predicting long-term response in patients with HCC treated with radiation segmentectomy. CLINICAL RELEVANCE STATEMENT Response assessment extracted from early post-treatment MRI after radiation segmentectomy predicts complete response in patients with HCC with high PPV (≥ 0.96). KEY POINTS • Early post-treatment response assessment on MRI predicts response in patients with HCC treated with radiation segmentectomy with fair to good accuracy and excellent positive predictive value. • There was no difference in diagnostic accuracy between mRECIST, LI-RADS, and subtraction for predicting HCC response to radiation segmentectomy.
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Affiliation(s)
- Daniel Stocker
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Michael J King
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria El Homsi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey Gnerre
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brett Marinelli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Moritz Wurnig
- Institute of Radiology, Spital Lachen AG, Lachen, Switzerland
| | - Myron Schwartz
- Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Edward Kim
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mai Z, Yang Q, Xu J, Xie H, Ban X, Xu G, Zhang R. Response evaluation of hepatocellular carcinoma treated with stereotactic body radiation therapy: magnetic resonance imaging findings. Abdom Radiol (NY) 2023; 48:1995-2007. [PMID: 36939911 PMCID: PMC10167191 DOI: 10.1007/s00261-023-03827-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE To summarize the magnetic resonance imaging manifestations of hepatocellular carcinoma (HCC) with and without progression after stereotactic body radiation therapy (SBRT) and evaluate the treatment effect using the modified Liver Reporting and Data System (LI-RADS). METHODS Between January 2015 and December 2020, 102 patients with SBRT-treated HCC were included. Tumor size, signal intensity, and enhancement patterns at each follow-up period were analyzed. Three different patterns of enhancement: APHE and wash-out, non-enhancement, and delayed enhancement. For modified LI-RADS, delayed enhancement with no size increase were considered to be a "treatment-specific expected enhancement pattern" for LR-TR non-viable. RESULTS Patients were divided into two groups: without (n = 96) and with local progression (n = 6). Among patients without local progression, APHE and wash-out pattern demonstrated conversion to the delayed enhancement (71.9%) and non-enhancement (20.8%) patterns, with decreased signal intensity on T1WI(92.9%) and DWI(99%), increased signal intensity on T1WI (99%), and decreased size. The signal intensity and enhancement patterns stabilized after 6-9 months. Six cases with progression exhibited tumor growth, APHE and wash-out, and increased signal intensity on T2WI/DWI. Based on the modified LI-RADS criteria, 74% and 95% showed LR-TR-nonviable in 3 and 12 months post-SBRT, respectively. CONCLUSIONS After SBRT, the signal intensity and enhancement patterns of HCCs showed a temporal evolution. Tumor growth, APHE and wash-out, and increased signal intensity on T2WI/DWI indicates tumor progression. Modified LI-RADS criteria showed good performance in evaluating nonviable lesions after SBRT.
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Affiliation(s)
- Zhijun Mai
- Department of Radiology, Sun Yat-Sen University Cancer Center, No.651 Dongfeng Road East, Guangzhou, 510060, China
| | - Qiuxia Yang
- Department of Radiology, Sun Yat-Sen University Cancer Center, No.651 Dongfeng Road East, Guangzhou, 510060, China
| | - Jiahui Xu
- Department of Radiology, Sun Yat-Sen University Cancer Center, No.651 Dongfeng Road East, Guangzhou, 510060, China
| | - Hui Xie
- Department of Radiology, Sun Yat-Sen University Cancer Center, No.651 Dongfeng Road East, Guangzhou, 510060, China
| | - Xiaohua Ban
- Department of Radiology, Sun Yat-Sen University Cancer Center, No.651 Dongfeng Road East, Guangzhou, 510060, China
| | - Guixiao Xu
- Department of Radiology, Sun Yat-Sen University Cancer Center, No.651 Dongfeng Road East, Guangzhou, 510060, China
| | - Rong Zhang
- Department of Radiology, Sun Yat-Sen University Cancer Center, No.651 Dongfeng Road East, Guangzhou, 510060, China.
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Liu R, Li H, Qiu Y, Liu H, Cheng Z. Recent Advances in Hepatocellular Carcinoma Treatment with Radionuclides. Pharmaceuticals (Basel) 2022; 15:1339. [PMID: 36355512 PMCID: PMC9694760 DOI: 10.3390/ph15111339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 06/20/2024] Open
Abstract
As the third leading cause of cancer death worldwide, hepatocellular carcinoma (HCC) is characterized by late detection, difficult diagnosis and treatment, rapid progression, and poor prognosis. Current treatments for liver cancer include surgical resection, radiofrequency ablation, liver transplantation, chemotherapy, external radiation therapy, and internal radionuclide therapy. Radionuclide therapy is the use of high-energy radiation emitted by radionuclides to eradicate tumor cells, thus achieving the therapeutic effect. Recently, with the continuous development of biomedical technology, the application of radionuclides in treatment of HCC has progressed steadily. This review focuses on three types of radionuclide-based treatment regimens, including transarterial radioembolization (TARE), radioactive seed implantation, and radioimmunotherapy. Their research progress and clinical applications are summarized. The advantages, limitations, and clinical potential of radionuclide treatment of HCC are discussed.
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Affiliation(s)
- Ruiqi Liu
- Institute of Molecular Medicine, College of Life and Health Sciences, Northeastern University, Shenyang 110000, China
| | - Hong Li
- Institute of Molecular Medicine, College of Life and Health Sciences, Northeastern University, Shenyang 110000, China
| | - Yihua Qiu
- Institute of Molecular Medicine, College of Life and Health Sciences, Northeastern University, Shenyang 110000, China
| | - Hongguang Liu
- Institute of Molecular Medicine, College of Life and Health Sciences, Northeastern University, Shenyang 110000, China
| | - Zhen Cheng
- State Key Laboratory of Drug Research, Molecular Imaging Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- Shandong Laboratory of Yantai Drug Discovery, Bohai Rim Advanced Research Institute for Drug Discovery, Yantai 264117, China
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4
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Alnammi M, Wortman J, Therrien J, Afnan J. MRI features of treated hepatocellular carcinoma following locoregional therapy: a pictorial review. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2299-2313. [PMID: 35524803 DOI: 10.1007/s00261-022-03526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 12/24/2022]
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer death worldwide and within the United States. Liver transplant or partial liver resection is the definitive treatment of choice for HCC; however, the majority of cases are detected in advanced stages due to its early-stage asymptomatic nature, often precluding surgical treatment. Locoregional therapy plays an essential role in HCC management, including curative intent, as a bridge to transplant, or in some cases palliative therapy. Radiologists play a critical role in assessing tumor response following treatment to guide further management that may potentially impact transplantation eligibility; therefore, it is important for radiologists to have an understanding of different locoregional therapies and the variations of imaging response to different therapies. In this review article, we outline the imaging response to ablative therapy (AT), transarterial chemoembolization (TACE), selective internal radiation therapy (SIRT), and stereotactic body radiation therapy (SBRT). We will also briefly discuss the basic concepts of these locoregional therapies. This review focuses on the imaging features following locoregional treatment for hepatocellular carcinoma following AT, TACE, SIRT, and SBRT.
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Affiliation(s)
- Mohanned Alnammi
- Department of Diagnostic Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Jeremy Wortman
- Department of Diagnostic Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Jaclyn Therrien
- Department of Diagnostic Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Jalil Afnan
- Department of Diagnostic Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.
