1
|
Manabe T, Ogawa C, Takuma K, Nakahara M, Oura K, Tadokoro T, Fujita K, Tani J, Shibatoge M, Morishita A, Kudo M, Masaki T. Usefulness of the Measurement of Psoas Muscle Volume for Sarcopenia Diagnosis in Patients with Liver Disease. Diagnostics (Basel) 2023; 13:diagnostics13071245. [PMID: 37046463 PMCID: PMC10093033 DOI: 10.3390/diagnostics13071245] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Computed tomography (CT) is often used in the diagnosis of sarcopenia. In this study, we validated the assessment of sarcopenia by the psoas muscle volume using versatile software. The study involved a retrospective analysis of data from 190 patients with liver disease who underwent grip-strength testing and abdominal pelvic computed tomography. To assess sarcopenia, SYNAPSE 3D was used to obtain the skeletal muscle index, the psoas muscle index (PMI), and the simple method. We also used the recently proposed PMI cutoff values, for which the usefulness has been evaluated (O-PMI). The cutoff value of the psoas muscle volume index (PMVI) was determined using one of the diagnostic methods as the gold standard. All diagnostic methods showed that patients with sarcopenia had shorter survival, with O-PMI having the highest hazard ratio (HR) (HR, 6.12; 95% confidence interval [CI], 2.6–14.41; p < 0.001). Even when sarcopenia could not be diagnosed by O-PMI, low PMVI was associated with shorter survival (HR, 3.53; 95% CI, 1.34–9.32; p = 0.01). PMVI may be useful in the evaluation of sarcopenia, including the identification of poor overall survival in cases that cannot be diagnosed by O-PMI, which is considered more useful than PMI.
Collapse
|
2
|
Xu J, Yin Y, Yang J, Chen L, Li Z, Shen J, Wang W, Ni C. Modified quantitative and volumetric response evaluation criteria for patients with hepatocellular carcinoma after transarterial chemoembolization. Front Oncol 2023; 13:957722. [PMID: 36761945 PMCID: PMC9905806 DOI: 10.3389/fonc.2023.957722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
Objective This study aimed to investigate the cutoff value of quantitative and volumetric response evaluation criteria for patients with hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) and compare the performance of the modified criteria to one-dimensional criteria in survival prediction. Methods A retrospective single-center study was performed for treatment-naive patients with HCC who underwent initial TACE between June 2015 and June 2019. Treatment response assessment was performed after the first observation by contrast CT or MRI, with the measurement of diameters by modified Response Evaluation Criteria in Solid Tumors (mRECIST) and volumes by quantitative European Association for Study of the Liver (qEASL). Overall survival (OS) was the primary endpoint of this study. The new cutoff value for volumetric response evaluation criteria was created using restricted cubic splines. The performance of modified qEASL (mqEASL, with the new cutoff value) and mRECIST on survival prediction was compared by Cox regression models in internal and external validation. Results A total of 129 patients (mean age, 60 years ± 11 [standard deviation]; 111 men) were included and divided into training (n=90) and validation (n=39) cohorts. The cutoff value for the viable volume reduction was set at 57.0%. The mqEASL enabled separation of non-responders and responders in terms of median OS (p<0.001), 11.2 months (95% CI, 8.5-17.2 months) vs. 31.5 months (95% CI, 25.5-44.0 months). Two multivariate models were developed with independent prognostic factors (tumor response, metastasis, portal vein tumor thrombus, and subsequent treatment) to predict OS. Model 2 (for mqEASL) had a greater Harrel's C index, higher time-dependent area under the receiving operator characteristic curve (AUROC), and more precise calibration on 6-month survival rates than Model 1 (for mRECIST). Conclusions With the modified cutoff value, the quantitative and volumetric response of HCC patients to TACE becomes a precise predictor of overall survival. Further studies are needed to verify this modification before application in clinical practice.
Collapse
|
3
|
Xu L, Wang S, Wang S, Wang Y, Li W, Lin G, Yuan Z. Baseline apparent diffusion coefficients: Validation study of new predictor of survival in patients with unresectable hepatocellular carcinoma following chemoembolization. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:507-516. [PMID: 33814481 DOI: 10.3233/xst-200827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate whether the baseline apparent diffusion coefficient (ADC) can predict survival in the hepatocellular carcinoma (HCC) patients receiving chemoembolization. MATERIALS AND METHODS Diffusion-weighted MR imaging of HCC patients is performed within 2 weeks before chemoembolization. The ADC of the largest index lesion is recorded. Responses are assessed by mRECIST after the start of the second course of chemoembolization. Receiver operating characteristic (ROC) curve analysis is performed to evaluate the diagnostic performance and determine optimal cut-off values. Cox regression and Kaplan-Meier survival analyses are used to explore the differences in overall survival (OS) between the responders and non-responders. RESULTS The difference is statistically significant in the baseline ADC between the responders and non-responders (P < 0.001). ROC analyses indicate that the baseline ADC value is a good predictor of response to treatment with an area under the ROC curve (AUC) of 0.744 and the optimal cut-off value of 1.22×10-3 mm2/s. The Cox regression model shows that the baseline ADC is an independent predictor of OS, with a 57.2% reduction in risk. CONCLUSION An optimal baseline ADC value is a functional imaging response biomarker that has higher discriminatory power to predict tumor response and prolonged survival following chemoembolization in HCC patients.
Collapse
Affiliation(s)
- Lichao Xu
- Department of Interventional Radiology and Image Guided Medicine, Shanghai Cancer Hospital, Fudan University, Shanghai, China
| | - Shiqin Wang
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Shengping Wang
- Department of Radiology, Shanghai Cancer Hospital, Fudan University, Shanghai, China
| | - Ying Wang
- Department of Interventional Radiology and Image Guided Medicine, Shanghai Cancer Hospital, Fudan University, Shanghai, China
| | - Wentao Li
- Department of Interventional Radiology and Image Guided Medicine, Shanghai Cancer Hospital, Fudan University, Shanghai, China
| | - Guangwu Lin
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Zheng Yuan
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
- Department of Radiology, Shanghai No. 85 Hospital, Shanghai, China
| |
Collapse
|
4
|
King MJ, Tong A, Dane B, Huang C, Zhan C, Shanbhogue K. Response assessment of hepatocellular carcinoma treated with yttrium-90 radioembolization: inter-reader variability, comparison with 3D quantitative approach, and role in the prediction of clinical outcomes. Eur J Radiol 2020; 133:109351. [DOI: 10.1016/j.ejrad.2020.109351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 12/26/2022]
|
5
|
Shaghaghi M, AliyariG Hasabeh M, Ameli S, Ghadimi M, Hazhirkarzar B, Rezvani Habibabadi R, Tang H, Khoshpouri P, Wu Q, Pandey A, Pandey P, Baghdadi A, Kamel IR. Role of tumor margin and ADC change in defining the need for additional treatments after the first TACE in patients with unresectable HCC. Eur J Radiol 2020; 133:109389. [PMID: 33166831 DOI: 10.1016/j.ejrad.2020.109389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/14/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To define the number of TACE sessions needed to improve patients' overall survival (OS) in different subgroups of unresectable HCC. METHODS This retrospective cohort included 180 patients who got TACE between 2005-2016 as the initial treatment for unresectable HCC. Tumor margin (well- vs. ill-defined) was determined by two radiologists at baseline. Well-defined group was divided into two groups (ADC-responders vs. ADC-nonresponders) based on %ADC change (ΔADC-cutoff = 25 %). Accordingly, patients were categorized into three groups, ill-defined, well-defined ADC-responders, or well-defined ADC-nonresponders. Cox-analysis was used to compare the survival benefit of multiple TACE in different groups. RESULTS Ill-defined HCC (n = 108) was associated with worse survival (HR = 1.95,p < 0.001). Multiple TACE were associated with increased OS (HR = 0.88,p = 0.033) in these patients, with significant survival improvement after ≥4TACE. ΔADC was not related to OS in ill-defined group. In well-defined group (n = 72), multiple TACE were not associated with improved OS (HR = 0.181,p = 0.090). These patients were categorized into two groups based on ΔADC-cutoff. ADC-responders (ΔADC≥25 %) had the longest survival than other groups(p = 0.015). Multiple TACE sessions were not associated with better OS in this group (HR = 1.004,p = 0.982). By contrast, incremental number of TACE were associated with significantly longer OS in ADC-nonresponders (ΔADC<25 %) (HR = 0.79,p = 0.034). These patients' OS significantly improved after ≥3TACE. CONCLUSION The survival benefit of sequential TACE sessions varies for different HCC subgroups. There was no significant survival benefit associated with multiple TACE in well-defined lesions responding to the first TACE. The most survival benefit was for ADC-nonresponder well-defined group and it was least for ill-defined HCC group, regardless of ADC-response.
