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Meine TC, Ringe KI. [Ablation of liver tumors : From pre-interventional imaging to post-interventional assessment]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:503-514. [PMID: 38780657 DOI: 10.1007/s00117-024-01308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/25/2024]
Abstract
The aim of this article is to provide an overview on the most frequently applied image-guided, percutaneous, local ablative techniques for treatment of primary and secondary liver tumors. The technical procedures of microwave ablation (MWA) and radiofrequency ablation (RFA) are presented. The pre-interventional diagnostics, indications and feasibility are also discussed, taking the current national guidelines into consideration. Finally, treatment outcomes and recommendations on post-interventional imaging following local tumor ablation are presented.
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Affiliation(s)
- Timo C Meine
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| | - Kristina I Ringe
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
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The role of dynamic and diffusion MR imaging in therapeutic response assessment after microwave ablation of hepatocellular carcinoma using LI-RADS v2018 treatment response algorithm. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00428-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Hepatocellular carcinoma (HCC) is considered as one of the major causes of morbidity and mortality worldwide. Microwave ablation (MWA) is a widely used treatment option having less morbidity and complications as compared with surgery and liver transplantation. MRI is the most widely used modality in the assessment of treatment response after MWA. Currently, LI-RADS v2018 algorithm is considered the cornerstone in daily clinical practice for assessment of the treatment response after locoregional therapy. The aim of the study was to assess the role of dynamic MRI and diffusion imaging in the assessment of treatment response and detection of tumor viability following microwave ablation therapy of HCC according to LI-RADS v2018 treatment response algorithm.
Results
This retrospective study was performed over 45 HCC lesions underwent MWA as the only therapeutic procedure and followed up by dynamic MRI with diffusion images and then classified according to the LI-RADS treatment response criteria into LR-TR viable and LR-TR nonviable groups. All the malignant lesions found in this study showed arterial phase hyperenhancment (APHE), whether in the early or late arterial phases. Delayed washout was found in all malignant lesions as well. In the diffusion analysis, the mean ADC value for the malignant lesions was 0.900 ± 0.126 × 10-3 mm2/s, while the mean ADC of the treatment-related specific benign parenchymal enhancement was 1.284 ± 0.129 × 10-3 mm2/s with a significant statistical difference in between (P = 0.0001) and a cutoff value of 1.11 × 10-3 mm2/s. Our findings showed that the dynamic MRI has 100% sensitivity, 93.5% specificity, 87.5% PPV, and 100% NPV in the detection of tumoral activity compared with 71.43% sensitivity, 93.55% specificity, 83.33% PPV, and 87.88% NPV for diffusion images.
Conclusion
LI-RADS 2018 provides a treatment response algorithm superior to the previously used assessment criteria. MRI with dynamic contrast-enhanced technique and diffusion imaging provide a powerful tool in the evaluation of treatment response after microwave ablation of hepatocellular carcinoma using the LI-RADS treatment response criteria and is considered a reliable method in differentiating between the recurrent or residual malignant lesions and the posttreatment benign liver changes.
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Zhang G, Li W, Wang G, He X, Xu L, Wang S, Peng W. Multimode tumor ablation therapy induced different diffusion and microvasculature related parameters change on functional magnetic resonance imaging compared to radiofrequency ablation in liver tumor: An observational study. Medicine (Baltimore) 2020; 99:e20795. [PMID: 32590762 PMCID: PMC7329015 DOI: 10.1097/md.0000000000020795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
To explore different posttreatment changes between multimode tumor ablation therapy (MTAT) and radiofrequency ablation (RFA) using intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and diffusion kurtosis imaging (DKI) in patients with hepatic malignancies.Eighty - seven patients with one hundred and twenty eight hepatic lesions receiving MTAT or RFA underwent IVIM-DWI and DKI before and after treatment. The mean value of apparent diffusion coefficient (ADC), IVIM-DWI parameters, including true diffusion coefficient (D), pseudo-diffusion coefficient (DP), perfusion fraction (f), and DKI parameters including diffusion coefficient (DK), apparent diffusional kurtosis (K) were retrospectively compared prior to and following treatment as well as between treatment groups. The degree of parameters change after ablation was compared between 2 treatment modalities.The mean value of ADC, D, and DK increased while f, and K decreased significantly in MTAT group. In RFA group, just ADC and K showed significantly change following treatment. The ADC and D value were higher in MTAT group than in RFA group 1 month after treatment. While f was lower in MTAT group after treatment compared with RFA group. The ADC, D and DK increased (21.89 ± 24.95% versus 8.76 ± 19.72%, P = .04 for ADC, 33.78 ± 54.01% versus 7.91 ± 25.16%, P = .03 for D, 25.91 ± 36.28% versus 1.75 ± 46.42%, P = .01 for DK) while f declined (-32.62 ± 41.48% versus 6.51 ± 44.16%, P < .001) more in MTAT group.The MTAT induced different posttreatment changes on water molecule diffusion and microvasculature related functional MR parameters compared to RFA in patients with liver tumors.
