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Peng Y, Liu H, Miao M, Cheng X, Chen S, Yan K, Mu J, Cheng H, Liu G. Micro-Nano Convergence-Driven Radiotheranostic Revolution in Hepatocellular Carcinoma. ACS APPLIED MATERIALS & INTERFACES 2025. [PMID: 40347149 DOI: 10.1021/acsami.5c05525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2025]
Abstract
Radiotherapy, as an important means of treating hepatocellular carcinoma (HCC), has shown unique therapeutic advantages, especially in patients who are unable to undergo surgery or transplantation. It mainly includes external radiotherapy, transarterial radioembolization and intratumoral radioactive particle implantation. However, under the influence of factors such as the hypoxic characteristics of the liver tumor microenvironment and the radioresistance of tumor cells, the effect of radiotherapy may be unstable and may cause side effects, affecting the quality of life of patients. In recent years, with the development of nanotechnology, drug delivery systems based on micro-nanomaterials have provided new solutions for improving the effect of radiotherapy for HCC. Despite this, the application of micro-nano drug delivery systems in the treatment of HCC still faces some challenges, mainly including the in vivo safety and in vivo metabolism of micro-nano materials. This article reviews the latest progress of micro-nano materials in the treatment of HCC, especially their application in radiosensitization and their clinical translation potential. This article systematically analyzes the role of micro-nanomaterials in external or internal radiotherapy sensitization and radioimmunotherapy and explores the advantages of micro-nanomaterials in improving the treatment effect of HCC.
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Affiliation(s)
- Yisheng Peng
- State Key Laboratory of Vaccine for Infectious Diseases, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Hui Liu
- State Key Laboratory of Vaccine for Infectious Diseases, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Mengmeng Miao
- State Key Laboratory of Vaccine for Infectious Diseases, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Xu Cheng
- State Key Laboratory of Vaccine for Infectious Diseases, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Shangqing Chen
- State Key Laboratory of Vaccine for Infectious Diseases, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Kaifei Yan
- State Key Laboratory of Vaccine for Infectious Diseases, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Jing Mu
- Institute of Precision Medicine, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Hongwei Cheng
- State Key Laboratory of Vaccine for Infectious Diseases, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
- Zhuhai UM Science & Technology Research Institute, University of Macau, Macau SAR 999078, China
| | - Gang Liu
- State Key Laboratory of Vaccine for Infectious Diseases, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China
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Tsurusaki M, Sofue K, Murakami T, Tanigawa N. Radiological Assessment and Therapeutic Evaluation in Hepatocellular Carcinoma: Differentiation and Treatment Response with Japanese Guidelines. Cancers (Basel) 2024; 17:101. [PMID: 39796729 PMCID: PMC11719590 DOI: 10.3390/cancers17010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Revised: 12/27/2024] [Accepted: 12/29/2024] [Indexed: 01/13/2025] Open
Abstract
The liver is supplied by a dual blood flow system consisting of the portal vein and hepatic artery. Imaging techniques for diagnosing hepatocellular carcinoma (HCC) have been developed along with blood flow imaging, which visualizes the amount of arterial and portal blood flow. The diagnosis of HCC differentiation is important for early-stage liver cancer screening and determination of treatment strategies. Dynamic computed tomography/magnetic resonance imaging (MRI) includes blood flow imaging and MRI with contrast-enhanced ultrasound and liver-specific contrast agents are used in combination. In addition, unlike the Response Evaluation Criteria in Solid Tumors (RECIST) (version 1.1), which is the standard for determining treatment efficacy for solid tumors in general, tumor necrosis is generally considered a treatment effect in HCC, and the modified RECIST and Liver Cancer Direct Effectiveness Criteria (RECICL) are widely used. Familiarity with the definitions, criteria, and potential challenges of the mRECIST and RECICL is essential for their effective application in clinical practice. This review integrates the latest advancements in systemic treatments and imaging techniques, including the role of LI-RADS and updates on molecular-targeted therapies such as regorafenib, supported by some systematic review and meta-analysis.
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Affiliation(s)
- Masakatsu Tsurusaki
- Department of Radiology, Kansai Medical University Medical Center, Moriguchi 570-8503, Osaka, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan; (K.S.); (T.M.)
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan; (K.S.); (T.M.)
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University, Hirakata 573-1010, Osaka, Japan;
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Kierans AS, Fowler KJ, Chernyak V. LI-RADS in 2024: recent updates, planned refinements, and future directions. Abdom Radiol (NY) 2024:10.1007/s00261-024-04730-w. [PMID: 39671010 DOI: 10.1007/s00261-024-04730-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 11/25/2024] [Accepted: 11/26/2024] [Indexed: 12/14/2024]
Abstract
Initially released in 2011, liver imaging reporting and data (LI-RADS) CT/MRI diagnostic algorithm categorizes hepatic observations on an ordinal scale based on the probability of hepatocellular carcinoma, malignancy, or benignity, and guides reproducible interpretation, clear communication, and standardized terminology for liver imaging. LI-RADS has significantly expanded in scope in the past decade, with the inclusion of algorithms that address screening and surveillance, diagnosis with contrast enhanced ultrasound (CEUS), and treatment response assessment with both CEUS and CT/MRI. LI-RADS algorithms undergo periodic refinements based on accumulating scientific evidence, user feedback, and technological advancements. This manuscript discusses recent LI-RADS algorithm refinements, planned updates, with a focus on LI-RADS CT/MRI diagnostic algorithm, and future goals.
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Aslam A, Chernyak V, Miller FH, Bashir M, Do R, Sirlin C, Lewandowski RJ, Kim CY, Kielar AZ, Kambadakone AR, Yarmohammadi H, Kim E, Owen D, Charalel RA, Shenoy-Bhangle A, Burke LM, Mendiratta-Lala M, Atzen S. CT/MRI LI-RADS 2024 Update: Treatment Response Assessment. Radiology 2024; 313:e232408. [PMID: 39530896 PMCID: PMC11605109 DOI: 10.1148/radiol.232408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 05/28/2024] [Accepted: 07/17/2024] [Indexed: 11/16/2024]
Abstract
With the rising incidence of hepatocellular carcinoma, there has been increasing use of local-regional therapy (LRT) to downstage or bridge to transplant, for definitive treatment, and for palliation. The CT/MRI Liver Imaging Reporting and Data System (LI-RADS) Treatment Response Assessment (TRA) algorithm provides guidance for step-by-step tumor assessment after LRT and standardized reporting. Current evidence suggests that the algorithm performs well in the assessment of tumor response to arterial embolic and loco-ablative therapies and fair when assessing response to radiation-based therapies, with limited data to validate the latter. Both evidence-based and expert-based refinements of the algorithm are needed to improve its diagnostic accuracy after varying types of LRT. This review provides an overview of the challenges and limitations of the LI-RADS TRA algorithm version 2017 and discusses the refinements introduced in the updated 2024 LI-RADS algorithm for CT/MRI.