Collapse
Affiliation(s)
- Mohammadreza Shaghaghi
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Mounes AliyariG Hasabeh
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Sanaz Ameli
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Maryam Ghadimi
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Bita Hazhirkarzar
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Roya Rezvani Habibabadi
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Hao Tang
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Pegah Khoshpouri
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Qingxia Wu
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Ankur Pandey
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Pallavi Pandey
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Azarakhsh Baghdadi
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Ihab R Kamel
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA.
| |
Collapse
|
6
|
Post-TACE changes in ADC histogram predict overall and transplant-free survival in patients with well-defined HCC: a retrospective cohort with up to 10 years follow-up. Eur Radiol 2020; 31:1378-1390. [PMID: 32894356 DOI: 10.1007/s00330-020-07237-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/19/2020] [Accepted: 08/27/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the role of change in apparent diffusion coefficient (ADC) histogram after the first transarterial chemoembolization (TACE) in predicting overall and transplant-free survival in well-circumscribed hepatocellular carcinoma (HCC). METHODS Institution database was searched for HCC patients who got conventional TACE during 2005-2016. One hundred four patients with well-circumscribed HCC and complete pre- and post-TACE liver MRI were included. Volumetric MRI metrics including tumor volume, mean ADC, skewness, and kurtosis of ADC histograms were measured. Univariate and multivariable Cox models were used to test the independent role of change in imaging parameters to predict survival. P values < 0.05 were considered significant. RESULTS In total, 367 person-years follow-up data were analyzed. After adjusting for baseline liver function, tumor volume, and treatment modality, incremental percent change in ADC (ΔADC) was an independent predictor of longer overall and transplant-free survival (p = 0.009). Overall, a decrease in ADC-kurtosis (ΔkADC) showed a strong role in predicting longer survival (p = 0.021). Patients in the responder group (ΔADC ≥ 35%) had the best survival profile, compared with non-responders (ΔADC < 35%) (p < 0.001). ΔkADC, as an indicator of change in tissue homogeneity, could distinguish between poor and fair survival in non-responders (p < 0.001). It was not a measure of difference among responders (p = 0.244). Non-responders with ΔkADC ≥ 1 (homogeneous post-TACE tumor) had the worst survival outcome (HR = 5.70, p < 0.001), and non-responders with ΔkADC < 1 had a fair survival outcome (HR = 2.51, p = 0.029), compared with responders. CONCLUSIONS Changes in mean ADC and ADC kurtosis, as a measure of change in tissue heterogeneity, can be used to predict overall and transplant-free survival in well-circumscribed HCC, in order to monitor early response to TACE and identify patients with treatment failure and poor survival outcome. KEY POINTS • Changes in the mean and kurtosis of ADC histograms, as the measures of change in tissue heterogeneity, can be used to predict overall and transplant-free survival in patients with well-defined HCC. • A ≥ 35% increase in volumetric ADC after TACE is an independent predictor of good survival, regardless of the change in ADC histogram kurtosis. • In patients with < 35% ADC change, a decrease in ADC histogram kurtosis indicates partial response and fair survival, while ∆kurtosis ≥ 1 correlates with the worst survival outcome.
Collapse
|
7
|
Comparing HCC arterial tumour vascularisation on baseline imaging and after lipiodol cTACE: how do estimations of enhancing tumour volumes differ on contrast-enhanced MR and CT? Eur Radiol 2019; 30:1601-1608. [PMID: 31811428 DOI: 10.1007/s00330-019-06430-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/05/2019] [Accepted: 08/27/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES In this study, pre-treatment target lesion vascularisation in either contrast-enhanced (CE) CT or MRI and post-treatment lipiodol deposition in native CT scans were compared in HCC patients who underwent their first cTACE treatment. We analysed the impact of stratification according to cTACE selectivity on these correlations. METHODS Seventy-eight HCC patients who underwent their first cTACE procedure were retrospectively included. Pre-treatment tumour vascularisation in arterial contrast phase and post-treatment lipiodol deposition in native CT scans were evaluated using the qEASL (quantitative tumour enhancement) method. Correlations were analysed using scatter plots, the Pearson correlation coefficient (PCC) and linear regression analysis. Subgroup analysis was performed according to lobar, segmental and subsegmental execution of cTACE. RESULTS Arterial tumour volumes in both baseline CE CT (R2 = 0.83) and CE MR (R2 = 0.82) highly correlated with lipiodol deposition after cTACE. The regression coefficient between lipiodol deposition and enhancing tumour volume was 1.39 for CT and 0.33 for MR respectively, resulting in a ratio of 4.24. After stratification according to selectivity of cTACE, the regression coefficient was 0.94 (R2 = 1) for lobar execution, 1.38 (R2 = 0.96) for segmental execution and 1.88 (R2 = 0.89) for subsegmental execution in the CE CT group. CONCLUSIONS Volumetric lipiodol deposition can be used as a reference to compare different imaging modalities in detecting vital tumour volumes. That approach proved CE MRI to be more sensitive than CE CT. Selectivity of cTACE significantly impacts the respective regression coefficients which allows for an innovative approach to the assessment of technical success after cTACE with a multitude of possible applications. KEY POINTS • Lipiodol deposition after cTACE highly correlates with pre-treatment tumour vascularisation and can be used as a reference to compare different imaging modalities in detecting vital tumour volumes. • Lipiodol deposition also correlates with the selectivity of cTACE and can therefore be used to quantify the technical success of the intervention.
Collapse
|
8
|
Diffusion-weighted imaging of hepatocellular carcinoma before and after transarterial chemoembolization: role in survival prediction and response evaluation. Abdom Radiol (NY) 2019; 44:2740-2750. [PMID: 31069479 DOI: 10.1007/s00261-019-02030-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Survival outcomes of patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) are heterogeneous. Measuring the apparent diffusion coefficient (ADC) using diffusion-weighted imaging (DWI) may improve overall survival prediction. AIM To assess the value of measuring the ADC before and after TACE in predicting overall survival. METHODS A retrospective analysis was performed in HCC patients treated with TACE at a tertiary referral center between 2008 and 2017. The ADC values and changes in ADC value (ΔADC) of HCC lesions (≥ 1 cm) and liver parenchyma were assessed by DWI ≤ 3 months before and after first TACE. Pre- and post-TACE ADC values were compared with tumor response according to mRECIST and correlated with overall survival (OS) in a univariable and multivariable Cox-regression analysis. RESULTS A total of 89 patients were included, mostly Child-Pugh A (85%) and BCLC stage B (53%) with a median OS of 21.7 months (95% CI 17.6-25.9). Tumor ADC increased from 1081 mm2/s before (IQR 964-1225) to 1328 mm2/s (IQR 1197-1560) after TACE (p < 0.001). Responders according to mRECIST showed a higher ΔADC after first TACE than non-responders (26 vs. 14%, p = 0.048). Pre-TACE ADC and ΔADC were not significantly associated with OS in both univariable and multivariable analysis, whereas response according to mRECIST remained an independent predictor of OS. CONCLUSION mRECIST was confirmed as an independent prognostic factor of OS, but pre- or post-TACE ADC measurements were not. Response according to mRECIST was associated with a higher increase in ADC than non-response.