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Miller FH, Lopes Vendrami C, Gabr A, Horowitz JM, Kelahan LC, Riaz A, Salem R, Lewandowski RJ. Evolution of Radioembolization in Treatment of Hepatocellular Carcinoma: A Pictorial Review. Radiographics 2021; 41:1802-1818. [PMID: 34559587 DOI: 10.1148/rg.2021210014] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Transarterial radioembolization (TARE) with yttrium 90 has increasingly been performed to treat hepatocellular carcinoma (HCC). TARE was historically used as a palliative lobar therapy for patients with advanced HCC beyond surgical options, ablation, or transarterial chemoembolization, but recent advancements have led to its application across the Barcelona Clinic Liver Cancer staging paradigm. Newer techniques, termed radiation lobectomy and radiation segmentectomy, are being performed before liver resection to facilitate hypertrophy of the future liver remnant, before liver transplant to bridge or downstage to transplant, or as a definite curative treatment. Imaging assessment of therapeutic response to TARE is challenging as the intent of TARE is to deliver local high-dose radiation to tumors through microembolic microspheres, preserving blood flow to promote radiation injury to the tumor. Because of the microembolic nature, early imaging assessment after TARE cannot rely solely on changes in size. Knowledge of the evolving methods of TARE along with the tools to assess posttreatment imaging and response is essential to optimize TARE as a therapeutic option for patients with HCC. ©RSNA, 2021.
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Affiliation(s)
- Frank H Miller
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Camila Lopes Vendrami
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Ahmed Gabr
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Jeanne M Horowitz
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Linda C Kelahan
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Ahsun Riaz
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Riad Salem
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Robert J Lewandowski
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
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Wang C, Padgett KR, Su MY, Mellon EA, Maziero D, Chang Z. Multi-parametric MRI (mpMRI) for treatment response assessment of radiation therapy. Med Phys 2021; 49:2794-2819. [PMID: 34374098 DOI: 10.1002/mp.15130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/11/2022] Open
Abstract
Magnetic resonance imaging (MRI) plays an important role in the modern radiation therapy (RT) workflow. In comparison with computed tomography (CT) imaging, which is the dominant imaging modality in RT, MRI possesses excellent soft-tissue contrast for radiographic evaluation. Based on quantitative models, MRI can be used to assess tissue functional and physiological information. With the developments of scanner design, acquisition strategy, advanced data analysis, and modeling, multiparametric MRI (mpMRI), a combination of morphologic and functional imaging modalities, has been increasingly adopted for disease detection, localization, and characterization. Integration of mpMRI techniques into RT enriches the opportunities to individualize RT. In particular, RT response assessment using mpMRI allows for accurate characterization of both tissue anatomical and biochemical changes to support decision-making in monotherapy of radiation treatment and/or systematic cancer management. In recent years, accumulating evidence have, indeed, demonstrated the potentials of mpMRI in RT response assessment regarding patient stratification, trial benchmarking, early treatment intervention, and outcome modeling. Clinical application of mpMRI for treatment response assessment in routine radiation oncology workflow, however, is more complex than implementing an additional imaging protocol; mpMRI requires additional focus on optimal study design, practice standardization, and unified statistical reporting strategy to realize its full potential in the context of RT. In this article, the mpMRI theories, including image mechanism, protocol design, and data analysis, will be reviewed with a focus on the radiation oncology field. Representative works will be discussed to demonstrate how mpMRI can be used for RT response assessment. Additionally, issues and limits of current works, as well as challenges and potential future research directions, will also be discussed.
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Affiliation(s)
- Chunhao Wang
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
| | - Kyle R Padgett
- Department of Radiation Oncology, University of Miami, Miami, Florida, USA.,Department of Radiology, University of Miami, Miami, Florida, USA
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, California, USA.,Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Eric A Mellon
- Department of Radiation Oncology, University of Miami, Miami, Florida, USA
| | - Danilo Maziero
- Department of Radiation Oncology, University of Miami, Miami, Florida, USA
| | - Zheng Chang
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
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7
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Malla RR, Kumari S, Kgk D, Momin S, Nagaraju GP. Nanotheranostics: Their role in hepatocellular carcinoma. Crit Rev Oncol Hematol 2020; 151:102968. [DOI: 10.1016/j.critrevonc.2020.102968] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/24/2020] [Accepted: 04/15/2020] [Indexed: 12/14/2022] Open
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8
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Spina JC, Hume I, Pelaez A, Peralta O, Quadrelli M, Garcia Monaco R. Expected and Unexpected Imaging Findings after 90Y Transarterial Radioembolization for Liver Tumors. Radiographics 2020; 39:578-595. [PMID: 30844345 DOI: 10.1148/rg.2019180095] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Transarterial radioembolization (TARE), also called radioembolization or selective internal radiation therapy, is an interventional radiology technique used to treat primary liver tumors and liver metastases. The aim of this therapy is to deliver tumoricidal doses of radiation to liver tumors while selecting a safe radiation dose limit for nontumoral liver and lung tissue. Hence, correct treatment planning is essential to obtaining good results. However, this treatment invariably results in some degree of irradiation of normal liver parenchyma, inducing different radiologic findings that may affect follow-up image interpretation. When evaluating treatment response, the treated area size, tumor necrosis, devascularization, and changes seen at functional MRI must be taken into account. Unlike with other interventional procedures, with TARE, it can take several months for the tumor response to become evident. Ideally, responding lesions will show reduced size and decreased enhancement 3-6 months after treatment. In addition, during follow-up, there are many imaging findings related to the procedure itself (eg, peritumoral edema, inflammation, ring enhancement, hepatic fibrosis, and capsular retraction) that can make image interpretation and response evaluation difficult. Possible complications, either hepatic or extrahepatic, also can occur and include biliary injuries, hepatic abscess, radioembolization-induced liver disease, and radiation pneumonitis or dermatitis. A complete understanding of these possible posttreatment changes is essential for correct radiologic interpretations during the follow-up of patients who have undergone TARE. ©RSNA, 2019.
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Affiliation(s)
- Juan C Spina
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Isabel Hume
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Ana Pelaez
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Oscar Peralta
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Marcos Quadrelli
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Ricardo Garcia Monaco
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
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9
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Lauenstein TC, Schelhorn J, Kinner S. Assessment of Tumor Response with MRI and CT After Radioembolization. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Deipolyi AR, England RW, Ridouani F, Riedl CC, Kunin HS, Boas FE, Yarmohammadi H, Sofocleous CT. PET/CT Imaging Characteristics After Radioembolization of Hepatic Metastasis from Breast Cancer. Cardiovasc Intervent Radiol 2019; 43:488-494. [PMID: 31732778 DOI: 10.1007/s00270-019-02375-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/06/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To define positron emission tomography/computed tomography (PET/CT) imaging characteristics during follow-up of patients with metastatic breast cancer (MBC) treated with yttrium-90 (Y90) radioembolization (RE). MATERIALS AND METHODS From January 2011 to October 2017, 30 MBC patients underwent 38 Y90 glass or resin RE treatments. Pre-RE PET/CT was performed on average 51 days before RE. There were 68 PET/CTs performed after treatment. Response was assessed using modified PERCIST criteria focusing on the hepatic territory treated with RE, normalizing SUVpeak to the mean SUV of liver uninvolved by tumor. An objective response (OR) was defined as a decrease in SUVpeak by at least 30%. RESULTS Of the 68 post-RE scans, 6 were performed at 0-30 days, 15 at 31-60 days, 9 at 61-90 days, 13 at 91-120 days, 14 scans at 121-180 days, and 11 scans at > 180 days after RE. Of the 30 patients, 25 (83%) achieved OR on at least one follow-up. Median survival was 15 months after the first RE administration. Highest response rates occurred at 30-90 days, with over 75% of cases demonstrating OR at that time. After 180 days, OR was seen in only 25%. There was a median TTP of 169 days among responders. CONCLUSION In MBC, follow-up PET/CT after RE demonstrates optimal response rates at 30-90 days, with progression noted after 180 days. These results help to guide the timing of imaging and also to inform patients of expected outcomes after RE.