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Affiliation(s)
- Anum Aslam
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Victoria Chernyak
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Frank H. Miller
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Mustafa Bashir
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Richard Do
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Claude Sirlin
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Robert J. Lewandowski
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Charles Y. Kim
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Ania Zofia Kielar
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Avinash R. Kambadakone
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Hooman Yarmohammadi
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Edward Kim
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Dawn Owen
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Resmi A. Charalel
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Anuradha Shenoy-Bhangle
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Lauren M. Burke
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Mishal Mendiratta-Lala
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Sarah Atzen
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
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Young S, Sanghvi T, Ragulojan R, Torkian P, Todatry S, D'Souza D, Flanagan S, Golzarian J. Local recurrence following a complete radiologic response in hepatocellular carcinoma patients: comparison of transarterial chemoembolisation and transarterial radioembolisation. Clin Radiol 2024; 79:371-377. [PMID: 38341344 DOI: 10.1016/j.crad.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024]
Abstract
AIM To evaluate and compare the rates of local recurrence in hepatocellular carcinoma (HCC) patients who undergo selective transarterial radioembolisation (TARE) or transarterial chemoembolisation (TACE) and achieve a complete response (CR) radiologically. MATERIALS AND METHODS All patients undergoing treatment with TARE or TACE at a single academic institution were reviewed retrospectively. Those who had been treated previously, presented with multifocal disease, had non-selective TARE or TACE, or did not achieve a complete response (CR) radiologically were excluded. RESULTS In total 110 patients were included (TACE n=60 [54.5%]; TARE n=50 [45.5%]). TARE patients were older (66.4 ± 9.4 versus 61.2 ± 5.6 years, p<0.001) and had larger tumours (4.4 ± 2.2 versus 3 ± 1.4 cm, p=0.002). TACE patients were significantly more likely to suffer a local recurrence (31/60, 51.7% versus 9/50, 18%, p<0.001) and had a significantly shorter time to recurrence (median 8.3 {interquartile range [IQR]}: 12 versus median 17.9 [IQR: 23.5] months, p=0.001). A local time to progression (TTP) Kaplan-Meier curve demonstrated TACE patients had a significantly shorter local TTP (hazard ratio [HR]: 7.2; 95% confidence interval [CI]: 3.64-14.24; p<0.001) and treatment modality (TACE or TARE; HR: 0.05; 95% CI: 0.005-0.5; p=0.01) was found to be associated with local recurrences on multivariate Cox proportional HR analysis. When overall TTP was evaluated, again TACE patients were found to have a significantly shorter TTP (HR: 2.13 [1.28-3.53], p=0.004). CONCLUSION In HCC patients undergoing selective treatment who achieve a CR radiologically, those treated with TARE may be less likely to suffer recurrence, either local or general, than those treated with TACE.
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Affiliation(s)
- S Young
- Department of Radiology, University of Arizona, Division of Interventional Radiology, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724, USA.
| | - T Sanghvi
- Minneapolis VA Hospital, 1 Veterans Dr, Minneapolis, MN 55417, USA
| | - R Ragulojan
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - P Torkian
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - S Todatry
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - D D'Souza
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - S Flanagan
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - J Golzarian
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
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Yu Q, Neale M, Ungchusri E, Rothenberger NJ, Liao C, Patel M, Pillai A, Navuluri R, Ahmed O, Ha TV. Tumor Size and Watershed Area Correlate with Incomplete Treatment and Tumor Progression after Selective Radioembolization for Hepatocellular Carcinoma. J Vasc Interv Radiol 2024:S1051-0443(24)00125-8. [PMID: 38336031 DOI: 10.1016/j.jvir.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE To identify factors of incomplete treatment after segmental transarterial radioembolization (TARE) for treatment-naive and solitary hepatocellular carcinoma (HCC). MATERIALS AND METHODS A total of 75 consecutive patients (age, 68.5 years [SD ± 8.0]; 25/75 [33.3%] women) with treatment-naive, solitary HCC underwent segmental or subsegmental TARE with glass microspheres (tumor size, 3.8 cm [SD ± 2.2]; administered dose, 222.6 Gy [SD ± 123.9]) at a single institution from November 2015 to June 2022. Radiologic response and progression-free survival (PFS) were assessed as per modified Response Evaluation Criteria in Solid Tumors. RESULTS Complete treatment was achieved in 48 of 75 (64.0%) patients (mean follow-up, 33.2 months [SD ± 27.4]). Patients with incomplete treatment (27/75, 36%) presented with larger tumor size (5.0 [SD ± 2.5] vs 3.1 [SD ± 1.6] cm; P = .0001), with more tumors located in the watershed zone (81.5% vs 41.7%; P = .001). These patients were less likely to be bridged to transplant or resection (22.2% vs 52.1%; P = .015). Watershed tumors demonstrated worse target tumor PFS (median PFS, 19 months vs not reached; P = .0104) and overall PFS (9.1 months vs not reached; P = .0077). Watershed location was associated with worse PFS among tumors >3 cm in size (8.4 months vs not reached; P = .035) but not in tumors ≤3 cm in size (52.2 months vs not reached; P = .915). CONCLUSIONS Tumor size and watershed location were associated with incomplete treatment after segmental TARE for HCC. Watershed tumors were associated with worse PFS, particularly tumors larger than 3 cm. These tumors may require careful treatment planning and repeated treatments to ensure a durable response.
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Affiliation(s)
- Qian Yu
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois.
| | - Monika Neale
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Ethan Ungchusri
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | | | - Chuanhong Liao
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Mikin Patel
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Anjana Pillai
- Department of Hepatology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Rakesh Navuluri
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Osman Ahmed
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Thuong Van Ha
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
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7
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Patel R, Aslam A, Parikh ND, Mervak B, Mubarak E, Higgins L, Lala K, Conner JF, Khaykin V, Bashir M, Do RKG, Burke LMB, Smith EN, Kim CY, Shampain KL, Owen D, Mendiratta-Lala M. Updates on LI-RADS Treatment Response Criteria for Hepatocellular Carcinoma: Focusing on MRI. J Magn Reson Imaging 2023; 57:1641-1654. [PMID: 36872608 PMCID: PMC11078141 DOI: 10.1002/jmri.28659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 03/07/2023] Open
Abstract
As the incidence of hepatocellular carcinoma (HCC) and subsequent treatments with liver-directed therapies rise, the complexity of assessing lesion response has also increased. The Liver Imaging Reporting and Data Systems (LI-RADS) treatment response algorithm (LI-RADS TRA) was created to standardize the assessment of response after locoregional therapy (LRT) on contrast-enhanced CT or MRI. Originally created based on expert opinion, these guidelines are currently undergoing revision based on emerging evidence. While many studies support the use of LR-TRA for evaluation of HCC response after thermal ablation and intra-arterial embolic therapy, data suggest a need for refinements to improve assessment after radiation therapy. In this manuscript, we review expected MR imaging findings after different forms of LRT, clarify how to apply the current LI-RADS TRA by type of LRT, explore emerging literature on LI-RADS TRA, and highlight future updates to the algorithm. EVIDENCE LEVEL: 3. TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Richa Patel
- Department of Radiology, Stanford, California, USA
| | - Anum Aslam
- Department of Radiology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Neehar D Parikh
- Department of Internal Medicine, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Benjamin Mervak
- Department of Radiology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Eman Mubarak
- Department of Radiology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Lily Higgins
- Department of Radiology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kayli Lala
- Department of Radiology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jack F Conner
- Department of Radiology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Valerie Khaykin
- Department of Radiology and Hepatology, University of Michigan Medicine, Michigan, USA
| | - Mustafa Bashir
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Richard Kinh Gian Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lauren M B Burke
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Elainea N Smith
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles Y Kim
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Kimberly L Shampain
- Department of Radiology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
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8
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Kuang D, Zhang N, Zhang M, Li H, Han X, Ren J, Duan X. Correlation between magnetic resonance images of peritumor margin enhancement and prognosis in hepatocellular carcinoma after drug-eluting bead transcatheter arterial chemoembolization. Front Oncol 2023; 13:957710. [PMID: 37081977 PMCID: PMC10110982 DOI: 10.3389/fonc.2023.957710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/22/2023] [Indexed: 04/07/2023] Open
Abstract
PurposeThe aim of this study is to investigate the morphological characteristics and clinical significance of magnetic resonance (MR) images of peritumor margin enhancement in hepatocellular carcinoma (HCC) after drug-eluting bead transcatheter arterial chemoembolization (DEB-TACE).MethodsFrom January 2017 to December 2020, a total of 162 patients who received a diagnosis of HCC were included in our study. We began the follow-up with magnetic resonance imaging (MRI) for complete response assessment, and peritumor margin enhancements were classified as sharp and rough types according to morphology. During the follow-up, data such as progression or remission of the two enhancement modalities, morphological changes in terms of margin enhancements observed in MR images, and alpha-fetoprotein (AFP) levels were recorded.ResultsIn the follow-up period of 36 months, 70 and 92 patients with sharp- and rough-type peritumor margins, respectively, were observed. At the end of the follow-up, patients with sharp-type margins had lower AFP levels and longer progression-free survival than those with rough-type margins (P < 0.05). Furthermore, the sharp-type margin was thinner than the rough-type margin (all P < 0.05). Moreover, the sharp-type group had a high incidence of tumors with a diameter of < 5 cm, whereas the rough-type group had a high incidence of tumors with a diameter of ≥ 5 cm. Continuous enhancements of peritumor margins in MRI were greater in the sharp-type group than in the rough-type group. Most of the patients with a sharp-type margin achieved disease remission (94.3%, P < 0.05), whereas most of those with a rough-type margin experienced disease progression (84.8%, P < 0.05).ConclusionsPatients with HCC with a sharp-type margin enhancement on MRI after DEB-TACE mostly demonstrated benign lesions with a good prognosis, whereas those with a rough-type margin mostly demonstrated malignant growth.