Collapse
|
9
|
Luo Y, Pandey A, Ghasabeh MA, Pandey P, Varzaneh FN, Zarghampour M, Khoshpouri P, Ameli S, Li Z, Hu D, Kamel IR. Prognostic value of baseline volumetric multiparametric MR imaging in neuroendocrine liver metastases treated with transarterial chemoembolization. Eur Radiol 2019; 29:5160-5171. [DOI: 10.1007/s00330-019-06100-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 12/17/2022]
|
10
|
Nörthen A, Asendorf T, Shin HO, Hinrichs JB, Werncke T, Vogel A, Kirstein MM, Wacker FK, Rodt T. Parametric response mapping cut-off values that predict survival of hepatocellular carcinoma patients after TACE. Abdom Radiol (NY) 2018; 43:3288-3300. [PMID: 29680967 DOI: 10.1007/s00261-018-1610-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Parametric response mapping (PRM) is a novel image-analysis technique applicable to assess tumor viability and predict intrahepatic recurrence of hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE). However, to date, the prognostic value of PRM for prediction of overall survival in HCC patients undergoing TACE is unclear. The objective of this explorative, single-center study was to identify cut-off values for voxel-specific PRM parameters that predict the post TACE overall survival in HCC patients. METHODS PRM was applied to biphasic CT data obtained at baseline and following 3 TACE treatments of 20 patients with HCC tumors ≥ 2 cm. The individual portal venous phases were registered to the arterial phases followed by segmentation of the largest lesion, i.e., the region of interest (ROI). Segmented voxels with their respective arterial and portal venous phase density values were displayed as a scatter plot. Voxel-specific PRM parameters were calculated and compared to patients' survival at 1, 2, and 3 years post treatment to identify the maximal predictive parameters. RESULTS The hypervascularized tissue portion of the ROI was found to represent an independent predictor of the post TACE overall survival. For this parameter, cut-off values of 3650, 2057, and 2057 voxels, respectively, were determined to be optimal to predict overall survival at 1, 2, and 3 years after TACE. Using these cut points, patients were correctly classified as having died with a sensitivity of 80, 92, and 86% and as still being alive with a specificity of 60, 75, and 83%, respectively. The prognostic accuracy measured by area under the curve (AUC) values ranged from 0.73 to 0.87. CONCLUSION PRM may have prognostic value to predict post TACE overall survival in HCC patients.
Collapse
Affiliation(s)
- Aventinus Nörthen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073, Göttingen, Germany
| | - Hoen-Oh Shin
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Thomas Werncke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Thomas Rodt
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| |
Collapse
|
11
|
Choi MH, Park GE, Oh SN, Park MY, Rha SE, Lee YJ, Jung SE, Choi JI. Reproducibility of mRECIST in Measurement and Response Assessment for Hepatocellular Carcinoma Treated by Transarterial Chemoembolization. Acad Radiol 2018; 25:1363-1373. [PMID: 29555570 DOI: 10.1016/j.acra.2018.02.013] [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] [Received: 01/19/2018] [Revised: 01/30/2018] [Accepted: 02/03/2018] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the reproducibility of Modified Response Evaluation Criteria in Solid Tumors (mRECIST) for hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) using multiphasic computed tomography. MATERIALS AND METHODS The institutional review board approved this retrospective study. We evaluated 97 patients who underwent TACE (60 conventional TACE [cTACE] and 37 drug-eluting bead TACE [DEB-TACE]) for HCC from 2010 to 2014. Four radiologists evaluated pairs of dynamic liver CTs scanned within 2 months before and after TACE based on mRECIST. Assessment of intra- or interobserver reproducibility for response categorization and sum of long diameter were evaluated using weighted kappa statistics (κ) and intraclass correlation coefficients, respectively. The relationship between concordance of target lesion selection and agreement of target lesion response was evaluated using Fisher exact test. RESULTS Intraobserver reproducibility for overall response was moderate to excellent (κ = 0.525-0.865). Interobserver reproducibility was improved on the second review compared to the first review and it was good in both treatment groups (κ = 0.627 for cTACE and 0.602 for DEB-TACE). Between the two treatment methods, intra- or interobserver reproducibility was better after cTACE than DEB-TACE. Intraclass correlation coefficients for sum of long diameter measurement showed excellent intra- or interobserver reproducibility. The concordance rate of target lesion selection was significantly higher for patients with radiologists' agreement for target lesion response than patients with disagreed response (P = .003). CONCLUSIONS The intra- and interobserver reproducibility of mRECIST in patients with HCC after TACE was moderate to excellent, and the reproducibility was slightly better after cTACE than DEB-TACE.
Collapse
|
12
|
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]
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
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]
|
15
|
Updates in hepatic oncology imaging. Surg Oncol 2017; 26:195-206. [DOI: 10.1016/j.suronc.2017.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 12/17/2022]
|
16
|
Raoul JL, Adhoute X, Gilabert M, Edeline J. How to assess the efficacy or failure of targeted therapy: Deciding when to stop sorafenib in hepatocellular carcinoma. World J Hepatol 2016; 8:1541-1546. [PMID: 28050234 PMCID: PMC5165267 DOI: 10.4254/wjh.v8.i35.1541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023] Open
Abstract
Sorafenib is thus far the only systemic treatment for hepatocellular carcinoma (HCC) based on the results of two randomized controlled trials performed in Western and in Eastern countries, despite a poor response rate (from 2% to 3.3%) following conventional evaluation criteria. It is now recognized that the criteria (European Association of the Study of the Liver criteria, modified response evaluation criteria in solid tumors) based on contrast enhanced techniques (computed tomography scan, magnetic resonance imaging) aimed to assess the evolution of the viable part of the tumor (hypervascularized on arterial phase) are of major interest to determine the efficacy of sorafenib and of most antiangiogenic drugs in patients with HCC. The role of alpha-fetoprotein serum levels remains unclear. In 2016, in accordance with the SHARP and the Asia-Pacific trials, sorafenib must be stopped when tolerance is poor despite dose adaptation or in cases of radiological and symptomatic progression. This approach will be different in cases of available second-line therapy trials. Some recent data (in renal cell carcinoma) revealed that despite progression in patients who received sorafenib, this drug can still decrease tumor progression compared to drug cessation. Then, before deciding to continue sorafenib post-progression or shift to another drug, knowing other parameters of post-progression survival (Child-Pugh class, Barcelona Clinic Liver Cancer, alpha-fetoprotein, post-progression patterns in particular, the development of extrahepatic metastases and of portal vein thrombosis) will be of major importance.
Collapse
|
17
|
Ronot M, Clift AK, Vilgrain V, Frilling A. Functional imaging in liver tumours. J Hepatol 2016; 65:1017-1030. [PMID: 27395013 DOI: 10.1016/j.jhep.2016.06.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 02/08/2023]
Abstract
Functional imaging encompasses techniques capable of assessing physiological parameters of tissues, and offers useful clinical information in addition to that obtained from morphological imaging. Such techniques may include magnetic resonance imaging with diffusion-weighted sequences or hepatobiliary contrast agents, perfusion imaging, or molecular imaging with radiolabelled tracers. The liver is of major importance in oncological practice; not only is hepatocellular carcinoma one of the malignancies with steadily rising incidence worldwide, but hepatic metastases are regularly observed with a range of solid neoplasms. Within the realm of hepatic oncology, different functional imaging modalities may occupy pivotal roles in lesion characterisation, treatment selection and follow-up, depending on tumour size and type. In this review, we characterise the major forms of functional imaging, discuss their current application to the management of patients with common primary and secondary liver tumours, and anticipate future developments within this field.