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Affiliation(s)
- Amy R Deipolyi
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ryan W England
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fourat Ridouani
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher C Riedl
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Henry S Kunin
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - F Edward Boas
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hooman Yarmohammadi
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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11
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Alpha-Fetoprotein, Des-Gamma-Carboxy Prothrombin, and Modified RECIST Response as Predictors of Survival after Transarterial Radioembolization for Hepatocellular Carcinoma. J Vasc Interv Radiol 2019; 30:1194-1200.e1. [PMID: 31235408 DOI: 10.1016/j.jvir.2019.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 02/07/2023] Open
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12
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Gordic S, Wagner M, Zanato R, Hectors S, Besa C, Kihira S, Kim E, Taouli B. Prediction of hepatocellular carcinoma response to 90Yttrium radioembolization using volumetric ADC histogram quantification: preliminary results. Cancer Imaging 2019; 19:29. [PMID: 31142363 PMCID: PMC6541997 DOI: 10.1186/s40644-019-0216-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/16/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose To assess the predictive value of volumetric apparent diffusion coefficient (vADC) histogram quantification obtained before and 6 weeks (6w) post-treatment for assessment of hepatocellular carcinoma (HCC) response to 90Yttrium radioembolization (RE). Methods In this retrospective study, 22 patients (M/F 15/7, mean age 65y) who underwent lobar RE were included between October 2013 and November 2014. All patients underwent routine liver MRI pre-treatment and 6w after RE. Two readers assessed index tumor response at 6 months after RE in consensus, using mRECIST criteria. vADC histogram parameters of index tumors at baseline and 6w, and changes in vADC (ΔvADC) histogram parameters were calculated. The predictive value of ADC metrics was assessed by logistic regression with stepwise parameter selection and ROC analyses. Results Twenty two HCC lesions (mean size 3.9 ± 2.9 cm, range 1.2–12.3 cm) were assessed. Response at 6 months was as follows: complete response (CR, n = 6), partial response (PR, n = 3), stable disease (SD, n = 12) and progression (PD, n = 1). vADC median/mode at 6w (1.81–1.82 vs. 1.29–1.35 × 10− 3 mm2/s) and ΔvADC median/max (27–44% vs. 0–10%) were significantly higher in CR/PR vs. SD/PD (p = 0.011–0.036), while there was no significant difference at baseline. Logistic regression identified vADC median at 6w as an independent predictor of response (CR/PR) with odds ratio (OR) of 3.304 (95% CI: 1.099–9.928, p = 0.033) and AUC of 0.77. ΔvADC mean was identified as an independent predictor of CR with OR of 4.153 (95%CI: 1.229–14.031, p = 0.022) and AUC of 0.91. Conclusion Diffusion histogram parameters obtained at 6w and early changes in ADC from baseline are predictive of subsequent response of HCCs treated with RE, while pre-treatment vADC histogram parameters are not. These results need confirmation in a larger study. Trial registration This retrospective study was IRB-approved and the requirement for informed consent was waived.
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Affiliation(s)
- Sonja Gordic
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Mathilde Wagner
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sorbonne Universités, UPMC, Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Riccardo Zanato
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Stefanie Hectors
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cecilia Besa
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, 8331150, Santiago, Chile
| | - Shingo Kihira
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA
| | - Edward Kim
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA
| | - Bachir Taouli
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA.
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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: 20] [Impact Index Per Article: 4.0] [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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Ahmed AF, Samreen N, Grajo JR, Zendejas I, Sistrom CL, Collinsworth A, Esnakula A, Shah JL, Cabrera R, Geller BS, Toskich BB. Angiosomal radiopathologic analysis of transarterial radioembolization for the treatment of hepatocellular carcinoma. Abdom Radiol (NY) 2018; 43:1825-1836. [PMID: 29052747 DOI: 10.1007/s00261-017-1354-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess the radiopathologic correlation following Yttrium-90 transarterial radioembolization (TARE) of hepatocellular carcinoma (HCC) using variable radiodosimetry to identify imaging surrogates of histologic response. METHODS Twelve patients with HCC underwent ablative (≥ 190 Gy) and/or non-ablative (< 190 Gy) TARE delivered in a segmental, lobar, or combined fashion as a surgical neoadjuvant or bridge to transplantation. Both targeted tumor and treatment angiosome were analyzed before and after TARE utilizing hepatocyte-specific contrast-enhanced MRI or contrast-enhanced CT. Responses were graded using EASL and mRECIST criteria. Histologic findings including percent tumor necrosis and adjacent hepatic substrate effects were correlated with imaging features. RESULTS Complete pathologic necrosis (CPN) was observed in 7/12 tumors post-TARE. Ablative and non-ablative dosing resulted in CPN in 5/6 and 2/6 tumors, respectively. Hyperintensity on T2-weighted imaging, the absence of hepatocyte-specific gadolinium contrast uptake, and plateau or persistent enhancement kinetics in the angiosome correlated with CPN and performed similarly to EASL and mRECIST criteria in predicting CPN. CONCLUSIONS The absence of hepatocyte-specific contrast uptake, increased signal on T2-weighted sequences, and plateau or persistent enhancement in the angiosome may represent MRI surrogates of CPN following TARE of HCC. These findings correlated with EASL and mRECIST response criteria. Further investigation is needed to determine the role of these findings as possible adjuncts to conventional imaging criteria.
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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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Bargellini I, Crocetti L, Turini FM, Lorenzoni G, Boni G, Traino AC, Caramella D, Cioni R. Response Assessment by Volumetric Iodine Uptake Measurement: Preliminary Experience in Patients with Intermediate-Advanced Hepatocellular Carcinoma Treated with Yttrium-90 Radioembolization. Cardiovasc Intervent Radiol 2018; 41:1373-1383. [PMID: 29654507 DOI: 10.1007/s00270-018-1962-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/05/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE To retrospectively compare early response to yttrium-90 radioembolization (Y90) according to volumetric iodine uptake (VIU) changes, Response Evaluation Criteria In Solid Tumor 1.1 (RECIST 1.1) and modified RECIST (mRECIST) in patients with intermediate-advanced hepatocellular carcinoma (HCC) and to explore their association with survival. MATERIALS AND METHODS Twenty-four patients treated with Y90 and evaluated with dual-energy computed tomography before and 6 weeks after treatment were included. VIU was measured on late arterial phase spectral images; 6-week VIU response was defined as: complete response (CR, absence of enhancing tumor), partial response (PR, ≥ 15% VIU reduction), progressive disease (PD, ≥ 10% VIU increase) and stable disease (criteria of CR/PR/PD not met). RECIST 1.1 and mRECIST were evaluated at 6 weeks and 6 months. Responders included CR and PR. Overall survival (OS) was evaluated by Kaplan-Meier analysis and compared by Cox regression analysis. RESULTS High intraobserver and interobserver agreements were observed in VIU measurements (k > 0.98). VIU identified a higher number of responders (18 patients, 75%), compared to RECIST 1.1 (12.5% at 6 weeks and 23.8% at 6 months) and mRECIST (29.2% at 6 weeks and 61.9% at 6 months). There was no significant correlation between OS and RECIST 1.1 (P = 0.45 at 6 weeks; P = 0.21 at 6 months) or mRECIST (P = 0.38 at 6 weeks; P = 0.79 at 6 months); median OS was significantly higher in VIU responders (17.2 months) compared to non-responders (7.4 months) (P = 0.0022; HR 8.85; 95% CI 1.29-88.1). CONCLUSION VIU is highly reproducible; as opposite to mRECIST and RECIST 1.1, early VIU response correlates with OS after Y90 in intermediate-advanced HCC patients.