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Affiliation(s)
| | | | | | | | | | | | - Xuhua Duan
- *Correspondence: Jianzhuang Ren, ; Xuhua Duan,
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9
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Fahmy D, Alksas A, Elnakib A, Mahmoud A, Kandil H, Khalil A, Ghazal M, van Bogaert E, Contractor S, El-Baz A. The Role of Radiomics and AI Technologies in the Segmentation, Detection, and Management of Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:cancers14246123. [PMID: 36551606 PMCID: PMC9777232 DOI: 10.3390/cancers14246123] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary hepatic neoplasm. Thanks to recent advances in computed tomography (CT) and magnetic resonance imaging (MRI), there is potential to improve detection, segmentation, discrimination from HCC mimics, and monitoring of therapeutic response. Radiomics, artificial intelligence (AI), and derived tools have already been applied in other areas of diagnostic imaging with promising results. In this review, we briefly discuss the current clinical applications of radiomics and AI in the detection, segmentation, and management of HCC. Moreover, we investigate their potential to reach a more accurate diagnosis of HCC and to guide proper treatment planning.
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Affiliation(s)
- Dalia Fahmy
- Diagnostic Radiology Department, Mansoura University Hospital, Mansoura 35516, Egypt
| | - Ahmed Alksas
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Ahmed Elnakib
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Ali Mahmoud
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Heba Kandil
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
- Faculty of Computer Sciences and Information, Mansoura University, Mansoura 35516, Egypt
| | - Ashraf Khalil
- College of Technological Innovation, Zayed University, Abu Dhabi 4783, United Arab Emirates
| | - Mohammed Ghazal
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates
| | - Eric van Bogaert
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Sohail Contractor
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Ayman El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
- Correspondence:
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10
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Radiological and pathological assessment with EOB-MRI after Y90 radiation lobectomy prior to liver resection for hepatocellular carcinoma. HPB (Oxford) 2022; 24:2185-2192. [PMID: 36085263 DOI: 10.1016/j.hpb.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/09/2022] [Accepted: 08/15/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Radiation lobectomy (RL) utilizes Yttrium-90 (Y90) radioembolization for achieving tumor control and inducing contralateral lobe hypertrophy. Our objective was to evaluate the chronological changes occurring radiologically and histopathologically after Y90 RL. METHODS We retrospectively reviewed 22 patients with chronic liver disease who underwent Y90 RL prior to planned liver resection for hepatocellular carcinoma. Gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (EOB-MRI) was performed every 3 months. RESULTS Future liver remnant volume (FLRV) significantly increased up to 9 months after Y90 RL. Gd-EOB-DTPA uptake in the treated lobe experienced a 40% reduction in enhancement ratio (ER) during ensuing first 3 months, and never recovered. The reduced ER in the non-tumoral parenchyma was significantly correlated with increased FLRV and FLR (r = 0.41 and r = 0.35, respectively; both p < 0.01). Histopathological evaluation of non-tumor liver tissue found features of sinusoidal obstruction syndrome as an early change after Y90 RL (median 5.7 months) and parenchymal collapse as a late change (mean 11 months). DISCUSSION The reduced uptake of Gd-EOB-DTPA at 3 months post Y90 RL correlates with a significant increase in FLRV prior to liver resection. EOB-MRI evaluation at 3 months can guide future plan of action after Y90 RL.
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11
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Katharina Ingenerf M, Karim H, Fink N, Ilhan H, Ricke J, Treitl KM, Schmid-Tannwald C. Apparent diffusion coefficients (ADC) in response assessment of transarterial radioembolization (TARE) for liver metastases of neuroendocrine tumors (NET): a feasibility study. Acta Radiol 2022; 63:877-888. [PMID: 34225464 PMCID: PMC9194807 DOI: 10.1177/02841851211024004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background In patients with hepatic neuroendocrine tumors (NETs) locoregional therapies
such as transarterial radioembolization (TARE) are increasingly applied.
Response evaluation remains challenging and previous studies assessing
response with diffusion-weighted imaging (DWI) have been inconclusive. Purpose To perform a feasibility study to evaluate if response assessment with
quantitative apparent diffusion coefficient (ADC) in patients with liver
metastases of NETs after TARE will be possible. Material and Methods Retrospectively, 43 patients with 120 target lesions who obtained abdominal
magnetic resonance imaging (MRI) with DWI 39±28 days before and 74±46 days
after TARE were included. Intralesional ADC (ADCmin,
ADCmax, and ADCmean) were measured for a maximum
number of three lesions per patient on baseline and post-interventional DWI.
Tumor response was categorized according to RECIST 1.1 and mRECIST. Results TARE resulted in partial remission (PR) in 23% (63%), in stable disease (SD)
in 73% (23%), in progressive disease (PD) in 5% (7%) and in complete
response (CR) in 0% (1%) according to RECIST 1.1 (mRECIST, respectively).
ADC values increased significantly (P<0.005) after TARE
in the PR group whereas there was no significant change in the PD group.
Post-therapeutic ADC values of SD lesions increased significantly when
evaluated by RECIST 1.1 but not if evaluated by mRECIST. Percentual changes
of ADCmean values were slightly higher for responders compared to
non-responders (P<0.05). Conclusion ADC values seem to represent an additional marker for treatment response
evaluation after TARE in patients with secondary hepatic NET. A conclusive
study seems feasible though patient-based evaluation and overall survival
and progression free survival as alternate primary endpoints should be
considered.
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Affiliation(s)
- Maria Katharina Ingenerf
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, Munich, Germany
| | - Homeira Karim
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, Munich, Germany
| | - Nicola Fink
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, Munich, Germany
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, Munich, Germany
| | - Karla-Maria Treitl
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, Munich, Germany
| | - Christine Schmid-Tannwald
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, Munich, Germany
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12
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Alnammi M, Wortman J, Therrien J, Afnan J. MRI features of treated hepatocellular carcinoma following locoregional therapy: a pictorial review. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2299-2313. [PMID: 35524803 DOI: 10.1007/s00261-022-03526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 12/24/2022]
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer death worldwide and within the United States. Liver transplant or partial liver resection is the definitive treatment of choice for HCC; however, the majority of cases are detected in advanced stages due to its early-stage asymptomatic nature, often precluding surgical treatment. Locoregional therapy plays an essential role in HCC management, including curative intent, as a bridge to transplant, or in some cases palliative therapy. Radiologists play a critical role in assessing tumor response following treatment to guide further management that may potentially impact transplantation eligibility; therefore, it is important for radiologists to have an understanding of different locoregional therapies and the variations of imaging response to different therapies. In this review article, we outline the imaging response to ablative therapy (AT), transarterial chemoembolization (TACE), selective internal radiation therapy (SIRT), and stereotactic body radiation therapy (SBRT). We will also briefly discuss the basic concepts of these locoregional therapies. This review focuses on the imaging features following locoregional treatment for hepatocellular carcinoma following AT, TACE, SIRT, and SBRT.