Collapse
Affiliation(s)
- Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, Centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| | | | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, Centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Andrea Frilling
- Department of Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
18
|
Bouda D, Lagadec M, Alba CG, Barrau V, Dioguardi Burgio M, Moussa N, Vilgrain V, Ronot M. Imaging review of hepatocellular carcinoma after thermal ablation: The good, the bad, and the ugly. J Magn Reson Imaging 2016; 44:1070-1090. [DOI: 10.1002/jmri.25369] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 06/16/2016] [Indexed: 12/11/2022] Open
Affiliation(s)
- Damien Bouda
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Matthieu Lagadec
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Carmela Garcia Alba
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Vincent Barrau
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Marco Dioguardi Burgio
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Nadia Moussa
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Valérie Vilgrain
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
- University Paris Diderot; Sorbonne Paris Cité, INSERM UMR 1149 Paris France
| | - Maxime Ronot
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
- University Paris Diderot; Sorbonne Paris Cité, INSERM UMR 1149 Paris France
| |
Collapse
|
19
|
Zhu X, Sobhani F, Xu C, Pan L, Ghasebeh MA, Kamel IR. Quantitative volumetric functional MR imaging: an imaging biomarker of early treatment response in hypo-vascular liver metastasis patients after yttrium-90 transarterial radioembolization. Abdom Radiol (NY) 2016; 41:1495-504. [PMID: 26960726 DOI: 10.1007/s00261-016-0694-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the value of quantitative volumetric functional MR imaging in early assessment of response to yttrium-90-labeled ((90)Y) transarterial radioembolization (TARE) in patients with hypo-vascular liver metastases. MATERIALS AND METHODS Seventy four metastatic lesions in 14 patients with hypo-vascular liver metastases after TARE were included in this retrospective study. Diffusion and contrast-enhanced MR imaging was performed before and early after treatment. All MR images were analyzed by two experienced radiologists. Response by anatomic metrics (RECIST, mRECIST, EASL) and functional metrics (ADC and arterial and venous enhancement) were reported in targeted and non-targeted lesions. A two-sample paired t test was used to compare the changes after TARE. A p value of <0.05 was considered statistically significant. RESULTS The anatomic metrics did not show any significant changes in both targeted and non-targeted groups. Targeted lesions demonstrated an increase in mean volumetric ADC (23.4%; p = 0.01), a decrease in arterial and venous enhancement (-22.9% and -6.7%, respectively; p < 0.001 and p = 0.002, respectively) 1 month after treatment. Twenty one responding lesions (42%) by RECIST at 6 months demonstrated a significant increase in volumetric ADC (37.2%; p = 0.01), decrease in arterial and venous enhancement (-58.5% and -23.9%, respectively; p < 0.001) at 1 month post-treatment. Responding lesions did not change significantly by anatomic metrics. CONCLUSIONS RECIST, mRECIST, and EASL criteria failed to stratify lesions into responders and non-responders early after TARE in hypo-vascular liver metastasis. Quantitative volumetric functional MR imaging could be a promising tool as a biomarker for predicting early response and can potentially be utilized in clinical trials.
Collapse
|
20
|
Hoogenboom TC, Thursz M, Aboagye EO, Sharma R. Functional imaging of hepatocellular carcinoma. Hepat Oncol 2016; 3:137-153. [PMID: 30191034 DOI: 10.2217/hep-2015-0005] [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: 11/16/2015] [Accepted: 01/20/2016] [Indexed: 02/06/2023] Open
Abstract
Imaging plays a key role in the clinical management of hepatocellular carcinoma (HCC), but conventional imaging techniques have limited sensitivity in visualizing small tumors and assessing response to locoregional treatments and sorafenib. Functional imaging techniques allow visualization of organ and tumor physiology. Assessment of functional characteristics of tissue, such as metabolism, proliferation and stiffness, may overcome some of the limitations of structural imaging. In particular, novel molecular imaging agents offer a potential tool for early diagnosis of HCC, and radiomics may aid in response assessment and generate prognostic models. Further prospective research is warranted to evaluate emerging techniques and their cost-effectiveness in the context of HCC in order to improve detection and response assessment.
Collapse
Affiliation(s)
- Tim Ch Hoogenboom
- Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.,Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Mark Thursz
- Department of Hepatology, Imperial College NHS Trust, 10th Floor, Norfolk Place, St Mary's Hospital, London, UK.,Department of Hepatology, Imperial College NHS Trust, 10th Floor, Norfolk Place, St Mary's Hospital, London, UK
| | - Eric O Aboagye
- Comprehensive Cancer Imaging Centre at Imperial College, Faculty of Medicine, Imperial College London, GN1, Ground Floor, Commonwealth building, Hammersmith Campus, London, UK.,Comprehensive Cancer Imaging Centre at Imperial College, Faculty of Medicine, Imperial College London, GN1, Ground Floor, Commonwealth building, Hammersmith Campus, London, UK
| | - Rohini Sharma
- Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.,Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| |
Collapse
|
21
|
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.
Collapse
|
22
|
Chen BB, Murakami T, Shih TTF, Sakamoto M, Matsui O, Choi BI, Kim MJ, Lee JM, Yang RJ, Zeng MS, Chen RC, Liang JD. Novel Imaging Diagnosis for Hepatocellular Carcinoma: Consensus from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014). Liver Cancer 2015; 4:215-27. [PMID: 26734577 PMCID: PMC4698631 DOI: 10.1159/000367742] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Current novel imaging techniques in the diagnosis of hepatocellular carcinoma (HCC), with the latest evidence in this field, was discussed at the Asia-Pacific Primary Liver Cancer Expert (APPLE) meeting held in Taipei, Taiwan, in July 2014. Based on their expertise in a specific area of research, the novel imaging group comprised 12 participants from Japan, South Korea, Taiwan, and China and it included 10 abdominal radiologists, one hepatologist, and one pathologist. The expert participants discussed topics related to HCC imaging that were divided into four categories: (i) detection method, (ii) diagnostic method, (iii) evaluation method, and (iv) functional method. Consensus was reached on 10 statements; specific comments on each statement were provided to explain the rationale for the voting results and to suggest future research directions.
Collapse
Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
| | - Takamichi Murakami
- Department of Radiology, Kinki University, Faculty of Medicine, Osaka, Japan,*Takamichi Murakami, MD, PhD, Department of Radiology, Kinki University, Faculty of Medicine, 377-2, Ohno-Higashi, Osakasayama-City, Osaka 589-8511 (Japan), TEL. +81 72 366 0221, E-Mail
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo
| | - Osamu Matsui
- Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | | | - Myeong-Jin Kim
- Department of Radiology, Yonsei University College of Medicine
| | - Jeong Min Lee
- Department of Radiology, Seoul National University, Seoul, Republic of Korea
| | - Ren-jie Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Interventional Therapy, Peking University Cancer Hospital & Institute, Beijing, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ran-Chou Chen
- Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Heping Fuyou Branch, Taipei City Hospital, Taiwan (ROC)
| | - Ja-Der Liang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
| |
Collapse
|
23
|
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.