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Affiliation(s)
- Irene Bargellini
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy.
| | - Laura Crocetti
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
| | - Francesca Maria Turini
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
| | - Giulia Lorenzoni
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
| | - Giuseppe Boni
- Department of Nuclear Medicine, Pisa University Hospital, Via Roma 55, 56126, Pisa, Italy
| | | | - Davide Caramella
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
| | - Roberto Cioni
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
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Abstract
CLINICAL/METHODICAL ISSUE Detection and characterization of focal liver lesions. STANDARD RADIOLOGICAL METHODS Due to its excellent soft tissue contrast, the availability of liver-specific contrast agents and the possibility of functional imaging, magnetic resonance imaging (MRI) is the method of choice for the evaluation of focal liver lesions. METHODICAL INNOVATIONS Diffusion-weighted imaging (DWI) enables generation of functional information about the microstructure of a tissue besides morphological information. PERFORMANCE In the detection of focal liver lesions DWI shows a better detection rate compared to T2w sequences and a slightly poorer detection rate compared to dynamic T1w sequences. In principle, using DWI it is possible to distinguish malignant from benign liver lesions and also to detect a therapy response at an early stage. ACHIEVEMENTS For both detection and characterization of focal liver lesions, DWI represents a promising alternative to the morphological sequences; however, a more detailed characterization with the use of further sequences should be carried out particularly for the characterization of solid benign lesions. For the assessment and prognosis of therapy response, DWI offers advantages compared to morphological sequences. PRACTICAL RECOMMENDATIONS For the detection of focal liver lesions DWI is in principle sufficient. After visual detection of a solid liver lesion a more detailed characterization should be carried out using further sequences (in particular dynamic T1w sequences). The DWI procedure should be used for the assessment and prognosis of a therapy response.
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Affiliation(s)
- P Riffel
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - S O Schoenberg
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - J Krammer
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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Vogl TJ, Mohamed SA, Albrecht MH, Gruber-Roh T, Lin H, Nour Eldin NEA, Bednarova I, Naguib NN, Panahi B. Transarterial chemoembolization in pancreatic adenocarcinoma with liver metastases: MR-based tumor response evaluation, apparent diffusion coefficient (ADC) patterns, and survival rates. Pancreatology 2018; 18:94-99. [PMID: 29221632 DOI: 10.1016/j.pan.2017.11.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 11/26/2017] [Accepted: 11/28/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE To retrospectively investigate the effectiveness of triple drug combination transarterial chemoembolization (TACE) on local tumor response and survival in patients with liver metastases from pancreatic cancer. Also, this study will evaluate the variances in response regarding the number of metastases, assess the correlation between tumor response and the changes in the apparent diffusion coefficients (ADC) in diffusion weighted (DW) MRI. MATERIALS AND METHODS One hundred and twelve patients (58 men and 54 women; mean age 57) with malignant liver metastases from pancreatic adenocarcinoma underwent at least one session of TACE with a chemotherapeutic combination of mitomycin C, cisplatin, and gemcitabine. A size-based evaluation of tumor response (response evaluation criteria in solid tumors (RECIST)) was conducted, along with ADC values, and survival indices as related to treatment pattern. RESULTS Four weeks following the end of the treatment, 78.26% of patients showed stable disease and 11.59% showed partial response. The median survival time was 19 months and for the stable disease group, 26 months. Low pretreatment ADC values showed no significant correlation to poor response to treatment (r = 0.347,p = 0.146). CONCLUSION The triple drug TACE technique showed improvements in median survival times in patients with hepatic metastases from pancreatic carcinoma and helped control disease progression, whereas the number of hepatic lesions was not a statistically significant factor in patients' response to TACE. The data suggest that pre-treatment ADC values in DW-MRI have no statistical correlation with tumor response.
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Affiliation(s)
- Thomas J Vogl
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany
| | - Sherif A Mohamed
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany.
| | - Moritz H Albrecht
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany; Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston SC, USA
| | - Tatjana Gruber-Roh
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany
| | - Han Lin
- Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston SC, USA
| | - Nour Eldin A Nour Eldin
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany
| | - Iliana Bednarova
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany; Institute of Diagnostic Radiology, Department of Medical and Biological Science, Udine, Italy
| | - Nagy N Naguib
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany
| | - Bita Panahi
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany
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Lewis H, Ghasabeh M, Khoshpouri P, Kamel I, Pawlik T. Functional hepatic imaging as a biomarker of primary and secondary tumor response to loco-regional therapies. Surg Oncol 2017; 26:411-422. [DOI: 10.1016/j.suronc.2017.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023]
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20
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Imaging of Hepatocellular Carcinoma Response After 90Y Radioembolization. AJR Am J Roentgenol 2017; 209:W263-W276. [DOI: 10.2214/ajr.17.17993] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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Boas FE, Bodei L, Sofocleous CT. Radioembolization of Colorectal Liver Metastases: Indications, Technique, and Outcomes. J Nucl Med 2017; 58:104S-111S. [PMID: 28864605 DOI: 10.2967/jnumed.116.187229] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/08/2017] [Indexed: 12/16/2022] Open
Abstract
Liver metastases are a major cause of death from colorectal cancer. Intraarterial therapy options for colorectal liver metastases include chemoinfusion via a hepatic arterial pump or port, irinotecan-loaded drug-eluting beads, and radioembolization using 90Y microspheres. Intraarterial therapy allows the delivery of a high dose of chemotherapy or radiation into liver tumors while minimizing the impact on liver parenchyma and avoiding systemic effects. Specificity in intraarterial therapy can be achieved both through preferential arterial flow to the tumor and through selective catheter positioning. In this review, we discuss indications, contraindications, preprocedure evaluation, activity prescription, follow-up, outcomes, and complications of radioembolization of colorectal liver metastases. Methods for preventing off-target embolization, increasing the specificity of microsphere delivery, and reducing the lung-shunt fraction are discussed. There are 2 types of 90Y microspheres: resin and glass. Because glass microspheres have a higher activity per particle, they can deliver a particular radiation dose with fewer particles, likely reducing embolic effects. Glass microspheres thus may be more suitable when early stasis or reflux is a concern, in the setting of hepatocellular carcinoma with portal vein invasion, and for radiation segmentectomy. Because resin microspheres have a lower activity per particle, more particles are needed to deliver a particular radiation dose. Resin microspheres thus may be preferable for larger tumors and those with high arterial flow. In addition, resin microspheres have been approved by the U.S. Food and Drug Administration for colorectal liver metastases, whereas institutional review board approval is required before glass microspheres can be used under a compassionate-use or research protocol. Finally, radiation segmentectomy involves delivering a calculated lobar activity of 90Y microspheres selectively to treat a tumor involving 1 or 2 liver segments. This technique administers a very high radiation dose and effectively causes the ablation of tumors that are too large or are in a location considered unsafe for thermal ablation. The selective delivery spares surrounding normal liver, reducing the risk of liver failure.
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Affiliation(s)
- F Edward Boas
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Lisa Bodei
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Constantinos T Sofocleous
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
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22
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Gbolahan OB, Schacht MA, Beckley EW, LaRoche TP, O'Neil BH, Pyko M. Locoregional and systemic therapy for hepatocellular carcinoma. J Gastrointest Oncol 2017; 8:215-228. [PMID: 28480062 DOI: 10.21037/jgo.2017.03.13] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The management of hepatocellular carcinoma (HCC) remains challenging due to late presentation and the presence of accompanying liver dysfunction. As such, most patients are not eligible for curative resection and liver transplant. Management in this scenario depends on a number of factors including hepatic function, tumor burden, patency of hepatic vasculature and patients' functional status. Based on these, patients can be offered catheter based intra-arterial therapy for intermediate stage disease and in more advanced disease, sorafenib. Given recent data, regorafenib is now an option following failure of sorafenib. Catheter directed intra-arterial therapy takes advantage of tumor hypervascularity and the unique dual blood supply of the liver, as hepatic tumors receive arterial perfusion via the hepatic artery while the rest of the liver is supplied by the portal vein. This allows selective embolization and delivery of chemotherapeutic agents to the tumor. Compared to best supportive care, intra-arterial therapy offers a survival benefit in intermediate stage HCC and is the recommended approach for treatment. None of the catheter based approaches; including bland embolization, conventional trans-arterial chemoembolization (cTACE), drug eluting bead trans-arterial chemoembolization (DEB-TACE) or trans-arterial radioembolization (TARE) offers a clear advantage over the other, although DEB-TACE may be characterized by less systemic toxicity. All of these approaches are contraindicated in patients with portal vein thrombosis (PVT). On the other hand, intra-arterial, radio embolization, with Yttrium-90 (Y90) can be offered to patients with PVT. The place of this modality in management of HCC is still being investigated. The role of sorafenib in advanced HCC is not in doubt, as until recently, it was the only systemic therapy approved for the management in this setting. This is despite multiple trials evaluating other agents. The addition of sorafenib to catheter-based therapy in intermediate stage disease has also failed to show any benefit. The modest survival benefit with sorafenib and the failure of other targeted agents suggest that it is important to look beyond inhibition of angiogenesis in advanced HCC. Identification of key drivers and mediators of HCC remains paramount for successful drug development. In line with this, it is refreshing that the excitement that has followed developments in cancer immunotherapy is finding its way to HCC with early trials of anti-PD1 monoclonal antibodies showing sufficient activity that phase III trials are now ongoing for Pembrolizumab and Nivolumab in advanced HCC. Future drug development efforts will focus on defining the feasibility of combining different treatment approaches targeting multiple important modulators of HCC.