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Affiliation(s)
- Mohanned Alnammi
- Department of Diagnostic Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Jeremy Wortman
- Department of Diagnostic Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Jaclyn Therrien
- Department of Diagnostic Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Jalil Afnan
- Department of Diagnostic Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.
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13
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Benkö T, König J, Theysohn JM, Schotten C, Saner FH, Treckmann J, Radunz S. Bridging treatment prior to liver transplantation for hepatocellular carcinoma: radioembolization or transarterial chemoembolization? Eur J Med Res 2022; 27:74. [PMID: 35619164 PMCID: PMC9134704 DOI: 10.1186/s40001-022-00708-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In hepatocellular carcinoma (HCC) patients, intraarterial therapies are regularly employed as a bridge to liver transplantation to prevent tumor progression during waiting time. Objective of this study was to compare HCC recurrence after liver transplantation following TACE or radioembolization bridging treatment. METHODS We retrospectively analyzed prospectively collected data on 131 consecutive HCC patients who underwent liver transplantation between January 2007 and December 2017 at our liver transplant center (radioembolization n = 44, TACE n = 87). Multivariable logistic regression and cox proportional hazard regression models were used to evaluate factors associated with tumor recurrence and post-transplant survival. RESULTS Between groups, patients were comparable with regards to age and gender. In the radioembolization group, Milan criteria for HCC were met significantly less frequently (20.5% vs. 65.5%, p < 0.0001). Patients in the radioembolization group required significantly fewer intraarterial treatments (1 [1-2] vs. 1 [1-7], p = 0.0007). On explant specimen, tumor differentiation, microvascular invasion and tumor necrosis were comparable between the groups. HCC recurrence and overall survival were similar between the groups. Multivariable analysis detected increasing recipient age, male gender, complete tumor necrosis and absence of microvascular invasion being independently associated with decreased odds for HCC recurrence. Increasing model of end-stage liver disease (MELD) score and tumor recurrence were independently associated with increased odds of post-transplant death. CONCLUSIONS Intraarterial bridging treatment leading to tumor necrosis may not only prevent waitlist drop-out but also facilitate long-term successful liver transplantation in HCC patients. Both radioembolization and TACE represent potent treatment strategies.
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Affiliation(s)
- Tamás Benkö
- Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
| | - Julia König
- Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
| | - Jens M Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Clemens Schotten
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Fuat H Saner
- Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
| | - Jürgen Treckmann
- Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
| | - Sonia Radunz
- Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany.
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14
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Rim Enhancement after Technically Successful Transarterial Chemoembolization in Hepatocellular Carcinoma: A Potential Mimic of Incomplete Embolization or Reactive Hyperemia? Tomography 2022; 8:1148-1158. [PMID: 35448728 PMCID: PMC9028792 DOI: 10.3390/tomography8020094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022] Open
Abstract
Contrast enhancement at the margins/rim of embolization areas in hepatocellular-carcinoma (HCC) lesions treated with transarterial chemoembolization (TACE) might be an early prognostic indicator for HCC recurrence. The aim of this study was to evaluate the predictive value of rim perfusion for TACE recurrence as determined by perfusion CT (PCT). A total of 52 patients (65.6 ± 9.3 years) underwent PCT directly before, immediately after (within 48 h) and at follow-up (95.3 ± 12.5 days) after TACE. Arterial-liver perfusion (ALP), portal-venous perfusion (PVP) and hepatic-perfusion index (HPI) were evaluated in normal liver parenchyma, and on the embolization rim as well as the tumor bed. A total of 42 lesions were successfully treated, and PCT measurements showed no residually vascularized tumor areas. Embolization was not entirely successful in 10 patients with remaining arterialized focal nodular areas (ALP 34.7 ± 10.1 vs. 4.4 ± 5.3 mL/100 mL/min, p < 0.0001). Perfusion values at the TACE rim were lower in responders compared to normal adjacent liver parenchyma and edges of incompletely embolized tumors (ALP liver 16.3 ± 10.1 mL/100 mL/min, rim responder 8.8 ± 8.7 mL/100 mL/min, rim non-responder 23.4 ± 8.6 mL/100 mL/min, p = 0.005). At follow-up, local tumor relapse was observed in 17/42, and 15/42 showed no recurrence (ALP 39.1 ± 10.1 mL/100 mL/min vs. 10.0 ± 7.4 mL/100 mL/min, p = 0.0008); four patients had de novo disseminated disease and six patients were lost in follow-up. Rim perfusion was lower compared to adjacent recurring HCC and not different between groups. HCC lesions showed no rim perfusion after TACE, neither immediately after nor at follow-up at three months, both for mid-term responders and mid-term relapsing HCCs, indicating that rim enhancement is not a sign of reactive hyperemia and not predictive of early HCC recurrence.
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15
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Vietti Violi N, Gnerre J, Law A, Hectors S, Bane O, Doucette J, Abboud G, Kim E, Schwartz M, Fiel MI, Taouli B. Assessment of HCC response to Yttrium-90 radioembolization with gadoxetate disodium MRI: correlation with histopathology. Eur Radiol 2022; 32:6493-6503. [PMID: 35380226 DOI: 10.1007/s00330-022-08732-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/19/2022] [Accepted: 03/11/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND AIMS Transarterial 90Y radioembolization (TARE) is increasingly being used for hepatocellular carcinoma (HCC) treatment. However, tumor response assessment after TARE may be challenging. We aimed to assess the diagnostic performance of gadoxetate disodium MRI for predicting complete pathologic necrosis (CPN) of HCC treated with TARE, using histopathology as the reference standard. METHODS This retrospective study included 48 patients (M/F: 36/12, mean age: 62 years) with HCC treated by TARE followed by surgery with gadoxetate disodium MRI within 90 days of surgery. Two radiologists evaluated tumor response using RECIST1.1, mRECIST, EASL, and LI-RADS-TR criteria and evaluated the percentage of necrosis on subtraction during late arterial, portal venous, and hepatobiliary phases (AP/PVP/HBP). Statistical analysis included inter-reader agreement, correlation between radiologic and pathologic percentage of necrosis, and prediction of CPN using logistic regression and ROC analyses. RESULTS Histopathology demonstrated 71 HCCs (2.8 ± 1.7 cm, range: 0.5-7.5 cm) including 42 with CPN, 22 with partial necrosis, and 7 without necrosis. EASL and percentage of tumor necrosis on subtraction at the AP/PVP were independent predictors of CPN (p = 0.02-0.03). Percentage of necrosis, mRECIST, EASL, and LI-RADS-TR had fair to good performance for diagnosing CPN (AUCs: 0.78 - 0.83), with a significant difference between subtraction and LI-RADS-TR for reader 2, and in specificity between subtraction and other criteria for both readers (p-range: 0.01-0.04). Radiologic percentage of necrosis was significantly correlated to histopathologic degree of tumor necrosis (r = 0.66 - 0.8, p < 0.001). CONCLUSIONS Percentage of tumor necrosis on subtraction and EASL criteria were significant independent predictors of CPN in HCC treated with TARE. Image subtraction should be considered for assessing HCC response to TARE when using MRI. KEY POINTS • Percentage of tumor necrosis on image subtraction and EASL criteria are significant independent predictors of complete pathologic necrosis in hepatocellular carcinoma treated with90Y radioembolization. • Subtraction, mRECIST, EASL, and LI-RADS-TR have fair to good performance for diagnosing complete pathologic necrosis in hepatocellular carcinoma treated with90Y radioembolization.
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Affiliation(s)
- Naik Vietti Violi
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine Mount Sinai, New York, NY, USA.,Department of Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jeffrey Gnerre
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA
| | - Amy Law
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA
| | - Stefanie Hectors
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Octavia Bane
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - John Doucette
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ghadi Abboud
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Edward Kim
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA
| | - Myron Schwartz
- The Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Isabel Fiel
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine Mount Sinai, New York, NY, USA. .,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA.