Collapse
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.
| |
Collapse
|
24
|
Imaging of the Liver Following Interventional Therapy for Hepatic Neoplasms. Radiol Clin North Am 2015; 53:1061-76. [DOI: 10.1016/j.rcl.2015.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
25
|
Kim BK, Kim KA, Kim MJ, Park JY, Kim DY, Ahn SH, Han KH, Kim SU, Park MS. Inter-observer variability of response evaluation criteria for hepatocellular carcinoma treated with chemoembolization. Dig Liver Dis 2015; 47:682-8. [PMID: 25977216 DOI: 10.1016/j.dld.2015.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/26/2015] [Accepted: 04/07/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data comparing EASL and mRECIST criteria for response evaluation in treatment of hepatocellular carcinoma are rare. We evaluated inter-observer variability by these two response evaluation criteria in treatment-naïve patients undergoing chemoembolization. METHODS For 133 patients undergoing chemoembolization, two radiologists independently measured sum of bi-dimensional and uni-dimensional diameters at baseline using both EASL criteria and mRECIST, and their changes on first follow-up for up to 5 target lesions. RESULTS Concordance correlation coefficients for sum of bi-dimensional and uni-dimensional diameters at baseline between two observers were 0.992 and 0.988, respectively. However, those for their changes on follow-up were 0.865 and 0.877, respectively. Similarly, mean differences in sum of bi-dimensional and uni-dimensional diameters at baseline between two observers were small; -0.455 and 0.079 cm, respectively. However, mean differences in changes (%) in sum of bi-dimensional and uni-dimensional diameters on first follow-up between observers increased by -9.715% and -9.320%, respectively. Regarding tumour numbers, kappa-value between observers was 0.942. For treatment response (complete or partial response, stable disease and progression), kappa-value was 0.941 by both criteria. When only up to two target lesions were assessed, kappa-value was 1.000 by both criteria. CONCLUSIONS Inter-observer agreements using both response evaluation criteria were excellent, especially when up to two targets were assessed.
Collapse
Affiliation(s)
- Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Republic of Korea; Liver Cirrhosis Clinical Research Center, Republic of Korea
| | - Kyung Ah Kim
- Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Myeong-Jin Kim
- Department of Radiology, Yonsei University College of Medicine, Republic of Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Republic of Korea; Liver Cirrhosis Clinical Research Center, Republic of Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Republic of Korea; Liver Cirrhosis Clinical Research Center, Republic of Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Republic of Korea; Liver Cirrhosis Clinical Research Center, Republic of Korea; Brain Korea 21 Project for Medical Science, Seoul, Republic of Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Republic of Korea; Liver Cirrhosis Clinical Research Center, Republic of Korea; Brain Korea 21 Project for Medical Science, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Republic of Korea; Liver Cirrhosis Clinical Research Center, Republic of Korea.
| | - Mi-Suk Park
- Department of Radiology, Yonsei University College of Medicine, Republic of Korea.
| |
Collapse
|
26
|
Histogram Analysis of CT Perfusion of Hepatocellular Carcinoma for Predicting Response to Transarterial Radioembolization: Value of Tumor Heterogeneity Assessment. Cardiovasc Intervent Radiol 2015. [PMID: 26216725 DOI: 10.1007/s00270-015-1185-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate in patients with hepatocellular carcinoma (HCC), whether assessment of tumor heterogeneity by histogram analysis of computed tomography (CT) perfusion helps predicting response to transarterial radioembolization (TARE). MATERIALS AND METHODS Sixteen patients (15 male; mean age 65 years; age range 47-80 years) with HCC underwent CT liver perfusion for treatment planning prior to TARE with Yttrium-90 microspheres. Arterial perfusion (AP) derived from CT perfusion was measured in the entire tumor volume, and heterogeneity was analyzed voxel-wise by histogram analysis. Response to TARE was evaluated on follow-up imaging (median follow-up, 129 days) based on modified Response Evaluation Criteria in Solid Tumors (mRECIST). Results of histogram analysis and mean AP values of the tumor were compared between responders and non-responders. Receiver operating characteristics were calculated to determine the parameters' ability to discriminate responders from non-responders. RESULTS According to mRECIST, 8 patients (50%) were responders and 8 (50%) non-responders. Comparing responders and non-responders, the 50th and 75th percentile of AP derived from histogram analysis was significantly different [AP 43.8/54.3 vs. 27.6/34.3 mL min(-1) 100 mL(-1)); p < 0.05], while the mean AP of HCCs (43.5 vs. 27.9 mL min(-1) 100 mL(-1); p > 0.05) was not. Further heterogeneity parameters from histogram analysis (skewness, coefficient of variation, and 25th percentile) did not differ between responders and non-responders (p > 0.05). If the cut-off for the 75th percentile was set to an AP of 37.5 mL min(-1) 100 mL(-1), therapy response could be predicted with a sensitivity of 88% (7/8) and specificity of 75% (6/8). CONCLUSION Voxel-wise histogram analysis of pretreatment CT perfusion indicating tumor heterogeneity of HCC improves the pretreatment prediction of response to TARE.
Collapse
|
27
|
Three-dimensional conformal radiation therapy in the liver: MRI findings along a time continuum. J Comput Assist Tomogr 2015; 39:356-64. [PMID: 25700224 DOI: 10.1097/rct.0000000000000219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Recent development of 3-dimensional conformal radiation therapies provides a concentrated radiation dose to the tumor. To achieve this goal, a complex design of multiple narrow beamlets is used to shape the radiation exposure to conform to the shape of the tumor. Imaging findings after novel radiation therapy techniques differ from those of conventional radiation therapy. This article discusses changes in the liver parenchyma and tumor after conformal radiation therapy focusing on magnetic resonance imaging.
Collapse
|
28
|
Wang Z, Chapiro J, Schernthaner R, Duran R, Chen R, Geschwind JF, Lin M. Multimodality 3D Tumor Segmentation in HCC Patients Treated with TACE. Acad Radiol 2015; 22:840-5. [PMID: 25863795 DOI: 10.1016/j.acra.2015.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 02/12/2015] [Accepted: 03/08/2015] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To validate the concordance of a semiautomated multimodality lesion segmentation technique between contrast-enhanced magnetic resonance imaging (CE-MRI), cone-beam computed tomography (CBCT), and multidetector CT (MDCT) in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). MATERIALS AND METHODS This retrospective analysis included 45 patients with unresectable HCC who underwent baseline CE-MRI within 1 month before the treatment, intraprocedural CBCT during conventional TACE, and MDCT within 24 hours after TACE. Fourteen patients were excluded because of atypical lesion morphology, portal vein invasion, or small lesion size which precluded sufficient lesion visualization. Thirty-one patients with a total of 40 target lesions were included into the analysis. A tumor segmentation software, based on non-Euclidean geometry and theory of radial basis functions, was used to allow for the segmentation of target lesions in 3D on all three modalities. The algorithm created image-based masks located in a 3D region whose center and size were defined by the user, yielding the nomenclature "semiautomatic". On the basis of that, tumor volumes on all three modalities were calculated and compared using a linear regression model (R(2) values). Residual plots were used to analyze drift and variance of the values. RESULTS The mean value of tumor volumes was 18.72 ± 19.13 cm(3) (range, 0.41-59.16 cm(3)) on CE-MRI, 21.26 ± 21.99 cm(3) (range, 0.62-86.82 cm(3)) on CBCT, and 19.88 ± 20.88 cm(3) (range, 0.45-75.24 cm(3)) on MDCT. The average volumes of the tumor were not significantly different between CE-MRI and DP-CBCT, DP-CBCT and MDCT, MDCT and CE-MRI (P = .577, .770, and .794, respectively). A strong correlation between volumes on CE-MRI and CBCT, CBCT and MDCT, MDCT and CE-MRI was observed (R(2) = 0.974, 0.992 and 0.983, respectively). When plotting the residuals, no drift was observed for all methods showing deviations of no >10% of absolute volumes (in cm(3)). CONCLUSIONS A semiautomated 3D segmentation of HCC lesions treated with TACE provides high volumetric concordance across all tested imaging modalities.