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Affiliation(s)
- Guangyuan Zhang
- Department of Radiology, Shanghai Proton and Heavy Ion Center
- Department of Radiology
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Wentao Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Guangzhi Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center
| | - Xinhong He
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center
| | - Lichao Xu
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center
| | | | - Weijun Peng
- Department of Radiology
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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Abstract
OBJECTIVE Imaging plays a key role in the assessment of patients before, during, and after percutaneous cryoablation of hepatic tumors. Intra-procedural and early post-procedure imaging with CT and MRI is vital to the assessment of technical success including adequacy of ablation zone coverage. Recognition of the normal expected post-procedure findings of hepatic cryoablation such as ice ball formation, hydrodissection, and the normal appearance of the ablation zone is crucial to be able to differentiate from complications including vascular, biliary, or non-target organ injury. Delayed imaging is essential for determination of clinical effectiveness and detection of unexpected findings such as residual unablated tumor and local tumor progression. The purpose of this article is to review the spectrum of expected and unexpected imaging findings that may occur during or after percutaneous cryoablation of hepatic tumors. CONCLUSION Differentiating expected from unexpected findings during and after hepatic cryoablation helps radiologists identify residual or recurrent tumor and detect procedure-related complications.
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Hussein RS, Tantawy W, Abbas YA. MRI assessment of hepatocellular carcinoma after locoregional therapy. Insights Imaging 2019; 10:8. [PMID: 30694398 PMCID: PMC6352610 DOI: 10.1186/s13244-019-0690-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 01/03/2019] [Indexed: 12/16/2022] Open
Abstract
Liver cirrhosis and hepatocellular carcinoma (HCC) constitute one of the major causes of morbidity, mortality, and high health care costs worldwide. Multiple treatment options are available for HCC depending on the clinical status of the patient, size and location of the tumor, and available techniques and expertise. Locoregional treatment options are multiple. The most challenging part is how to assess the treatment response by different imaging modalities, but our scope will be assessing the response to locoregional therapy for HCC by MRI. This will be addressed by conventional MR methods using LI-RADS v2018 and by functional MR using diffusion-weighted imaging, perfusion, and highlighting the value of the novel intravoxel incoherent motion (IVIM).
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Affiliation(s)
- Rasha S Hussein
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt.