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16
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Nuclear Medicine Therapy in primary liver cancers. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00180-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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17
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Tong VJW, Shelat VG, Chao YK. Clinical application of advances and innovation in radiation treatment of hepatocellular carcinoma. J Clin Transl Res 2021; 7:811-833. [PMID: 34988334 PMCID: PMC8715712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) management has evolved over the past two decades, with the development of newer treatment modalities. While various options are available, unmet needs are reflected through the mixed treatment outcome for intermediate-stage HCC. As HCC is radiosensitive, radiation therapies have a significant role in management. Radiation therapies offer local control for unresectable lesions and for patients who are not surgical candidates. Radiotherapy also provides palliation in metastatic disease, and acts as a bridge to resection and transplantation in selected patients. Advancements in radiotherapy modalities offer improved dose planning and targeted delivery, allowing for better tumor response and safer dose escalations while minimizing the risks of radiation-induced liver damage. Radiotherapy modalities are broadly classified into external beam radiation therapy and selective internal radiation therapy. With emerging modalities, radiotherapy plays a complementary role in the multidisciplinary care of HCC patients. AIM We aim to provide an overview of the role and clinical application of radiation therapies in HCC management. RELEVANCE FOR PATIENTS The continuous evolution of radiotherapy techniques allows for improved therapeutic outcomes while mitigating unwanted adverse effects, making it an attractive modality in HCC management. Rigorous clinical studies, quality research and comprehensive datasets will further its application in the present era of evidence-based practice in Medicine.
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Affiliation(s)
- Valerie J. W. Tong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore
| | - Yew Kuo Chao
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, 308433, Singapore
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18
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Karamchandani DM, Hammad H, Chetty R, Arnold CA. New Kids on the Block. Arch Pathol Lab Med 2021; 145:1569-1584. [PMID: 33571357 DOI: 10.5858/arpa.2020-0535-ra] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 12/31/2022]
Abstract
CONTEXT.— With the increasing development and use of iatrogenic agents, pathologists are encountering more novel foreign materials in retrieved gastrointestinal specimens. These colorful and unusual-appearing foreign materials can pose a diagnostic dilemma to those unaware of their morphology, especially if the relevant clinical history is lacking. OBJECTIVE.— To discuss the histopathologic features, clinical scenarios and significance, and differential diagnosis of relatively recently described, yet quickly expanding, family of iatrogenic agents that can present as foreign materials in gastrointestinal specimens-pharmaceutical fillers (crospovidone and microcrystalline cellulose), submucosal lifting agents (Eleview and ORISE), lanthanum carbonate, hydrophilic polymers, OsmoPrep, yttrium 90 microspheres (SIR-Sphere and TheraSphere), and resins (sodium polystyrene sulfonate, sevelamer, and bile acid sequestrants). DATA SOURCES.— We collate the findings of published literature, including recently published research papers, and authors' personal experiences from clinical sign-out and consult cases. CONCLUSIONS.— Correct identification of these iatrogenic agents is important because the presence of some novel agents can explain the histopathologic findings seen in the background specimen, and specific novel agents can serve as diagnostic clues to prompt the pathologist to consider other important and related diagnoses. Awareness of even biologically inert agents is important for accurate diagnosis and to avoid unnecessary and expensive diagnostic studies.
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Affiliation(s)
- Dipti M Karamchandani
- From the Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania (Karamchandani)
| | - Hazed Hammad
- The Department of Internal Medicine, Division of Gastroenterology and Hepatology (Hammad), University of Colorado, Anschutz Medical Center, Denver
| | - Runjan Chetty
- The Histopathology Department, Brighton & Sussex University Hospitals, Brighton, United Kingdom (Chetty)
| | - Christina A Arnold
- The Department of Pathology (Arnold), University of Colorado, Anschutz Medical Center, Denver
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19
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Kim GM. Superselective transarterial radioembolization for the treatment of hepatocellular carcinoma. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2021. [DOI: 10.18528/ijgii210051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Gyoung Min Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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20
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Abstract
Radiation segmentectomy is an yttrium-90 transarterial radioembolization treatment where a high radiation dose is administered to a small volume of liver to achieve a high tumoricidal dose to a target with anatomic surgical precision while sparing surrounding parenchyma. This therapeutic modality is often used to treat hepatocellular carcinoma, and recent studies have demonstrated that radiation segmentectomy is an effective treatment as a neoadjuvant to transplant, resection, or as a standalone treatment. This article provides a review of radiation segmentectomy, indications for treatment, recent outcome data, and guidelines for postprocedural management.
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Affiliation(s)
- Kristina Prachanronarong
- Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Edward Kim
- Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
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21
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Miller FH, Lopes Vendrami C, Gabr A, Horowitz JM, Kelahan LC, Riaz A, Salem R, Lewandowski RJ. Evolution of Radioembolization in Treatment of Hepatocellular Carcinoma: A Pictorial Review. Radiographics 2021; 41:1802-1818. [PMID: 34559587 DOI: 10.1148/rg.2021210014] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Transarterial radioembolization (TARE) with yttrium 90 has increasingly been performed to treat hepatocellular carcinoma (HCC). TARE was historically used as a palliative lobar therapy for patients with advanced HCC beyond surgical options, ablation, or transarterial chemoembolization, but recent advancements have led to its application across the Barcelona Clinic Liver Cancer staging paradigm. Newer techniques, termed radiation lobectomy and radiation segmentectomy, are being performed before liver resection to facilitate hypertrophy of the future liver remnant, before liver transplant to bridge or downstage to transplant, or as a definite curative treatment. Imaging assessment of therapeutic response to TARE is challenging as the intent of TARE is to deliver local high-dose radiation to tumors through microembolic microspheres, preserving blood flow to promote radiation injury to the tumor. Because of the microembolic nature, early imaging assessment after TARE cannot rely solely on changes in size. Knowledge of the evolving methods of TARE along with the tools to assess posttreatment imaging and response is essential to optimize TARE as a therapeutic option for patients with HCC. ©RSNA, 2021.
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Affiliation(s)
- Frank H Miller
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Camila Lopes Vendrami
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Ahmed Gabr
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Jeanne M Horowitz
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Linda C Kelahan
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Ahsun Riaz
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Riad Salem
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Robert J Lewandowski
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
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22
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Utility of Early Posttreatment PET/CT Evaluation Using FDG or 18F-FCH to Predict Response to 90Y Radioembolization in Patients With Hepatocellular Carcinoma. AJR Am J Roentgenol 2021; 218:359-369. [PMID: 34494448 DOI: 10.2214/ajr.21.26485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Assessment of hepatocellular carcinoma (HCC) treatment response after transarterial radioembolization (TARE) is challenging, as response by conventional imaging criteria may not become apparent until 6 months after treatment. Though HCC exhibits variability avidity for FDG, some cases of HCC without avidity for FDG show avidity for 18F-FCH. Objectives: To evaluate the utility of early posttreatment evaluation by PET/CT using FDG or 18F-FCH to predict 6-month treatment response and survival after TARE in patients with HCC. Methods: This retrospective study included 37 patients (mean age 67 years; 34 men, 3 women) with documented HCC treated by TARE who underwent both pretreatment FDG PET/CT and 18F-FCH PET/CT, as well as early FDG PET/CT and/or 18F-FCH PET/CT 4-8 weeks after treatment; FDG PET/CT and 18F-FCH PET/CT examinations were performed on separate dates. Only one of 73 initially identified potentially eligible patients was excluded due to lack of HCC avidity for both FDG and 18F-FCH. Response assessment by mRECIST on multiphase CT or MRI was performed at one-month and six-months in 23 patients. Early PET/CT response and one-month mRECIST response were assessed as predictors of six-month mRECIST response. Univariable and multivariable predictors of overall survival (OS) were identified. Results: On pretreatment PET/CT, 28 (76%) patients were FDG-positive, 15 (41%) FCH-positive 6 (16%) both FDG-positive and FCH-positive. Twelve of 28 FDG-positive HCCs exhibited early response by FDG PET/CT; 7 of 15 FCH-positive HCCs exhibited early response by 18F-FCH PET/CT. Twelve (52%) patients exhibited six-month mRECIST response. Early posttreatment PET/CT response exhibited 100% (12/12) sensitivity and 100% (11/11) specificity for six-month mRECIST response, whereas one-month mRECIST response exhibited 67% (8/12) sensitivity and 100% (11/11) specificity for six-month mRECIST response. Early postteatment PET/CT response was a significant independent predictor of OS on univariable (hazard ratio: 0.37, 95% CI: 0.15-0.93, p=.03) and multivariable analyses (hazard ratio: 0.24, 95% CI: 0.08-0.76, p=.01). Conclusion: Early post-TARE evaluation by PET/CT using FDG or 18F-FCH may predict six-month response and OS in patients with HCC. Clinical Impact: Early posttreatment evaluation with PET/CT could help more reliably identify true nonresponders after TARE, which in turn could prompt early adapted therapeutic management.