Collapse
|
29
|
Tacher V, Lin M, Duran R, Yarmohammadi H, Lee H, Chapiro J, Chao M, Wang Z, Frangakis C, Sohn JH, Maltenfort MG, Pawlik T, Geschwind JF. Comparison of Existing Response Criteria in Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization Using a 3D Quantitative Approach. Radiology 2015; 278:275-84. [PMID: 26131913 DOI: 10.1148/radiol.2015142951] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare currently available non-three-dimensional methods (Response Evaluation Criteria in Solid Tumors [RECIST], European Association for Study of the Liver [EASL], modified RECIST [mRECIST[) with three-dimensional (3D) quantitative methods of the index tumor as early response markers in predicting patient survival after initial transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS This was a retrospective single-institution HIPAA-compliant and institutional review board-approved study. From November 2001 to November 2008, 491 consecutive patients underwent intraarterial therapy for liver cancer with either conventional TACE or TACE with drug-eluting beads. A diagnosis of hepatocellular carcinoma (HCC) was made in 290 of these patients. The response of the index tumor on pre- and post-TACE magnetic resonance images was assessed retrospectively in 78 treatment-naïve patients with HCC (63 male; mean age, 63 years ± 11 [standard deviation]). Each response assessment method (RECIST, mRECIST, EASL, and 3D methods of volumetric RECIST [vRECIST] and quantitative EASL [qEASL]) was used to classify patients as responders or nonresponders by following standard guidelines for the uni- and bidimensional measurements and by using the formula for a sphere for the 3D measurements. The Kaplan-Meier method with the log-rank test was performed for each method to evaluate its ability to help predict survival of responders and nonresponders. Uni- and multivariate Cox proportional hazard ratio models were used to identify covariates that had significant association with survival. RESULTS The uni- and bidimensional measurements of RECIST (hazard ratio, 0.6; 95% confidence interval [CI]: 0.3, 1.0; P = .09), mRECIST (hazard ratio, 0.6; 95% CI: 0.6, 1.0; P = .05), and EASL (hazard ratio, 1.1; 95% CI: 0.6, 2.2; P = .75) did not show a significant difference in survival between responders and nonresponders, whereas vRECIST (hazard ratio, 0.6; 95% CI: 0.3, 1.0; P = .04), qEASL (Vol) (hazard ratio, 0.5; 95% CI: 0.3, 0.9; P = .02), and qEASL (%) (hazard ratio, 0.3; 95% CI: 0.15, 0.60; P < .001) did show a significant difference between these groups. CONCLUSION The 3D-based imaging biomarkers qEASL and vRECIST were tumor response criteria that could be used to predict patient survival early after initial TACE and enabled clear identification of nonresponders.
Collapse
Affiliation(s)
- Vania Tacher
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - MingDe Lin
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Rafael Duran
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Hooman Yarmohammadi
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Howard Lee
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Julius Chapiro
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Michael Chao
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Zhijun Wang
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Constantine Frangakis
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Jae Ho Sohn
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Mitchell Gil Maltenfort
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Timothy Pawlik
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| | - Jean-François Geschwind
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.)
| |
Collapse
|
30
|
Intraprocedural 3D Quantification of Lipiodol Deposition on Cone-Beam CT Predicts Tumor Response After Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2015; 38:1548-56. [PMID: 26001366 DOI: 10.1007/s00270-015-1129-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/26/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate whether intraprocedural 3D quantification of Lipiodol deposition on cone-beam computed tomography (CBCT) can predict tumor response on follow-up contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE). MATERIALS AND METHODS This IRB approved, retrospective analysis included 36 patients with 51 HCC target lesions, who underwent cTACE with CBCT. CE-MRI was acquired at baseline and 1 month after cTACE. Overall tumor volumes as well as intratumoral Lipiodol volumes on CBCT were measured and compared with the overall and necrotic (non-enhancing) tumor volumes on CE-MRI using the paired student's t test. Tumor response on CE-MRI was assessed using modified response evaluation criteria in solid tumors (mRECIST). A linear regression model was used to correlate tumor volumes, Lipiodol volumes, and the percentage of Lipiodol deposition on CBCT with the corresponding parameters on CE-MRI. Nonparametric spearman rank-order correlation and trend test were used to correlate the percentage of Lipiodol deposition in the tumor with tumor response. RESULT A strong correlation between overall tumor volumes on CBCT and CE-MRI was observed (R(2) = 0.986). In addition, a strong correlation was obtained between the volume of Lipiodol deposition on CBCT and tumor necrosis (in cm(3)) on CE-MRI (R(2) = 0.960), and between the percentage of Lipiodol deposition and tumor necrosis (R(2) = 0.979). Importantly, the extent of Lipiodol deposition (in percentage of total tumor volume) correlated strongly with tumor response on CE-MRI (Spearman rho = 0.84, p < 0.001). CONCLUSIONS Intraprocedural 3D quantification of Lipiodol deposition on CBCT can be used to predict tumor response on follow-up CE-MRI.
Collapse
|
31
|
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.
Collapse
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.
| |
Collapse
|
32
|
Abstract
Newly developed or advanced methods of ultrasonography and MR imaging provide combined anatomical and quantitative functional information about diffuse and focal liver diseases. Ultrasound elastography has a central role for staging liver fibrosis and an increasing role in grading portal hypertension; dynamic contrast-enhanced ultrasonography may improve tumor characterization. In clinical practice, MR imaging examinations currently include diffusion-weighted and dynamic MR imaging, enhanced with extracellular or hepatobiliary contrast agents. Moreover, quantitative parameters obtained with diffusion-weighted MR imaging, dynamic contrast-enhanced MR imaging and MR elastography have the potential to characterize further diffuse and focal liver diseases, by adding information about tissue cellularity, perfusion, hepatocyte transport function and visco-elasticity. The multiparametric capability of ultrasonography and more markedly of MR imaging gives the opportunity for high diagnostic performance by combining imaging biomarkers. However, image acquisition and post-processing methods should be further standardized and validated in multicenter trials.
Collapse
|
33
|
Valero V, Amini N, Spolverato G, Weiss MJ, Hirose K, Dagher NN, Wolfgang CL, Cameron AA, Philosophe B, Kamel IR, Pawlik TM. Sarcopenia adversely impacts postoperative complications following resection or transplantation in patients with primary liver tumors. J Gastrointest Surg 2015; 19:272-81. [PMID: 25389056 PMCID: PMC4332815 DOI: 10.1007/s11605-014-2680-4] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 10/10/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sarcopenia is a surrogate marker of patient frailty that estimates the physiologic reserve of an individual patient. We sought to investigate the impact of sarcopenia on short- and long-term outcomes in patients having undergone surgical intervention for primary hepatic malignancies. METHODS Ninety-six patients who underwent hepatic resection or liver transplantation for HCC or ICC at the John Hopkins Hospital between 2000 and 2013 met inclusion criteria. Sarcopenia was assessed by the measurement of total psoas major volume (TPV) and total psoas area (TPA). The impact of sarcopenia on perioperative complications and survival was assessed. RESULTS Mean age was 61.9 years and most patients were men (61.4 %). Mean adjusted TPV was lower in women (23.3 cm(3)/m) versus men (34.9 cm(3)/m) (P < 0.01); 47 patients (48.9 %) had sarcopenia. The incidence of a postoperative complication was 40.4 % among patients with sarcopenia versus 18.4 % among patients who did not have sarcopenia (P = 0.01). Of note, all Clavien grade ≥3 complications (n = 11, 23.4 %) occurred in the sarcopenic group. On multivariable analysis, the presence of sarcopenia was an independent predictive factor of postoperative complications (OR = 3.06). Sarcopenia was not associated with long-term survival (HR = 1.23; P = 0.51). CONCLUSIONS Sarcopenia, as assessed by TPV, was an independent factor predictive of postoperative complications following surgical intervention for primary hepatic malignancies.