| | - Wahid Tantawy
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt
| | - Yasser A Abbas
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt
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Gordic S, Corcuera-Solano I, Stueck A, Besa C, Argiriadi P, Guniganti P, King M, Kihira S, Babb J, Thung S, Taouli B. Evaluation of HCC response to locoregional therapy: Validation of MRI-based response criteria versus explant pathology. J Hepatol 2017; 67:1213-1221. [PMID: 28823713 DOI: 10.1016/j.jhep.2017.07.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/25/2017] [Accepted: 07/26/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS This study evaluates the performance of various magnetic resonance imaging (MRI) response criteria for the prediction of complete pathologic necrosis (CPN) of hepatocellular carcinoma (HCC) post locoregional therapy (LRT) using explant pathology as a reference. METHODS We included 61 patients (male/female 46/15; mean age 60years) who underwent liver transplantation after LRT with transarterial chemoembolization plus radiofrequency or microwave ablation (n=56), or 90Yttrium radioembolization (n=5). MRI was performed <90days before liver transplantation. Three independent readers assessed the following criteria: RECIST, EASL, modified RECIST (mRECIST), percentage of necrosis on subtraction images, and diffusion-weighted imaging (DWI), both qualitative (signal intensity) and quantitative (apparent diffusion coefficient [ADC]). The degree of necrosis was retrospectively assessed at histopathology. Intraclass correlation coefficient (ICC) and Cohen's kappa were used to assess inter-reader agreement. Logistic regression and receiver operating characteristic analyses were used to determine imaging predictors of CPN. Pearson correlation was performed between imaging criteria and pathologic degree of tumor necrosis. RESULTS A total of 97HCCs (mean size 2.3±1.3cm) including 28 with CPN were evaluated. There was excellent inter-reader agreement (ICC 0.77-0.86, all methods). EASL, mRECIST, percentage of necrosis and qualitative DWI were all significant (p<0.001) predictors of CPN, while RECIST and ADC were not. EASL, mRECIST and percentage of necrosis performed similarly (area under the curves [AUCs] 0.810-0.815) while the performance of qualitative DWI was lower (AUC 0.622). Image subtraction demonstrated the strongest correlation (r=0.71-0.72, p<0.0001) with pathologic degree of tumor necrosis. CONCLUSIONS EASL/mRECIST criteria and image subtraction have excellent diagnostic performance for predicting CPN in HCC treated with LRT, with image subtraction correlating best with pathologic degree of tumor necrosis. Thus, MR image subtraction is recommended for assessing HCC response to LRT. LAY SUMMARY The assessment of hepatocellular carcinoma (HCC) tumor necrosis after locoregional therapy is essential for additional treatment planning and estimation of outcome. In this study, we assessed the performance of various magnetic resonance imaging (MRI) response criteria (RECIST, mRECIST, EASL, percentage of necrosis on subtraction images, and diffusion-weighted imaging) for the prediction of complete pathologic necrosis of HCC post locoregional therapy on liver explant. Patients who underwent liver transplantation after locoregional therapy were included in this retrospective study. All patients underwent routine liver MRI within 90days of liver transplantation. EASL/mRECIST criteria and image subtraction had excellent diagnostic performance for predicting complete pathologic necrosis in treated HCC, with image subtraction correlating best with pathologic degree of tumor necrosis.
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Affiliation(s)
- Sonja Gordic
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Ashley Stueck
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cecilia Besa
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pamela Argiriadi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Preethi Guniganti
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael King
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shingo Kihira
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James Babb
- Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA
| | - Swan Thung
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Weiss J, Rempp H, Clasen S, Notohamiprodjo M, Keßler DE, Pereira PL, Blumenstock G, Nikolaou K, Hoffmann R. Diagnostic accuracy of different magnetic resonance imaging sequences for detecting local tumor progression after radiofrequency ablation of hepatic malignancies. Eur J Radiol 2017; 94:85-92. [PMID: 28655432 DOI: 10.1016/j.ejrad.2017.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/03/2017] [Accepted: 06/12/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of the individual sequences of a clinical routine liver MRI protocol for the detection of local tumour progression after radiofrequency (RF) ablation of hepatic malignancies. MATERIAL AND METHODS A cohort of 93 patients treated for 140 primary and secondary hepatic malignancies with RF ablation was assembled for this retrospective study. The cohort contained 31 cases of local tumour progression, which occurred 8.3±6.2months (range: 4.0-28.2 months) after treatment. All patients underwent clinical routine follow-up MRI at 1.5T including following sequences: unenhanced T1-weighted fast low angle shot (FLASH-2D), T2-weighted turbo-spin-echo sequence, contrast-enhanced (CE) T1-weighted volume-interpolated breath-hold examination (VIBE), diffusion-weighted imaging (DWI). Follow-up was 32.7±22.5months (range: 4.0-138.3 months). Two readers independently evaluated the individual sequences separately for signs of local tumour progression. Diagnostic confidence was rated on a 4-point scale. Inter-reader agreement was assessed with Coheńs kappa. Long-term follow-up and histological specimen served as standard of reference. RESULTS Both readers reached the highest sensitivity for detection of local tumour progression with unenhanced T1-FLASH 2D (88.2% and 94.1%, respectively) and the highest specificity with CE T1-VIBE (96.2% and 97.2%, respectively). Highest inter-reader agreement was reached with T1-FLASH-2D (kappa=0.83). Typical pitfalls for false-positive diagnoses were focal cholestasis and vasculature adjacent to the ablation zone. Diagnostic confidence was highest with CE T1-VIBE for reader 1 and DWI for reader 2. CONCLUSION Unenhanced T1-FLASH-2D is an essential sequence for follow-up imaging after tumour ablation with a high sensitivity for detection of local progression and a high inter-reader agreement.