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23
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Delaney LJ, Tantawi M, Wessner CE, Machado P, Forsberg F, Lyshchik A, O'Kane P, Liu JB, Civan J, Tan A, Anton K, Shaw CM, Eisenbrey JR. Predicting Long-Term Hepatocellular Carcinoma Response to Transarterial Radioembolization Using Contrast-Enhanced Ultrasound: Initial Experiences. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2523-2531. [PMID: 34130880 PMCID: PMC8355136 DOI: 10.1016/j.ultrasmedbio.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/26/2021] [Accepted: 05/06/2021] [Indexed: 05/12/2023]
Abstract
Conventional cross-sectional imaging done shortly after radioembolization of hepatocellular carcinoma (HCC) does not reliably predict long-term response to treatment. This study evaluated whether quantitative contrast-enhanced ultrasound (CEUS) can predict the long-term response of HCC to yttrium-90 (Y-90) treatment. Fifteen patients underwent CEUS at three time points: immediately following treatment and 1 and 2 wk post-treatment. Response 3-6 mo after treatment was categorized on contrast-enhanced magnetic resonance imaging by two experienced radiologists using the Modified Response Evaluation Criteria in Solid Tumors. CEUS data were analyzed by quantifying tumor perfusion and residual fractional vascularity using time-intensity curves. Patients with stable disease on magnetic resonance imaging had significantly greater fractional vascularity 2 wk post-treatment (65.15%) than those with partial or complete response (13.8 ± 9.9%, p = 0.007, and 14.9 ± 15.4%, p = 0.009, respectively). Complete responders had lower tumor vascularity at 2 wk than at post-operative examination (-38.3 ± 15.4%, p = 0.045). Thus, this pilot study suggests CEUS may provide an earlier indication of Y-90 treatment response than cross-sectional imaging.
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Affiliation(s)
- Lauren J Delaney
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mohamed Tantawi
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Patrick O'Kane
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jesse Civan
- Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Allison Tan
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin Anton
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Colette M Shaw
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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24
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Treatment response assessment following transarterial radioembolization for hepatocellular carcinoma. Abdom Radiol (NY) 2021; 46:3596-3614. [PMID: 33909092 DOI: 10.1007/s00261-021-03095-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/01/2021] [Accepted: 04/10/2021] [Indexed: 12/17/2022]
Abstract
Transarterial radioembolization with yttrium-90 microspheres is an established therapy for hepatocellular carcinoma. Post-procedural imaging is important for the assessment of both treatment response and procedural complications. A variety of challenging treatment-specific imaging phenomena complicate imaging assessment, such as changes in tumoral size, tumoral and peritumoral enhancement, and extrahepatic complications. A review of the procedural steps, emerging variations, and timelines for post-treatment tumoral and extra-tumoral imaging changes are presented, which may aid the reporting radiologist in the interpretation of post-procedural imaging. Furthermore, a description of post-procedural complications and their significance is provided.
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25
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Spieler B, Sabottke C, Moawad AW, Gabr AM, Bashir MR, Do RKG, Yaghmai V, Rozenberg R, Gerena M, Yacoub J, Elsayes KM. Artificial intelligence in assessment of hepatocellular carcinoma treatment response. Abdom Radiol (NY) 2021; 46:3660-3671. [PMID: 33786653 DOI: 10.1007/s00261-021-03056-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 02/08/2023]
Abstract
Artificial Intelligence (AI) continues to shape the practice of radiology, with imaging of hepatocellular carcinoma (HCC) being of no exception. This article prepared by members of the LI-RADS Treatment Response (TR LI-RADS) work group and associates, presents recent trends in the utility of AI applications for the volumetric evaluation and assessment of HCC treatment response. Various topics including radiomics, prognostic imaging findings, and locoregional therapy (LRT) specific issues will be discussed in the framework of HCC treatment response classification systems with focus on the Liver Reporting and Data System treatment response algorithm (LI-RADS TRA).
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26
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Gabr A, Kulik L, Mouli S, Riaz A, Ali R, Desai K, Mora RA, Ganger D, Maddur H, Flamm S, Boike J, Moore C, Thornburg B, Alasadi A, Baker T, Borja-Cacho D, Katariya N, Ladner DP, Caicedo JC, Lewandowski RJ, Salem R. Liver Transplantation Following Yttrium-90 Radioembolization: 15-Year Experience in 207-Patient Cohort. Hepatology 2021; 73:998-1010. [PMID: 32416631 DOI: 10.1002/hep.31318] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/31/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Radioembolization (yttrium-90 [Y90]) is used in hepatocellular carcinoma (HCC) as a bridging as well as downstaging liver-directed therapy to curative liver transplantation (LT). In this study, we report long-term outcomes of LT for patients with HCC who were bridged/downstaged by Y90. APPROACH AND RESULTS Patients undergoing LT following Y90 between 2004 and 2018 were included, with staging by United Network for Organ Sharing (UNOS) tumor-node-metastasis criteria at baseline pre-Y90 and pre-LT. Post-Y90 toxicities were recorded. Histopathological data of HCC at explant were recorded. Long-term outcomes, including overall survival (OS), recurrence-free survival (RFS), disease-specific mortality (DSM), and time-to-recurrence, were reported. Time-to-endpoint analyses were estimated using Kaplan-Meier. Univariate and multivariate analyses were performed using a log-rank test and Cox proportional-hazards model, respectively. During the 15-year period, 207 patients underwent LT after Y90. OS from LT was 12.5 years, with a median time to LT of 7.5 months [interquartile range, 4.4-10.3]. A total of 169 patients were bridged, whereas 38 were downstaged to LT. Respectively, 94 (45%), 60 (29%), and 53 (26%) patients showed complete, extensive, and partial tumor necrosis on histopathology. Three-year, 5-year, and 10-year OS rates were 84%, 77%, and 60%, respectively. Twenty-four patients developed recurrence, with a median RFS of 120 (95% confidence interval, 69-150) months. DSM at 3, 5, and 10 years was 6%, 11%, and 16%, respectively. There were no differences in OS/RFS for patients who were bridged or downstaged. RFS was higher in patients with complete/extensive versus partial tumor necrosis (P < 0.0001). For patients with UNOS T2 treated during the study period, 5.2% dropped out because of disease progression. CONCLUSIONS Y90 is an effective treatment for HCC in the setting of bridging/downstaging to LT. Patients who achieved extensive or complete necrosis had better RFS, supporting the practice of neoadjuvant treatment before LT.