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Affiliation(s)
- Olumide B Gbolahan
- 1Division of Hematology Oncology, 2Department of Interventional Radiology, Indiana University School of Medicine, Indianapolis, USA
| | - Michael A Schacht
- 1Division of Hematology Oncology, 2Department of Interventional Radiology, Indiana University School of Medicine, Indianapolis, USA
| | - Eric W Beckley
- 1Division of Hematology Oncology, 2Department of Interventional Radiology, Indiana University School of Medicine, Indianapolis, USA
| | - Thomas P LaRoche
- 1Division of Hematology Oncology, 2Department of Interventional Radiology, Indiana University School of Medicine, Indianapolis, USA
| | - Bert H O'Neil
- 1Division of Hematology Oncology, 2Department of Interventional Radiology, Indiana University School of Medicine, Indianapolis, USA
| | - Maximilian Pyko
- 1Division of Hematology Oncology, 2Department of Interventional Radiology, Indiana University School of Medicine, Indianapolis, USA
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Galbán CJ, Hoff BA, Chenevert TL, Ross BD. Diffusion MRI in early cancer therapeutic response assessment. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3458. [PMID: 26773848 PMCID: PMC4947029 DOI: 10.1002/nbm.3458] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 11/09/2015] [Accepted: 11/12/2015] [Indexed: 05/05/2023]
Abstract
Imaging biomarkers for the predictive assessment of treatment response in patients with cancer earlier than standard tumor volumetric metrics would provide new opportunities to individualize therapy. Diffusion-weighted MRI (DW-MRI), highly sensitive to microenvironmental alterations at the cellular level, has been evaluated extensively as a technique for the generation of quantitative and early imaging biomarkers of therapeutic response and clinical outcome. First demonstrated in a rodent tumor model, subsequent studies have shown that DW-MRI can be applied to many different solid tumors for the detection of changes in cellularity as measured indirectly by an increase in the apparent diffusion coefficient (ADC) of water molecules within the lesion. The introduction of quantitative DW-MRI into the treatment management of patients with cancer may aid physicians to individualize therapy, thereby minimizing unnecessary systemic toxicity associated with ineffective therapies, saving valuable time, reducing patient care costs and ultimately improving clinical outcome. This review covers the theoretical basis behind the application of DW-MRI to monitor therapeutic response in cancer, the analytical techniques used and the results obtained from various clinical studies that have demonstrated the efficacy of DW-MRI for the prediction of cancer treatment response. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | - B. D. Ross
- Correspondence to: B. D. Ross, University of Michigan School of Medicine, Center for Molecular Imaging and Department of Radiology, Biomedical Sciences Research Building, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA.
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24
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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: 13] [Impact Index Per Article: 1.6] [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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Lee EW, Alanis L, Cho SK, Saab S. Yttrium-90 Selective Internal Radiation Therapy with Glass Microspheres for Hepatocellular Carcinoma: Current and Updated Literature Review. Korean J Radiol 2016; 17:472-88. [PMID: 27390539 PMCID: PMC4936170 DOI: 10.3348/kjr.2016.17.4.472] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 03/20/2016] [Indexed: 12/13/2022] Open
Abstract
Hepatocellular carcinoma is the most common primary liver cancer and it represents the majority of cancer-related deaths in the world. More than 70% of patients present at an advanced stage, beyond potentially curative options. Ytrrium-90 selective internal radiation therapy (Y90-SIRT) with glass microspheres is rapidly gaining acceptance as a potential therapy for intermediate and advanced stage primary hepatocellular carcinoma and liver metastases. The technique involves delivery of Y90 infused glass microspheres via the hepatic arterial blood flow to the appropriate tumor. The liver tumor receives a highly concentrated radiation dose while sparing the healthy liver parenchyma due to its preferential blood supply from portal venous blood. There are two commercially available devices: TheraSphere® and SIR-Spheres®. Although, Y90-SIRT with glass microspheres improves median survival in patients with intermediate and advanced hepatocellular carcinoma and has the potential to downstage hepatocellular carcinoma so that the selected candidates meet the transplantable criteria, it has not gained widespread acceptance due to the lack of large randomized controlled trials. Currently, there are various clinical trials investigating the use of Y90-SIRT with glass microspheres for treatment of hepatocellular carcinoma and the outcomes of these trials may result in the incorporation of Y90-SIRT with glass microspheres into the treatment guidelines as a standard therapy option for patients with intermediate and advanced stage hepatocellular carcinoma.
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Affiliation(s)
- Edward Wolfgang Lee
- Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Lourdes Alanis
- Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Sung-Ki Cho
- Division of Interventional Radiology, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Sammy Saab
- Division of Hepatology, Department of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA 90024, USA
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Preliminary study of apparent diffusion coefficient assessment after ion beam therapy for hepatocellular carcinoma. Radiol Phys Technol 2016; 9:233-9. [PMID: 27055451 DOI: 10.1007/s12194-016-0354-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 01/18/2023]
Abstract
We evaluated the state of hepatocellular carcinoma (HCC) and the liver after ion beam therapy by analyzing the apparent diffusion coefficient (ADC). In this retrospective study, we evaluated 13 HCC lesions in 10 patients who underwent magnetic resonance imaging before and after therapy. Diffusion-weighted imaging was performed with use of b values of 0, 150, and 800 s/mm(2). The ADC was determined for the tumor, irradiated liver, and normal liver. The maximum size of the tumor was measured, and reduction in tumor size was determined as a ratio of the maximum size of the diameter of the tumor. We compared the ADC before and after the therapy with the reduction in tumor size ratio. The reduction in tumor size ratio was compared with the ADCs of the tumors. The ADC of the tumor and the irradiated liver were significantly higher after therapy than before therapy. The ADC of the normal liver was not significantly different before and after therapy. The reduction ratio increased significantly (R = 0.73, P = 0.006) after therapy at the second follow-up when compared with after therapy at the first follow-up. No correlation was found between the reduction ratio and the ADC of the tumor in each follow-up. Inflammation of the liver occurs after treatment as a result of radiation doses from the ion beam, and the tumor reaches a state of necrosis. ADC value analysis provides a non-invasive assessment and yields focal information regarding the tumor and liver before and after ion beam therapy.
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Abstract
PURPOSE To discuss guidelines and salient imaging findings of solid tumors treated with common intra-arterial procedures used in interventional oncology. METHODS A meticulous literature search of PubMed-indexed articles was conducted. Key words included "imaging + embolization," "imaging + TACE," "imaging + radioembolization," "imaging + Y90," "mRECIST," and "EASL." Representative post-treatment cross-sectional images were obtained from past cases in this institution. RESULTS Intra-arterial therapy (IAT) in interventional oncology includes bland embolization, chemoembolization, and radioembolization. Solid tumors of the liver are the primary focus of these procedures. Cross-sectional CT and/or MR are the main modalities used to image tumors after treatment. Traditional size-based response criteria (WHO and RECIST) alone are of limited utility in determining response to IAT; tumoral necrosis and enhancement must be considered. Specifically for HCC, the EASL and mRECIST guidelines are becoming widely adopted response criteria to assess these factors. DWI, FDG-PET, and CEUS are modalities that play an adjunctive but controversial role. CONCLUSIONS Radiologists must be aware that the different forms of intra-arterial therapy yield characteristic findings on cross-sectional imaging. Knowledge of these findings is integral to accurate assessment of tumor response and progression.