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Affiliation(s)
- Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany.
| | - Hansjoerg Rempp
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany
| | - Mike Notohamiprodjo
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany
| | - David-Emanuel Keßler
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany
| | - Philippe L Pereira
- Department of Radiology, Minimally Invasive Therapies and Nuclearmedicine, SLK-Kliniken Heilbronn GmbH, Am Gesundbrunnen 20-26, 74078 Heilbronn, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, Eberhard-Karls-University, Silcherstrasse 5, 72076 Tuebingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany
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Mao J, Tang S, Hong D, Zhao F, Niu M, Han X, Qi J, Bao H, Jiang Y, Fu C, Long D, Meng X, Su H. Therapeutic efficacy of novel microwave-sensitized mPEG-PLGA@ZrO 2@(DOX + ILS) drug-loaded microspheres in rabbit VX 2 liver tumours. NANOSCALE 2017; 9:3429-3439. [PMID: 28233003 DOI: 10.1039/c6nr09862b] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The use of nanomaterials as drug delivery systems shows good effects in treating tumors. However, the effective dose of drugs targeted to tumor tissues is very low because of the effect of the reticuloendothelial system (RES) in removing such foreign substances. In order to eliminate the RES effect, we developed mPEG-PLGA@ZrO2@(DOX + ILS) (mPEG-PLGA@ZrO2@[DOX + ILS]) drug-loaded microspheres. These microwave (MW)-sensitized microspheres directly embolized the blood-supply vessels of tumors to induce tumor ischemia and hypoxia, as well as to aggregate drugs within tumor tissues in a long-lasting manner. Additionally, combination with MW ablation can triple the effects for the inhibition of tumor growth. The MW sensitive ionic liquid (ILS) in microspheres can rapidly produce a high temperature in a MW field on the basis of MW sensitization, thus accelerating the degradation of microspheres to release DOX-loaded ZrO2 into the lesions to kill tumors. Microspheres can also prolong the pharmacological time and effect of drugs through the enhanced permeability and retention (EPR) effect of nanocarriers, as well as the sustained release of nanomaterials. Studies performed in vivo revealed that mPEG-PLGA@ZrO2@(DOX + ILS) showed good biosafety. We undertook sensitized microsphere embolism therapy using novel mPEG-PLGA@ZrO2@(DOX + ILS) microspheres in a rabbit VX2 liver tumor model. Three, 6 and 9 d after treatment, computed tomography indicated no significant change in tumor size, and diffusion weighted imaging showed a marked decrease of residual tumor tissues. With the multiple functions of inducing embolisms, sensitization, and the sustained release of chemotherapeutics, novel mPEG-PLGA@ZrO2@(DOX + ILS) microspheres can achieve good therapeutic efficacy, in combination with MW ablation and chemotherapy, while embolizing the blood vessels of arterial tumors.
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Affiliation(s)
- Jingsong Mao
- Department of Radiology First Hospital of China Medical University, No. 155 Nanjing North Road, Shenyang, 110001, P. R. China.
| | - Shunsong Tang
- Laboratory of Controllable Preparation and Application of Nanomaterials, Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China.
| | - Duo Hong
- Department of Radiology First Hospital of China Medical University, No. 155 Nanjing North Road, Shenyang, 110001, P. R. China.
| | - Fan Zhao
- Department of Radiology First Hospital of China Medical University, No. 155 Nanjing North Road, Shenyang, 110001, P. R. China.
| | - Meng Niu
- Department of Radiology First Hospital of China Medical University, No. 155 Nanjing North Road, Shenyang, 110001, P. R. China.