Collapse
Affiliation(s)
- Vicente Valero
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA
| | - Neda Amini
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA
| | - Gaya Spolverato
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA
| | - Matthew J. Weiss
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA
| | - Kenzo Hirose
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA
| | - Nabil N. Dagher
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA
| | - Christopher L. Wolfgang
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA
| | - Andrew A. Cameron
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA
| | - Benjamin Philosophe
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA
| | - Ihab R. Kamel
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M. Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA
| |
Collapse
|
34
|
Chapiro J, Duran R, Lin M, Schernthaner RE, Wang Z, Gorodetski B, Geschwind JF. Identifying Staging Markers for Hepatocellular Carcinoma before Transarterial Chemoembolization: Comparison of Three-dimensional Quantitative versus Non-three-dimensional Imaging Markers. Radiology 2014; 275:438-47. [PMID: 25531387 DOI: 10.1148/radiol.14141180] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose To test and compare the association between radiologic measurements of lesion diameter, volume, and enhancement on baseline magnetic resonance (MR) images with overall survival and tumor response in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Materials and Methods This HIPAA-compliant retrospective, single-institution analysis was approved by the institutional review board, with waiver of informed consent. It included 79 patients with unresectable HCC who were treated with TACE. Baseline arterial phase contrast material-enhanced (CE) MR imaging was used to measure the overall and enhancing tumor diameters. A segmentation-based three-dimensional quantification of the overall and enhancing tumor volumes was performed in each patient. Numeric cutoff values (5 cm for diameters and 65 cm(3) for volumes) were used to stratify the patient cohort in two groups. Tumor response rates according to Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) guidelines were recorded for all groups. Survival was evaluated by using Kaplan-Meier analysis and was compared by using Cox proportional hazard ratios (HRs) after univariate and multivariate analysis. Results Stratification according to overall and enhancing tumor diameters did not result in a significant separation of survival curves (HR, 1.4; 95% confidence interval [CI]: 0.7, 2.5; P = .234; and HR, 1.6; 95% CI: 0.9, 2.8; P = .08, respectively). The stratification according to overall and enhancing tumor volume achieved significance (HR, 1.8; 95% CI: 0.9, 3.4; P = .022; and HR, 1.8; 95% CI: 1.1, 3.1; P = .017, respectively). As for tumor response, higher response rates were observed in smaller lesions compared with larger lesions, when the 5-cm threshold (27% vs 15% for mRECIST and 45% vs 24% for EASL) was used. Conclusion As opposed to anatomic tumor diameter as the most commonly used staging marker, volumetric assessment of lesion size and enhancement on baseline CE MR images is strongly associated with survival of patients with HCC who were treated with TACE.
Collapse
Affiliation(s)
- Julius Chapiro
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, the Johns Hopkins Hospital, 1800 Orleans St, Sheikh Zayed Tower, Suite 7203, Baltimore, MD 21287 (J.C., R.D., M.L., R.E.S., Z.W., B.G., J.F.G.); Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany (J.C., B.G.); and U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.)
| | | | | | | | | | | | | |
Collapse
|
35
|
Chapiro J, Lin M, Duran R, Schernthaner RE, Geschwind JF. Assessing tumor response after loco-regional liver cancer therapies: the role of 3D MRI. Expert Rev Anticancer Ther 2014; 15:199-205. [PMID: 25371052 DOI: 10.1586/14737140.2015.978861] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Assessing the tumor response of liver cancer lesions after intraarterial therapies is of major clinical interest. Over the last two decades, tumor response criteria have come a long way from purely size-based, anatomic methods such as the Response Evaluation Criteria in Solid Tumors towards more functional, enhancement- and diffusion-based parameters with a strong emphasis on MRI as the ultimate imaging modality. However, the relatively low reproducibility of those one- and 2D techniques (modified Response Evaluation Criteria in Solid Tumors and the European Association for the Study of the Liver criteria) provided the rationale for the development of new, 3D quantitative assessment techniques. This review will summarize and compare the existing methodologies used for 3D quantitative tumor analysis and provide an overview of the published clinical evidence for the benefits of 3D quantitative tumor response assessment techniques.
Collapse
Affiliation(s)
- Julius Chapiro
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower, Suite 7203, Baltimore, MD 21287, USA
| | | | | | | | | |
Collapse
|
36
|
Volumetric assessment of tumour response using functional MR imaging in patients with hepatocellular carcinoma treated with a combination of doxorubicin-eluting beads and sorafenib. Eur Radiol 2014; 25:380-90. [PMID: 25226843 DOI: 10.1007/s00330-014-3412-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 08/19/2014] [Accepted: 08/25/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To prospectively assess treatment response using volumetric functional magnetic resonance imaging (MRI) metrics in patients with hepatocellular carcinoma (HCC) treated with the combination of doxorubicin-eluting bead-transarterial chemoembolization (DEB TACE) and sorafenib. METHODS A single center study enrolled 41 patients treated with systemic sorafenib, 400 mg twice a day, combined with DEB TACE. All patients had a pre-treatment and 3-4 week post-treatment MRI. Anatomic response criteria (RECIST, mRECIST and EASL) and volumetric functional response (ADC, enhancement) were assessed. Statistical analyses included paired Student's t-test, Kaplan-Meier curves, Cohen's Kappa, and multivariate cox proportional hazard model. RESULTS Median tumour size by RECIST remained unchanged post-treatment (8.3 ± 4.1 cm vs. 8.1 ± 4.3 cm, p = 0.44). There was no significant survival difference for early response by RECIST (p = 0.93). EASL and mRECIST could not be analyzed in 12 patients. Volumetric ADC increased significantly (1.32 × 10(-3) mm(2)/sec to 1.60 × 10(-3) mm(2)/sec, p < 0.001), and volumetric enhancement decreased significantly in HAP (38.2% to 17.6%, p < 0.001) and PVP (76.6% to 41.2%, p < 0.005). Patients who demonstrated ≥ 65% decrease PVP enhancement had significantly improved overall survival compared to non-responders (p < 0.005). CONCLUSION Volumetric PVP enhancement was demonstrated to be significantly correlated with survival in the combination of DEB TACE and sorafenib for patients with HCC, enabling precise stratification of responders and non-responders. KEY POINTS • PVP enhancement is significantly correlated with survival in responders (p < 0.005). • There was no significant survival difference for early response using RECIST (p = 0.93). • mRECIST or EASL could not assess tumour response in 29% of patients.