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Riaz A, Lewandowski RJ, Salem R. Locoregional Therapies for Primary and Secondary Hepatic Malignancies. Cancer Treat Res 2016; 168:233-256. [PMID: 29206376 DOI: 10.1007/978-3-319-34244-3_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Management of hepatic malignancies is a multidisciplinary task with the involvement of hepatologists, medical/surgical oncologists, transplant surgeons, and interventional radiologists. The patients should be selected for a specific targeted therapy after multidisciplinary consensus. Interventional oncology has established its role in the management of hepatic malignancies. Image-guided locoregional therapies decrease the rate of systemic toxicity without compromising tumoricidal effect.
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Functional magnetic resonance imaging response of targeted tumor burden and its impact on survival in patients with hepatocellular carcinoma. Invest Radiol 2015; 50:283-9. [PMID: 25396692 DOI: 10.1097/rli.0000000000000112] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate response of the targeted tumor burden by functional magnetic resonance imaging (MRI) including volumetric diffusion-weighted imaging and volumetric contrast-enhanced MRI (CE-MRI) and its impact on survival in patients with hepatocellular carcinoma treated with intra-arterial therapy (IAT). MATERIALS AND METHODS This institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study included 157 hepatocellular carcinoma lesions in 97 patients (78 men and 19 women; mean age, 64 years) treated with IAT. All patients had pretreatment and 3- to 4-week follow-up MRI with diffusion-weighted imaging and CE-MRI. All lesions 2 cm or larger that were targeted during the first session of IAT were segmented using research software (MR-Oncotreat) to determine targeted tumor burden relative to liver volume (%). Targeted tumor burden was stratified into low (≤10%) or high (>10%). Response using volumetric functional apparent diffusion coefficient (ADC; increase by ≥25%) and CE-MRI (decrease by ≥50% and ≥65% in arterial and venous enhancement [VE], respectively) was assessed in all targeted tumors (range, 1-11) using paired t tests. Kaplan-Meier survival analysis was performed and log-rank test was used to compare pairs of survival curves. Multivariate Cox regression analysis was performed to determine the simultaneous effect of treatment response and tumor burden on survival after adjusting for age, sex, and Child Pugh status. RESULTS There was a significant increase in volumetric ADC (median, 15%; P < 0.001) and a decrease in volumetric arterial enhancement (AE) and VE (median AE, -43% and portal venous phase (PVP), -29%, respectively; P < 0.001) 3 to 4 weeks after treatment in the targeted tumor burden. Multivariable Cox regression demonstrated that both ADC response and low tumor burden were independently associated with greater survival (hazard ratios, 0.53 and 0.55; P values, 0.025 and 0.016, respectively) after adjustment for age, sex, and Child Pugh status. Multivariable Cox regression models demonstrated no statistically significant relationship between AE response and survival after adjusting for tumor burden. However, multivariable Cox regression demonstrated that VE response was associated with greater survival only in those with low tumor burden (hazard ratio, 0.10; P = 0.001), indicating a strong interaction between VE response and tumor burden. CONCLUSION Quantifying targeted tumor burden is important in predicting patient survival when using functional MRI metrics in assessing treatment response.
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Kennedy AS, Ball DS, Cohen SJ, Cohn M, Coldwell DM, Drooz A, Ehrenwald E, Kanani S, Nutting CW, Moeslein FM, Putnam SG, Rose SC, Savin MA, Schirm S, Sharma NK, Wang EA. Hepatic imaging response to radioembolization with yttrium-90-labeled resin microspheres for tumor progression during systemic chemotherapy in patients with colorectal liver metastases. J Gastrointest Oncol 2015; 6:594-604. [PMID: 26697190 DOI: 10.3978/j.issn.2078-6891.2015.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To assess response and the impact of imaging artifacts following radioembolization with yttrium-90-labeled resin microspheres ((90)Y-RE) based on the findings from a central independent review of patients with liver-dominant metastatic colorectal cancer (mCRC). METHODS Patients with mCRC who received (90)Y-RE (SIR-Spheres(®); Sirtex Medical, Sydney, Australia) at nine US institutions between July 2002 and December 2011 were included in the analysis. Tumor response was assessed at baseline and 3 months using either the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0 or 1.1. For each lesion, known artifacts affecting the interpretation of response (peri-tumoral edema and necrosis) were documented. Survivals (Kaplan-Meier analyses) were compared in responders [partial response (PR)] and non-responders [stable (SD) or progressive disease (PD)]. RESULTS Overall, 195 patients (mean age 62 years) received (90)Y-RE after a median of 2 (range, 1-6) lines of prior chemotherapy. Using RECIST 1.0 and RECIST 1.1, 7.6% and 6.9% of patients were partial responders, 47.3% and 48.1% had SD, and 55.0% and 55.0% PD, respectively. RECIST 1.0 and RECIST 1.1 showed excellent agreement {Kappa =0.915 [95% confidence interval (CI): 0.856-0.975]}. Peri-tumoral edema was documented in 32.8%, necrosis in 48.1% and both in 57.3% of cases (using RECIST 1.0). Although baseline characteristics were similar in responders and non-responders (P>0.05), responders survived significantly longer in an analysis according to RECIST 1.0: PR median (95% CI) 25.2 (range, 9.2-49.4) months vs. SD 15.8 (range, 9.3-21.1) months vs. PD 7.1 (range, 6.0-9.5) months (P<0.0001). CONCLUSIONS RECIST 1.0 and RECIST 1.1 imaging responses provide equivalent interpretations in the assessment of hepatic tumors following (90)Y-RE. Radiologic lesion responses at 3 months must be interpreted with caution due to the significant proportion of patients with peri-tumoral edema and necrosis, which may lead to an under-estimation of PR/SD. Nevertheless, 3-month radiologic responses were predictive of prolonged survival.
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Affiliation(s)
- Andrew S Kennedy
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - David S Ball
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Steven J Cohen
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Michael Cohn
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Douglas M Coldwell
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Alain Drooz
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Eduardo Ehrenwald
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Samir Kanani
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Charles W Nutting
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Fred M Moeslein
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Samuel G Putnam
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Steven C Rose
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Michael A Savin
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Sabine Schirm
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Navesh K Sharma
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Eric A Wang
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
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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: 18] [Impact Index Per Article: 2.0] [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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Imaging of HCC-Current State of the Art. Diagnostics (Basel) 2015; 5:513-45. [PMID: 26854169 PMCID: PMC4728473 DOI: 10.3390/diagnostics5040513] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 12/17/2022] Open
Abstract
Early diagnosis of hepatocellular carcinoma (HCC) is crucial for optimizing treatment outcome. Ongoing advances are being made in imaging of HCC regarding detection, grading, staging, and also treatment monitoring. This review gives an overview of the current international guidelines for diagnosing HCC and their discrepancies as well as critically summarizes the role of magnetic resonance imaging (MRI) and computed tomography (CT) techniques for imaging in HCC. The diagnostic performance of MRI with nonspecific and hepatobililiary contrast agents and the role of functional imaging with diffusion-weighted imaging will be discussed. On the other hand, CT as a fast, cheap and easily accessible imaging modality plays a major role in the clinical routine work-up of HCC. Technical advances in CT, such as dual energy CT and volume perfusion CT, are currently being explored for improving detection, characterization and staging of HCC with promising results. Cone beam CT can provide a three-dimensional analysis of the liver with tumor and vessel characterization comparable to cross-sectional imaging so that this technique is gaining an increasing role in the peri-procedural imaging of HCC treated with interventional techniques.