| | - Xiangjun Han
- Department of Radiology First Hospital of China Medical University, No. 155 Nanjing North Road, Shenyang, 110001, P. R. China.
| | - Ji Qi
- Department of Radiology First Hospital of China Medical University, No. 155 Nanjing North Road, Shenyang, 110001, P. R. China.
| | - Han Bao
- Department of Radiology First Hospital of China Medical University, No. 155 Nanjing North Road, Shenyang, 110001, P. R. China.
| | - Yutian Jiang
- Department of Radiology First Hospital of China Medical University, No. 155 Nanjing North Road, Shenyang, 110001, P. R. China.
| | - Changhui Fu
- Laboratory of Controllable Preparation and Application of Nanomaterials, Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China.
| | - Dan Long
- Laboratory of Controllable Preparation and Application of Nanomaterials, Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China.
| | - Xianwei Meng
- Laboratory of Controllable Preparation and Application of Nanomaterials, Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China.
| | - Hongying Su
- Department of Radiology First Hospital of China Medical University, No. 155 Nanjing North Road, Shenyang, 110001, P. R. China.
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Barat M, Fohlen A, Cassinotto C, Jannot AS, Dautry R, Pelage JP, Boudiaf M, Pocard M, Eveno C, Taouli B, Soyer P, Dohan A. One-month apparent diffusion coefficient correlates with response to radiofrequency ablation of hepatocellular carcinoma. J Magn Reson Imaging 2016; 45:1648-1658. [PMID: 27766709 DOI: 10.1002/jmri.25521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/05/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess whether apparent diffusion coefficient (ADC) values at 1 and 3 months after radiofrequency ablation (RFA) may be associated with a favorable response to therapy for hepatocellular carcinoma (HCC) and liver metastases. MATERIALS AND METHODS Fifty-nine patients with HCC (n = 35) or liver metastases (n = 24) who underwent 1.5T diffusion-weighted magnetic resonance imaging (DWMRI) at 1 and 3 months post-RFA were included. ADC values of patients with local tumor recurrence were compared to those without local recurrence. A subgroup analysis was performed for HCC and metastases. RESULTS Thirty-eight HCC and 27 metastases were evaluated. The ADC value of HCC at 1 month after RFA was lower in recurrent tumors (0.957 ± 0.229 [SD] × 10-3 mm2 ) compared to tumors with complete response (1.414 ± 0.322 [SD] × 10-3 mm2 /s, P = 0.006). At multivariate analysis, ADC at 1 month was the single independent variable associated with recurrence for HCC (area under the receiver operating characteristic curve = 0.860). No significant association was observed for liver metastases (P = 0.089). CONCLUSION A low ADC value at 1 month after RFA is associated with an early local recurrence of HCC. This study does not confirm that such association exists for hepatic metastases. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1648-1658.
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Affiliation(s)
- Maxime Barat
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France
| | - Audrey Fohlen
- CNRS, UMR 6301-ISTCT, CERVOxy, GIP CYCERON, Caen, France.,CEA, DSV/I2BM, UMR6301-ISTCT, Caen, France.,Normandie Université, France.,UNICAEN, UMR6301-ISTCT, Caen, France.,CHU de CAEN, Service d'Imagerie Diagnostique et de Radiologie Thérapeutique, Caen, France
| | - Christophe Cassinotto
- Department of Diagnostic and Interventional Imaging, Hôpîtal Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,INSERM U1053, Université Bordeaux, Bordeaux, France
| | - Anne Sophie Jannot
- INSERM-UMRS 1138 Team 22, Cordeliers Research Center, Paris, France.,Paris Descartes University, Paris, France.,Department of Medical Informatics and Public Health, European George Pompidou Hospital, Paris, France
| | - Raphael Dautry
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France
| | - Jean-Pierre Pelage
- CNRS, UMR 6301-ISTCT, CERVOxy, GIP CYCERON, Caen, France.,CEA, DSV/I2BM, UMR6301-ISTCT, Caen, France.,Normandie Université, France.,UNICAEN, UMR6301-ISTCT, Caen, France.,CHU de CAEN, Service d'Imagerie Diagnostique et de Radiologie Thérapeutique, Caen, France
| | - Mourad Boudiaf
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France
| | - Marc Pocard
- Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France.,UMR CART - INSERM 965, Hôpital Lariboisière, Paris, France.,Department of Digestive Surgery, Hôpital Lariboisière, Paris, France
| | - Clarisse Eveno
- Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France.,UMR CART - INSERM 965, Hôpital Lariboisière, Paris, France.,Department of Digestive Surgery, Hôpital Lariboisière, Paris, France
| | - Bachir Taouli
- Department of Radiology and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Philippe Soyer
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France.,Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France.,UMR CART - INSERM 965, Hôpital Lariboisière, Paris, France
| | - Anthony Dohan
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France.,Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France.,UMR CART - INSERM 965, Hôpital Lariboisière, Paris, France.,McGill University Health Center, Department of Radiology, McGill University Health Center, Montreal, QC, Canada
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10
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Liu C, Park CS, Hall SK, Payne SJ. Mathematical model of the post-ablation enhancement zone as a tissue-level oedematic response. Int J Hyperthermia 2016; 33:111-121. [PMID: 27682026 DOI: 10.1080/02656736.2016.1198832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE A hyperdense rim is commonly observed at the periphery of ablation zones during post-ablation imaging (e.g. ultrasound) in tumours. A mathematical model has been developed here to investigate the occurrence of this enhanced rim, caused by the ablated cells, giving an indication of the location of the final ablation region. MATERIALS AND METHODS The enhanced rim has been assumed here to be due to a tissue-level oedematic response of viable cells, which necessitated coupling multiple modelling elements in a spatially distributed system: thermal cell death, tissue-state dependent ion concentration dynamics, ion transport in the extracellular space, and osmotic cell volume regulation. RESULTS In response to the imposed temperature function, an ablation zone was predicted, distinguishing the tissue state between 'dead' and 'alive'. A disturbance in intracellular/extracellular ion concentrations was induced due to ion redistribution, which acted as an osmotic stress and contributed to significant cell swelling in a thin rim at the periphery of the ablation zone. It was also found that the rim size only changed slightly with varying lesion size, in response to different temperature profiles. CONCLUSIONS The study presents a novel mathematical model to understand the enhanced rim surrounding the ablation zone by assuming tissue-level cell oedema as the primary potential cause. The model links the direct response to thermal injury to an observable secondary response, which could be of clinical value in that the location of this bright ring could potentially be used for more accurate determination of the extent of the ablation zone.
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Affiliation(s)
- Cong Liu
- a Institute of Biomedical Engineering, Department of Engineering Science , University of Oxford , Oxford , UK
| | - Chang Sub Park
- a Institute of Biomedical Engineering, Department of Engineering Science , University of Oxford , Oxford , UK
| | - Sheldon K Hall
- a Institute of Biomedical Engineering, Department of Engineering Science , University of Oxford , Oxford , UK
| | - Stephen J Payne
- a Institute of Biomedical Engineering, Department of Engineering Science , University of Oxford , Oxford , UK
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Abstract
Cancer therapy is mainly based on different combinations of surgery, radiotherapy, and chemotherapy. Additionally, targeted therapies (designed to disrupt specific tumor hallmarks, such as angiogenesis, metabolism, proliferation, invasiveness, and immune evasion), hormonotherapy, immunotherapy, and interventional techniques have emerged as alternative oncologic treatments. Conventional imaging techniques and current response criteria do not always provide the necessary information regarding therapy success particularly to targeted therapies. In this setting, MR imaging offers an attractive combination of anatomic, physiologic, and molecular information, which may surpass these limitations, and is being increasingly used for therapy response assessment.