Collapse
|
37
|
Chapiro J, Wood LD, Lin M, Duran R, Cornish T, Lesage D, Charu V, Schernthaner R, Wang Z, Tacher V, Savic LJ, Kamel IR, Geschwind JF. Radiologic-pathologic analysis of contrast-enhanced and diffusion-weighted MR imaging in patients with HCC after TACE: diagnostic accuracy of 3D quantitative image analysis. Radiology 2014; 273:746-58. [PMID: 25028783 DOI: 10.1148/radiol.14140033] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of three-dimensional ( 3D three-dimensional ) quantitative enhancement-based and diffusion-weighted volumetric magnetic resonance (MR) imaging assessment of hepatocellular carcinoma ( HCC hepatocellular carcinoma ) lesions in determining the extent of pathologic tumor necrosis after transarterial chemoembolization ( TACE transarterial chemoembolization ). MATERIALS AND METHODS This institutional review board-approved retrospective study included 17 patients with HCC hepatocellular carcinoma who underwent TACE transarterial chemoembolization before surgery. Semiautomatic 3D three-dimensional volumetric segmentation of target lesions was performed at the last MR examination before orthotopic liver transplantation or surgical resection. The amount of necrotic tumor tissue on contrast material-enhanced arterial phase MR images and the amount of diffusion-restricted tumor tissue on apparent diffusion coefficient ( ADC apparent diffusion coefficient ) maps were expressed as a percentage of the total tumor volume. Visual assessment of the extent of tumor necrosis and tumor response according to European Association for the Study of the Liver ( EASL European Association for the Study of the Liver ) criteria was performed. Pathologic tumor necrosis was quantified by using slide-by-slide segmentation. Correlation analysis was performed to evaluate the predictive values of the radiologic techniques. RESULTS At histopathologic examination, the mean percentage of tumor necrosis was 70% (range, 10%-100%). Both 3D three-dimensional quantitative techniques demonstrated a strong correlation with tumor necrosis at pathologic examination (R(2) = 0.9657 and R(2) = 0.9662 for quantitative EASL European Association for the Study of the Liver and quantitative ADC apparent diffusion coefficient , respectively) and a strong intermethod agreement (R(2) = 0.9585). Both methods showed a significantly lower discrepancy with pathologically measured necrosis (residual standard error [ RSE residual standard error ] = 6.38 and 6.33 for quantitative EASL European Association for the Study of the Liver and quantitative ADC apparent diffusion coefficient , respectively), when compared with non- 3D three-dimensional techniques ( RSE residual standard error = 12.18 for visual assessment). CONCLUSION This radiologic-pathologic correlation study demonstrates the diagnostic accuracy of 3D three-dimensional quantitative MR imaging techniques in identifying pathologically measured tumor necrosis in HCC hepatocellular carcinoma lesions treated with TACE transarterial chemoembolization .
Collapse
Affiliation(s)
- Julius Chapiro
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287 (J.C., M.L., R.D., R.S., Z.W., V.T., L.J.S., I.R.K., J.F.G.); Department of Pathology, The Johns Hopkins Hospital, Baltimore, Md (L.D.W., T.C.); Philips Research, Medisys, Suresnes, France (D.L.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (V.C.)
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Ye XD, Li WT, Yuan Z. Is Volumetric Functional MR Imaging Superior to Current Anatomic Imaging Response Criteria for Hepatocellular Carcinoma after Intraarterial Therapy? Radiology 2014; 271:619-620. [DOI: 10.1148/radiol.14132533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
39
|
Corona-Villalobos CP, Pawlik TM, Kamel IR. Imaging of the Patient with a Biliary Tract or Primary Liver Tumor. Surg Oncol Clin N Am 2014; 23:189-206. [DOI: 10.1016/j.soc.2013.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
40
|
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.
Collapse
|
41
|
Functional Volumetric MRI in Assessing Treatment Response to Intra-Arterial Therapy of Primary and Secondary Liver Tumors. J Comput Assist Tomogr 2014; 38:513-7. [DOI: 10.1097/rct.0000000000000072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
42
|
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.
Collapse
|
43
|
Bonekamp D, Bonekamp S, Halappa VG, Geschwind JFH, Eng J, Corona-Villalobos CP, Pawlik TM, Kamel IR. Interobserver agreement of semi-automated and manual measurements of functional MRI metrics of treatment response in hepatocellular carcinoma. Eur J Radiol 2013; 83:487-96. [PMID: 24387824 DOI: 10.1016/j.ejrad.2013.11.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 11/11/2013] [Accepted: 11/17/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the interobserver agreement in 50 patients with hepatocellular carcinoma (HCC) before and 1 month after intra-arterial therapy (IAT) using two semi-automated methods and a manual approach for the following functional, volumetric and morphologic parameters: (1) apparent diffusion coefficient (ADC), (2) arterial phase enhancement (AE), (3) portal venous phase enhancement (VE), (4) tumor volume, and assessment according to (5) the Response Evaluation Criteria in Solid Tumors (RECIST), and (6) the European Association for the Study of the Liver (EASL). MATERIALS AND METHODS This HIPAA-compliant retrospective study had institutional review board approval. The requirement for patient informed consent was waived. Tumor ADC, AE, VE, volume, RECIST, and EASL in 50 index lesions was measured by three observers. Interobserver reproducibility was evaluated using intraclass correlation coefficients (ICC). P<0.05 was considered to indicate a significant difference. RESULTS Semi-automated volumetric measurements of functional parameters (ADC, AE, and VE) before and after IAT as well as change in tumor ADC, AE, or VE had better interobserver agreement (ICC=0.830-0.974) compared with manual ROI-based axial measurements (ICC=0.157-0.799). Semi-automated measurements of tumor volume and size in the axial plane before and after IAT had better interobserver agreement (ICC=0.854-0.996) compared with manual size measurements (ICC=0.543-0.596), and interobserver agreement for change in tumor RECIST size was also higher using semi-automated measurements (ICC=0.655) compared with manual measurements (ICC=0.169). EASL measurements of tumor enhancement in the axial plane before and after IAT ((ICC=0.758-0.809), and changes in EASL after IAT (ICC=0.653) had good interobserver agreement. CONCLUSION Semi-automated measurements of functional changes assessed by ADC and VE based on whole-lesion segmentation demonstrated better reproducibility than ROI-based axial measurements, or RECIST or EASL measurements.
Collapse
Affiliation(s)
- David Bonekamp
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | - Susanne Bonekamp
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | - Vivek Gowdra Halappa
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | | | - John Eng
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | | | - Timothy M Pawlik
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; The Johns Hopkins School of Medicine, Department of Surgery, Oncology, Baltimore, MD, United States
| | - Ihab R Kamel
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States.
| |
Collapse
|
44
|
Bonekamp S, Bonekamp D, Geschwind JFH, Corona-Villalobos CP, Reyes DK, Pawlik TM, Kamel IR. Response stratification and survival analysis of hepatocellular carcinoma patients treated with intra-arterial therapy using MR imaging-based arterial enhancement fraction. J Magn Reson Imaging 2013; 40:1103-11. [PMID: 24214827 DOI: 10.1002/jmri.24465] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/11/2013] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To investigate the feasibility that arterial enhancement fraction (AEF) is associated with response of hepatocellular carcinoma (HCC) following intra-arterial therapy (IAT) and to compare AEF response with currently used tumor response metrics. MATERIALS AND METHODS The AEF, Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) of the largest treated index lesion and AEF of the tumor-free hepatic parenchyma was measured on representative axial images in 131 patients (108 male; mean age, 61.9 years). Clinical measures and patient survival were assessed. Statistical analysis included Wilcoxon signed-rank test and the COX proportional hazards model. RESULTS After IAT, the mean AEF of the tumor decreased by 22% (66.7-44.8%, P < 0.0001), while the mean AEF of the tumor-free parenchyma remained unchanged (27.2-26.5%, P = 0.50). Median survival of all 131 patients with liver cancer was 17 months. Patients were stratified into AEF-responders if they had an AEF-decrease ≥35% (AEF-responders: n = 67; AEF-nonresponders: n = 64). AEF-responders survived longer than nonresponders (34.8 months versus 10.8 months, hazard ratio = 0.39; P < 0.0001). Responders according to RECIST, mRECIST, or EASL did not survive significantly longer compared with nonresponders. CONCLUSION Evaluating the AEF values based on tri-phasic MRI is associated with tumor response in patients with unresectable HCC treated with IAT.
Collapse
Affiliation(s)
- Susanne Bonekamp
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | | | | | | | | | | |
Collapse
|