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Affiliation(s)
- Ahmed Gabr
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Laura Kulik
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Samdeep Mouli
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Ahsun Riaz
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Rehan Ali
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Kush Desai
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Ronald A Mora
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Daniel Ganger
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Haripriya Maddur
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Steven Flamm
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Justin Boike
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Christopher Moore
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Bartley Thornburg
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Ali Alasadi
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Talia Baker
- Department of SurgeryDivision of TransplantationUniversity of ChicagoChicagoIL
| | - Daniel Borja-Cacho
- Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Nitin Katariya
- Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Daniela P Ladner
- Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Juan Carlos Caicedo
- Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Robert J Lewandowski
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL.,Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Riad Salem
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL.,Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
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27
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Bekki Y, Marti J, Toshima T, Lewis S, Kamath A, Argiriadi P, Simpson W, Facciuto L, Patel RS, Gunasekaran G, Kim E, Schiano TD, Facciuto ME. A comparative study of portal vein embolization versus radiation lobectomy with Yttrium-90 micropheres in preparation for liver resection for initially unresectable hepatocellular carcinoma. Surgery 2021; 169:1044-1051. [PMID: 33648768 DOI: 10.1016/j.surg.2020.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Portal vein embolization before liver resection is considered the therapy of choice for patients with inadequate future liver remnants. The concept of radioembolization with Yttrium-90 to achieve the same goal has limited data. METHODS We retrospectively compared patients who underwent portal vein embolization and Yttrium-90 lobectomy before resection of hepatocellular carcinoma in patients with chronic liver disease. RESULTS Seventy-three patients underwent portal vein embolization and 22 patients underwent Yttrium-90. Forty-seven percent of patients before portal vein embolization required additional procedures for tumor control, and 27% of patients after Yttrium-90 required additional procedure to mainly induce further hypertrophy. Both therapies achieved the goal of future liver remnants >40%, but the degree of hypertrophy was significantly higher in Yttrium-90 patients (63% for Yttrium-90, 36% for portal vein embolization, P < .01). Tumor response was significantly better with Yttrium-90, achieving complete response in 50% of patients. Resectability rate was higher after portal vein embolization (85% for portal vein embolization, 64% for Yttrium-90, P = .03). Tumor progression was the most common reason precluding surgery. Complete tumor control was the reason not to pursue surgery in 18% of patients after Yttrium-90. CONCLUSION Both preoperative portal vein embolization and Yttrium-90, increases liver resectability rates by inducing hypertrophy of future liver remnants in patients with hepatocellular carcinoma and chronic liver disease. Yttrium-90 lobectomy achieved better tumor control and provided more time to assess therapy response, optimizing the indication for surgery.
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Affiliation(s)
- Yuki Bekki
- Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Josep Marti
- Department of Surgery, Centre Médico-Chirurgical de Tronquières, Aurillac, France
| | - Takeo Toshima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amita Kamath
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Pamela Argiriadi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - William Simpson
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lucas Facciuto
- Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rahul S Patel
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ganesh Gunasekaran
- Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Edward Kim
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Thomas D Schiano
- Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marcelo E Facciuto
- Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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Kim Y, Lee JS, Lee HW, Kim BK, Park JY, Kim DY, Ahn SH, Kim SU. Predictors of Complete Response in Patients with Hepatocellular Carcinoma Treated with Trans-Arterial Radioembolization. Curr Oncol 2021; 28:965-977. [PMID: 33617513 PMCID: PMC7985772 DOI: 10.3390/curroncol28010095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/02/2021] [Accepted: 02/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Trans-arterial radioembolization (TARE) has shown promising results in treating hepatocellular carcinoma (HCC). We identified independent predictors of radiological complete response (CR) in patients with intrahepatic HCC who were treated with TARE. METHODS Patients with intrahepatic HCC treated with TARE between 2011 and 2017 were recruited. CR was defined according to the modified Response Evaluation Criteria in Solid Tumors. Cox regression analysis was used to determine independent predictors of CR. RESULTS The median age of study participants (83 men and 19 women) was 64.3 years. The mean survival after TARE was 55.5 months, and 21 (20.6%) patients died during the study period. Patients who achieved CR (14 patients, 13.7%) had significantly higher serum albumin level (median 4.1 vs. 3.9 g/dL), lower total bilirubin level (median 0.6 vs. 0.7 mg/dL), lower aspartate aminotransferase level (median 30.0 vs. 43.0 IU/L), lower alkaline phosphatase level (median 79.0 vs. 103.0 IU/L), lower alpha-fetoprotein level (median 12.7 vs. 39.9 ng/mL), lower des-gamma-carboxyprothrombin level (median 575.5 vs. 2772.0 mAU/mL), lower model for end-stage liver disease (MELD) score (median 6.0 vs. 7.0), and smaller maximal tumor diameter (median 6.3 vs. 9.0 cm) compared to those who did not achieve CR (all p < 0.005). Multivariate Cox regression analysis showed that lower MELD score (hazard ratio (HR) = 0.436, p = 0.015) and maximal tumor size < 9 cm (HR = 11.180, p = 0.020) were independent predictors of an increased probability of radiological CR after TARE. CONCLUSIONS Low MELD score and small maximal tumor size were independently associated with an increased probability of CR after TARE in patients with intrahepatic HCC.
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Affiliation(s)
- Yuna Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (J.S.L.); (H.W.L.); (B.K.K.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Yonsei Liver Center, Severance Hospital, Seoul 03722, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jae Seung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (J.S.L.); (H.W.L.); (B.K.K.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Yonsei Liver Center, Severance Hospital, Seoul 03722, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (J.S.L.); (H.W.L.); (B.K.K.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Yonsei Liver Center, Severance Hospital, Seoul 03722, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (J.S.L.); (H.W.L.); (B.K.K.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Yonsei Liver Center, Severance Hospital, Seoul 03722, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (J.S.L.); (H.W.L.); (B.K.K.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Yonsei Liver Center, Severance Hospital, Seoul 03722, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (J.S.L.); (H.W.L.); (B.K.K.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Yonsei Liver Center, Severance Hospital, Seoul 03722, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (J.S.L.); (H.W.L.); (B.K.K.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Yonsei Liver Center, Severance Hospital, Seoul 03722, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.K.); (J.S.L.); (H.W.L.); (B.K.K.); (J.Y.P.); (D.Y.K.); (S.H.A.)
- Yonsei Liver Center, Severance Hospital, Seoul 03722, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea
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Toskich B, Vidal LL, Olson MT, Lewis JT, LeGout JD, Sella DM, Montazeri SA, Devcic Z, Lewis AR, Frey GT, Ritchie CA, Paz-Fumagalli R, Croome KP, Patel TC. Pathologic Response of Hepatocellular Carcinoma Treated with Yttrium-90 Glass Microsphere Radiation Segmentectomy Prior to Liver Transplantation: A Validation Study. J Vasc Interv Radiol 2021; 32:518-526.e1. [PMID: 33551304 DOI: 10.1016/j.jvir.2020.12.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate the pathologic outcomes of hepatocellular carcinoma (HCC) treated with Yttrium-90 radiation segmentectomy using glass microspheres prior to liver transplantation and explore parameters associated with pathologic necrosis. MATERIALS AND METHODS A single-institution retrospective analysis of HCC patients who received radiation segmentectomy prior to liver transplantation from November 2016 to May 2020 was performed. Patients were included if the treatment angiosome encompassed the entire tumor and could be correlated with available gross pathology. Archived histology slides were reviewed for percentage of pathologic necrosis. Thirty-three patients with 37 tumors were evaluated. The median tumor size was 2.3 cm (range, 1-6.7 cm). RESULTS All tumors received a single treatment. The median time from radiation segmentectomy to transplantation was 206 days (range, 58-550 days). Objective response per Modified Response Evaluation Criteria in Solid Tumors (mRECIST) was 92% (complete response, 76%; partial response, 16%). A total of 68% (n = 25) of tumors demonstrated ≥99% pathologic necrosis. Complete pathologic necrosis was present in 53% and 75% of tumors treated with >190 Gy (n = 18) and >500 Gy (n = 8) single-compartment Medical Internal Radiation Dose, respectively. Complete response per mRECIST, posttreatment angiosome T1 hypointensity, dose >190 Gy, microsphere specific activity >297 Bq, and a longer time between treatment and transplant were associated with ≥99% tumor necrosis (P < .05). No posttransplant tumor recurrences occurred within a median follow-up of 604 days (range, 138-1,223 days). CONCLUSIONS Radiation segmentectomy can serve as an ablative modality for the treatment of HCC prior to liver transplant.