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Ippolito D, Trattenero C, Talei Franzesi C, Casiraghi A, Lombardi S, Vacirca F, Corso R, Sironi S. Dynamic Contrast-Enhanced Magnetic Resonance Imaging With Gadolinium Ethoxybenzyl Diethylenetriamine Pentaacetic Acid for Quantitative Assessment of Vascular Effects on Hepatocellular-Carcinoma Lesions Treated by Transarterial Chemoembolization or Radiofrequency Ablation. J Comput Assist Tomogr 2016; 40:692-700. [PMID: 27560010 DOI: 10.1097/rct.0000000000000427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this study was to investigate the role of dynamic contrast-enhanced magnetic resonance imaging (MRI) in evaluation of blood flow changes related to transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) procedures in patients with hepatocellular carcinoma (HCC) lesions. METHODS Fifty-four patients, with biopsy-proven HCC, who underwent TACE or RFA, were evaluated, 1 month after treatment, with upper abdominal MRI examination. Multiplanar T2-weighted, T1-weighted, and dynamic contrast-enhanced sequences were acquired. Dedicated perfusion software (T1 Perfusion Package, Viewforum; Philips Medical Systems, The Netherlands) was used to generate color permeability maps. After placing regions of interest in normal hepatic parenchyma, in successfully treated lesions, and in area of recurrence, the following perfusion parameters were calculated and statistically analyzed: relative arterial, venous, and late enhancement; maximum enhancement; maximum relative enhancement, and time to peak. RESULTS Twenty-one of 54 patients had residual disease, and perfusion parameters values measured within tumor tissue were: relative arterial enhancement median, 42%; relative venous enhancement median, 69%; relative late enhancement median, 57.7%; maximum enhancement median, 749.6%; maximum relative enhancement median, 69%; time to peak median, 81.1 seconds. As for all the evaluated parameters, a significant difference (P < 0.05) was found between residual viable tumor tissue and effective treated lesions. CONCLUSIONS Dynamic contrast-enhanced MRI represents a complementary noninvasive tool that may offer quantitative and qualitative information about HCC lesions treated with TACE and RFA.
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Affiliation(s)
- Davide Ippolito
- From the *School of Medicine, University of Milano-Bicocca, Milan; and †Department of Diagnostic Radiology, H. S. Gerardo; ‡Department of Interventional Radiology, San Gerardo Hospital, Monza, Milan, Italy
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Imaging of HCC-Current State of the Art. Diagnostics (Basel) 2015; 5:513-45. [PMID: 26854169 PMCID: PMC4728473 DOI: 10.3390/diagnostics5040513] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 12/17/2022] Open
Abstract
Early diagnosis of hepatocellular carcinoma (HCC) is crucial for optimizing treatment outcome. Ongoing advances are being made in imaging of HCC regarding detection, grading, staging, and also treatment monitoring. This review gives an overview of the current international guidelines for diagnosing HCC and their discrepancies as well as critically summarizes the role of magnetic resonance imaging (MRI) and computed tomography (CT) techniques for imaging in HCC. The diagnostic performance of MRI with nonspecific and hepatobililiary contrast agents and the role of functional imaging with diffusion-weighted imaging will be discussed. On the other hand, CT as a fast, cheap and easily accessible imaging modality plays a major role in the clinical routine work-up of HCC. Technical advances in CT, such as dual energy CT and volume perfusion CT, are currently being explored for improving detection, characterization and staging of HCC with promising results. Cone beam CT can provide a three-dimensional analysis of the liver with tumor and vessel characterization comparable to cross-sectional imaging so that this technique is gaining an increasing role in the peri-procedural imaging of HCC treated with interventional techniques.
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Closed-Bore Interventional MRI: Percutaneous Biopsies and Ablations. AJR Am J Roentgenol 2015; 205:W400-10. [DOI: 10.2214/ajr.15.14732] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Belousova EL, Karmazanovskij GG, Kubyshkin VA, Chzhao AV, Vishnevskij VA, Karel'skaya NA, Davydenko PI. [Opportunities of magnetic resonance imaging in differential diagnosis of focal liver masses]. Khirurgiia (Mosk) 2015:78-84. [PMID: 26331173 DOI: 10.17116/hirurgia2015778-84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- E L Belousova
- A.V. Vishnevskiy Institute of Surgery, Moscow, Russia
| | | | - V A Kubyshkin
- A.V. Vishnevskiy Institute of Surgery, Moscow, Russia
| | - A V Chzhao
- A.V. Vishnevskiy Institute of Surgery, Moscow, Russia
| | | | | | - P I Davydenko
- A.V. Vishnevskiy Institute of Surgery, Moscow, Russia
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