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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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De Robertis R, Tinazzi Martini P, Demozzi E, Puntel G, Ortolani S, Cingarlini S, Ruzzenente A, Guglielmi A, Tortora G, Bassi C, Pederzoli P, D’Onofrio M. Prognostication and response assessment in liver and pancreatic tumors: The new imaging. World J Gastroenterol 2015; 21:6794-6808. [PMID: 26078555 PMCID: PMC4462719 DOI: 10.3748/wjg.v21.i22.6794] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/25/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023] Open
Abstract
Diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term “functional imaging” is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive “one-step” morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for post-treatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart from molecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations, prognostic stratification and post-treatment monitoring.
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Apparent diffusion coefficient quantification as an early imaging biomarker of response and predictor of survival following yttrium-90 radioembolization for unresectable infiltrative hepatocellular carcinoma with portal vein thrombosis. ACTA ACUST UNITED AC 2015; 39:969-78. [PMID: 24740759 DOI: 10.1007/s00261-014-0127-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate early diffusion-weighted imaging (DWI) at 30-days post-yttrium-90 (Y-90) radioembolization as a predictor of treatment response and survival in unresectable infiltrative hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT). MATERIALS AND METHODS In a prospective study, 18 consecutive patients with unresectable infiltrative HCC and PVT underwent Y-90 therapy. MR imaging was obtained pre Y-90, and at 1 and 3 months post-therapy with DWI fat-suppressed tri-directional diffusion gradient (b = 50, 400, 800 s/mm(2)). Response was evaluated using target mRECIST and EASL. Relative change in apparent diffusion coefficient (ADC) value of tumors was evaluated. Statistical analysis using receiver operator characteristic curves was performed. Paired t test and Pearson correlation coefficient (r) were used to assess intra- and inter-observer variability. Survival analysis was performed using Kaplan-Meier estimation and log-rank test. RESULTS Mean ADC values of all HCC's at baseline and at 30-days post-Y90 therapy was 0.86 × 10(-3) and 1.17×10(-3) mm(2)/s, respectively (p < 0.001). Tumors with objective response by mRECIST had significantly increased ADC value when compared to "non-responders" (1.27 vs. 1.05×10(-3) mm(2)/s, p = 0.002). A >30% increase in ADC value at 30-days was found to be at least 90% sensitive in predicting response at 90 days. A >30% increase in ADC value at 30-days predicted significantly prolonged survival. CONCLUSION A 30% increase in ADC value at 30-days measured post Y90 is a reproducible early imaging response biomarker predicting tumor response and prolonged survival following Y-90 therapy in infiltrative HCC with PVT.
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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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Schelhorn J, Best J, Reinboldt MP, Dechêne A, Gerken G, Ruhlmann M, Lauenstein TC, Antoch G, Kinner S. Does diffusion-weighted imaging improve therapy response evaluation in patients with hepatocellular carcinoma after radioembolization? comparison of MRI using Gd-EOB-DTPA with and without DWI. J Magn Reson Imaging 2014; 42:818-27. [DOI: 10.1002/jmri.24827] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/01/2014] [Indexed: 12/29/2022] Open
Affiliation(s)
- Juliane Schelhorn
- Department of Diagnostic and Interventional Radiology and Neuroradiology; University Hospital Essen; Germany
| | - Jan Best
- Department of Gastroenterology und Hepatology; University Hospital Essen; Essen, Germany
| | - Marcus P. Reinboldt
- Department of Diagnostic and Interventional Radiology and Neuroradiology; University Hospital Essen; Germany
| | - Alexander Dechêne
- Department of Gastroenterology und Hepatology; University Hospital Essen; Essen, Germany
| | - Guido Gerken
- Department of Gastroenterology und Hepatology; University Hospital Essen; Essen, Germany
| | - Marcus Ruhlmann
- Clinic of Nuclear Medicine; University Hospital Essen; Essen, Germany
| | - Thomas C. Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology; University Hospital Essen; Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology; Medical Faculty, University Dusseldorf; Dusseldorf Germany
| | - Sonja Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology; University Hospital Essen; Germany
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Vouche M, Salem R, Lewandowski RJ, Miller FH. Can volumetric ADC measurement help predict response to Y90 radioembolization in HCC? ACTA ACUST UNITED AC 2014; 40:1471-80. [DOI: 10.1007/s00261-014-0295-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Boas FE, Do B, Louie JD, Kothary N, Hwang GL, Kuo WT, Hovsepian DM, Kantrowitz M, Sze DY. Optimal imaging surveillance schedules after liver-directed therapy for hepatocellular carcinoma. J Vasc Interv Radiol 2014; 26:69-73. [PMID: 25446423 DOI: 10.1016/j.jvir.2014.09.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 09/08/2014] [Accepted: 09/18/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To optimize surveillance schedules for the detection of recurrent hepatocellular carcinoma (HCC) after liver-directed therapy. MATERIALS AND METHODS New methods have emerged that allow quantitative analysis and optimization of surveillance schedules for diseases with substantial rates of recurrence such as HCC. These methods were applied to 1,766 consecutive chemoembolization, radioembolization, and radiofrequency ablation procedures performed on 910 patients between 2006 and 2011. Computed tomography or magnetic resonance imaging performed just before repeat therapy was set as the time of "recurrence," which included residual and locally recurrent tumor as well as new liver tumors. Time-to-recurrence distribution was estimated by Kaplan-Meier method. Average diagnostic delay (time between recurrence and detection) was calculated for each proposed surveillance schedule using the time-to-recurrence distribution. An optimized surveillance schedule could then be derived to minimize the average diagnostic delay. RESULTS Recurrence is 6.5 times more likely in the first year after treatment than in the second. Therefore, screening should be much more frequent in the first year. For eight time points in the first 2 years of follow-up, the optimal schedule is 2, 4, 6, 8, 11, 14, 18, and 24 months. This schedule reduces diagnostic delay compared with published schedules and is cost-effective. CONCLUSIONS The calculated optimal surveillance schedules include shorter-interval follow-up when there is a higher probability of recurrence and longer-interval follow-up when there is a lower probability. Cost can be optimized for a specified acceptable diagnostic delay or diagnostic delay can be optimized within a specified acceptable cost.
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Affiliation(s)
- F Edward Boas
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10065.
| | - Bao Do
- Veterans Affairs Palo Alto Health Care System, Palo Alto
| | - John D Louie
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Nishita Kothary
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Gloria L Hwang
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | - William T Kuo
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | - David M Hovsepian
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | | | - Daniel Y Sze
- Department of Radiology, Stanford University Medical Center, Stanford, California
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Lewis S, Dyvorne H, Cui Y, Taouli B. Diffusion-weighted imaging of the liver: techniques and applications. Magn Reson Imaging Clin N Am 2014; 22:373-95. [PMID: 25086935 PMCID: PMC4121599 DOI: 10.1016/j.mric.2014.04.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diffusion-weighted imaging (DWI) is a technique that assesses the cellularity, tortuosity of the extracellular/extravascular space, and cell membrane density based on differences in water proton mobility in tissues. The strength of the diffusion weighting is reflected by the b value. DWI using several b values enables the quantification of the apparent diffusion coefficient. DWI is increasingly used in liver imaging for multiple reasons: it can add useful qualitative and quantitative information to conventional imaging sequences; it is acquired relatively quickly; it is easily incorporated into existing clinical protocols; and it is a noncontrast technique.
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Affiliation(s)
- Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Hadrien Dyvorne
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Yong Cui
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA.
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Riaz A, Awais R, Salem R. Side effects of yttrium-90 radioembolization. Front Oncol 2014; 4:198. [PMID: 25120955 PMCID: PMC4114299 DOI: 10.3389/fonc.2014.00198] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 07/15/2014] [Indexed: 12/12/2022] Open
Abstract
Limited therapeutic options are available for hepatic malignancies. Image guided targeted therapies have established their role in management of primary and secondary hepatic malignancies. Radioembolization with yttrium-90 ((90)Y) microspheres is safe and efficacious for treatment of hepatic malignancies. The tumoricidal effect of radioembolization is predominantly due to radioactivity and not ischemia. This article will present a comprehensive review of the side effects that have been associated with radioembolization using (90)Y microspheres. Some of the described side effects are associated with all transarterial procedures. Side effects specific to radioembolization will also be discussed in detail. Methods to decrease the incidence of these potential side effects will also be discussed.
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Affiliation(s)
- Ahsun Riaz
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University , Chicago, IL , USA
| | - Rafia Awais
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University , Chicago, IL , USA
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University , Chicago, IL , USA
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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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Added value of diffusion-weighted acquisitions in MRI of the abdomen and pelvis. AJR Am J Roentgenol 2014; 202:995-1006. [PMID: 24758652 DOI: 10.2214/ajr.12.9563] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this article is to review abdominopelvic applications of diffusion-weighted imaging (DWI), discuss advantages and limitations of DWI, and illustrate these with examples. CONCLUSION High-quality abdominopelvic DWI can be performed routinely on current MRI systems and may offer added value in image interpretation. Particularly in unenhanced MRI examinations, DWI may provide an alternative source of image contrast and improved conspicuity to identify and potentially characterize pathology. DWI is a powerful technique that warrants implementation in routine abdominal and pelvic imaging protocols.
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Xing M, Kooby DA, El-Rayes BF, Kokabi N, Camacho JC, Kim HS. Locoregional therapies for metastatic colorectal carcinoma to the liver--an evidence-based review. J Surg Oncol 2014; 110:182-96. [PMID: 24760444 DOI: 10.1002/jso.23619] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/18/2014] [Indexed: 12/17/2022]
Abstract
The liver is the most common visceral site of colorectal cancer metastasis and recurrence. Given that only 25% of patients with colorectal liver metastases are amenable to curative surgical resection at initial diagnosis, locoregional intra-arterial therapies including hepatic arterial infusion chemotherapy, conventional transarterial chemoembolization, drug-eluting-bead transarterial chemoembolization, and radioembolization have increasingly developed as viable treatment options. The rationale, efficacy, safety, and toxicity of each of these therapies are reviewed and stratified based on current evidence.
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Affiliation(s)
- Minzhi Xing
- Division of Interventional Radiology, Department of Radiology, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA; Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Early treatment response evaluation after yttrium-90 radioembolization of liver malignancy with CT perfusion. J Vasc Interv Radiol 2014; 25:747-59. [PMID: 24630751 DOI: 10.1016/j.jvir.2014.01.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/30/2013] [Accepted: 01/01/2014] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate computed tomography (CT) perfusion for assessment of early treatment response after transarterial radioembolization of patients with liver malignancy. MATERIALS AND METHODS Dynamic contrast-enhanced CT liver perfusion was performed before and 4 weeks after transarterial radioembolization in 40 patients (25 men and 15 women; mean age, 64 y ± 11; range, 35-80 y) with liver metastases (n = 27) or hepatocellular carcinoma (HCC) (n = 13). Arterial perfusion (AP) of tumors derived from CT perfusion and tumor diameters were measured on CT perfusion before and after transarterial radioembolization. Success of transarterial radioembolization was evaluated on morphologic follow-up imaging (median follow-up time, 4 mo) based on Response Evaluation Criteria in Solid Tumors (Version 1.1). CT perfusion parameters before and after transarterial radioembolization for different response groups were compared. Kaplan-Meier curves were plotted to illustrate overall 1-year survival rates. RESULTS Liver metastases showed significant differences in AP before and after transarterial radioembolization in responders (P < .05) but not in nonresponders (P = .164). In HCC, AP values before and after transarterial radioembolization were not significantly different in responders and nonresponders (P = .180 and P = .052). Tumor diameters were not significantly different on CT perfusion before and after transarterial radioembolization in responders and nonresponders with liver metastases and HCC (P = .654, P = .968, P = .148, P = .164). In patients with significant decrease of AP in liver metastases after transarterial radioembolization, 1-year overall survival was significantly higher than in patients showing no reduction of AP. CONCLUSIONS CT perfusion showed early reduction of AP in liver metastases responding to transarterial radioembolization; tumor diameter remained unchanged early after treatment. No significant early treatment response to transarterial radioembolization was found in patients with HCC. In patients with liver metastases, a decrease of AP after transarterial radioembolization was associated with a higher 1-year overall survival rate.
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Added value of diffusion-weighted MRI for evaluating viable tumor of hepatocellular carcinomas treated with radiotherapy in patients with chronic liver disease. AJR Am J Roentgenol 2014; 202:92-101. [PMID: 24370133 DOI: 10.2214/ajr.12.10212] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this article is to evaluate the added value of diffusion-weighted imaging (DWI) to the diagnostic performance of conventional MRI in diagnosing viable hepatocellular carcinoma (HCC) tumors treated with radiotherapy in patients with chronic liver disease. MATERIALS AND METHODS Twenty-nine patients with viable tumor and 35 patients without viable tumor were enrolled. We assessed the signal intensity of viable tumor compared with irradiated liver on MRI and DWI. Signal intensity ratios and apparent diffusion coefficient (ADC) ratios of viable tumor to nonirradiated liver were also assessed on DWI with ADC maps. Two observers reviewed conventional MRI and combined MRI and DWI and rated them using a 5-point scale. Diagnostic performance was evaluated using a receiver operating characteristic (ROC) curve. RESULTS Viable tumors showed hyperintensity on T2-weighted and arterial phase images (16/29 [55.2%]) and hypointensity on portal (22/29 [75.9%]), 3-minute late (19/29 [65.5%]), and hepatobiliary phase (23/29 [79.3%]) images. Twenty-seven (93.1%) viable tumors showed hyperintensity on DWI and hypointensity on ADC maps. Mean signal intensity ratios and ADC ratios of viable tumor on DWI with ADC maps were significantly higher and lower than those of irradiated liver. Diagnostic performance (area under the ROC curve) improved significantly after adding DWI, and interobserver agreement was moderate for conventional MRI (κ = 0.450) and good after adding DWI (κ = 0.748). CONCLUSION Adding DWI to conventional MRI can improve the detection of viable HCC tumors treated with radiotherapy compared to conventional MRI alone.
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Abstract
Transarterial radioembolization (TARE) with yttrium 90 microspheres is an increasingly popular therapy for both primary and secondary liver malignancies. TARE entails delivery of β-particle brachytherapy and embolization of the tumor vasculature. The consequent biological sequelae are distinct from those of other transarterial therapies for liver tumors, as reflected in the often baffling post-treatment imaging features. As the clinical use of TARE is increasing, more diverse post-treatment radiological findings are encountered with variable overlap among treatment response, residual disease, reactionary changes and complications. Thus, post-TARE image interpretation is challenging. This review provides a comprehensive description of the different findings seen in post-treatment scans, with the aim of facilitating appropriate radiological interpretation of post-TARE pathologic changes, notwithstanding their existing limitations.
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Affiliation(s)
- Pavel Singh
- Department of Diagnostic Imaging, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gopinathan Anil
- Department of Diagnostic Imaging, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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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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50
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Diffusion-weighted MRI of hepatocellular carcinoma in cirrhosis. Clin Radiol 2013; 69:1-10. [PMID: 24034549 DOI: 10.1016/j.crad.2013.07.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 07/16/2013] [Accepted: 07/18/2013] [Indexed: 12/17/2022]
Abstract
The internationally accepted diagnostic criteria for hepatocellular carcinoma (HCC) in cirrhosis are highly accurate for large tumours, but offer relatively low sensitivity for small (<2 cm) tumours. Diffusion-weighted imaging (DWI) is a functional magnetic resonance imaging (MRI) technique that has been studied extensively as an aid to visualize various abdominal malignancies, including HCC in cirrhosis. DWI maps water diffusivity, which in HCC may be restricted as a result of changes ensuing from hepatocarcinogenesis. The present review is based on up-to-date evidence and describes the strengths and weaknesses of DWI, both as a standalone technique and as an adjunct sequence to conventional protocols, in the diagnosis, staging, prognostication, and assessment of treatment response of HCC in cirrhosis.
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