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Affiliation(s)
- Beau Toskich
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida.
| | - Lucas L Vidal
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | - Matthew T Olson
- Department of Pathology, Mayo Clinic Florida, Jacksonville, Florida
| | - Jason T Lewis
- Department of Pathology, Mayo Clinic Florida, Jacksonville, Florida
| | - Jordan D LeGout
- Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | - David M Sella
- Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | - S Ali Montazeri
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | - Zlatko Devcic
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | - Andrew R Lewis
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | - Greg T Frey
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | - Charles A Ritchie
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | | | | | - Tushar C Patel
- Department of Transplant, Mayo Clinic Florida, Jacksonville, Florida
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Abstract
The diagnosis of hepatocellular carcinoma relies largely on non-invasive imaging, and is well suited for radiomics analysis. Radiomics is an emerging method for quantification of tumor heterogeneity by mathematically analyzing the spatial distribution and relationships of gray levels in medical images. The published studies on radiomics analysis of HCC provide encouraging data demonstrating potential utility for prediction of tumor biology, molecular profiles, post-therapy response, and outcome. The combination of radiomics data and clinical/laboratory information provides added value in many studies. Radiomics is a multi-step process that requires optimization and standardization, the development of semi-automated or automated segmentation methods, robust data quality control, and refinement of algorithms and modeling approaches for high-throughput data analysis. While radiomics remains largely in the research setting, the strong associations of predictive models and nomograms with certain pathologic, molecular, and immune markers with tumor aggressiveness and patient outcomes, provide great potential for clinical applications to inform optimized treatment strategies and patient prognosis.
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Aslam A, Do RKG, Chernyak V, Mendiratta-Lala M. LI-RADS Imaging Criteria for HCC Diagnosis and Treatment: Emerging Evidence. CURRENT HEPATOLOGY REPORTS 2020; 19:437-447. [DOI: 10.1007/s11901-020-00546-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 01/07/2025]
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Aslam A, Do RKG, Kambadakone A, Spieler B, Miller FH, Gabr AM, Charalel RA, Kim CY, Madoff DC, Mendiratta-Lala M. Hepatocellular carcinoma Liver Imaging Reporting and Data Systems treatment response assessment: Lessons learned and future directions. World J Hepatol 2020; 12:738-753. [PMID: 33200013 PMCID: PMC7643220 DOI: 10.4254/wjh.v12.i10.738] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/07/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality worldwide, with rising clinical and economic burden as incidence increases. There are a multitude of evolving treatment options, including locoregional therapies which can be used alone, in combination with each other, or in combination with systemic therapy. These treatment options have shown to be effective in achieving remission, controlling tumor progression, improving disease free and overall survival in patients who cannot undergo resection and providing a bridge to transplant by debulking tumor burden to downstage patients. Following locoregional therapy (LRT), it is crucial to provide treatment response assessment to guide management and liver transplant candidacy. Therefore, Liver Imaging Reporting and Data Systems (LI-RADS) Treatment Response Algorithm (TRA) was created to provide a standardized assessment of HCC following LRT. LI-RADS TRA provides a step by step approach to evaluate each lesion independently for accurate tumor assessment. In this review, we provide an overview of different locoregional therapies for HCC, describe the expected post treatment imaging appearance following treatment, and review the LI-RADS TRA with guidance for its application in clinical practice. Unique to other publications, we will also review emerging literature supporting the use of LI-RADS for assessment of HCC treatment response after LRT.
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Affiliation(s)
- Anum Aslam
- Department of Radiology, University of Michigan, Ann Arbor, MI 48019, United States.
| | - Richard Kinh Gian Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Avinash Kambadakone
- Abdominal Imaging and Interventional Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Bradley Spieler
- Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Ahmed M Gabr
- Department of Interventional Radiology, OHSU and Tanta University, Egypt, Portland, OR 97239, United States
| | - Resmi A Charalel
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, United States
| | - Charles Y Kim
- Department of Radiology, Duke University Medical Center, Duke University, Durham, NC 27710, United States
| | - David C Madoff
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06520, United States
| | - Mishal Mendiratta-Lala
- School of Medicine, 1500 East Medical Center Drive, University of Michigan, Ann Arbor, MI 48109, United States
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Ghosn M, Derbel H, Kharrat R, Oubaya N, Mulé S, Chalaye J, Regnault H, Amaddeo G, Itti E, Luciani A, Kobeiter H, Tacher V. Prediction of overall survival in patients with hepatocellular carcinoma treated with Y-90 radioembolization by imaging response criteria. Diagn Interv Imaging 2020; 102:35-44. [PMID: 33012693 DOI: 10.1016/j.diii.2020.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the potential of imaging criteria in predicting overall survival of patients with hepatocellular carcinoma (HCC) after a first transcatheter arterial yttrium-90 radioembolization (TARE) MATERIALS AND METHODS: From October 2013 to July 2017, 37 patients with HCC were retrospectively included. There were 34 men and 3 women with a mean age of 60.5±10.2 (SD) years (range: 32.7-78.9 years). Twenty-five patients (68%) were Barcelona Clinic Liver Cancer (BCLC) C and 12 (32%) were BCLC B. Twenty-four primary index tumors (65%) were>5cm. Three radiologists evaluated tumor response on pre- and 4-7 months post-TARE magnetic resonance imaging or computed tomography examinations, using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, modified RECIST (mRECIST), European Association for Study of the Liver (EASL), volumetric RECIST (vRECIST), quantitative EASL (qEASL) and the Liver Imaging Reporting and Data System treatment response algorithm. Kaplan-Meier survival curves were used to compare responders and non-responders for each criterion. Univariate and multivariate Cox proportional hazard ratio (HR) analysis were used to identify covariates associated with overall survival. Fleiss kappa test was used to assess interobserver agreement. RESULTS At multivariate analysis, RECIST 1.1 (HR: 0.26; 95% confidence interval [95% CI]: 0.09-0.75; P=0.01), mRECIST (HR: 0.22; 95% CI: 0.08-0.59; P=0.003), EASL (HR: 0.22; 95% CI: 0.07-0.63; P=0.005), and qEASL (HR: 0.30; 95% CI: 0.12-0.80; P=0.02) showed a significant difference in overall survival between responders and nonresponders. RECIST 1.1 had the highest interobserver reproducibility. CONCLUSION RECIST and mRECIST seem to be the best compromise between reproducibility and ability to predict overall survival in patients with HCC treated with TARE.
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Affiliation(s)
- M Ghosn
- Department of Medical Imaging, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
| | - H Derbel
- Department of Medical Imaging, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Unité Inserm 955, équipe 18, IMRB, University of Paris Est Créteil, 94010 Créteil, France
| | - R Kharrat
- Department of Medical Imaging, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - N Oubaya
- Public Health Department, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - S Mulé
- Department of Medical Imaging, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Unité Inserm 955, équipe 18, IMRB, University of Paris Est Créteil, 94010 Créteil, France
| | - J Chalaye
- Department of Nuclear Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, 51, avenue du-Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - H Regnault
- Department of Hepatology, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Unité Inserm 955, équipe 18, IMRB, University of Paris Est Créteil, 94010 Créteil, France
| | - G Amaddeo
- Department of Hepatology, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Unité Inserm 955, équipe 18, IMRB, University of Paris Est Créteil, 94010 Créteil, France
| | - E Itti
- Department of Nuclear Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, 51, avenue du-Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - A Luciani
- Department of Medical Imaging, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Unité Inserm 955, équipe 18, IMRB, University of Paris Est Créteil, 94010 Créteil, France
| | - H Kobeiter
- Department of Medical Imaging, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Unité Inserm 955, Équipe 8, IMRB, University of Paris Est Créteil, 94010 Créteil, France
| | - V Tacher
- Department of Medical Imaging, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Unité Inserm 955, équipe 18, IMRB, University of Paris Est Créteil, 94010 Créteil, France
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Long-term outcomes of living donor liver transplantation after locoregional treatment for hepatocellular carcinoma: an experience from a single institute. Surg Today 2020; 51:350-357. [PMID: 32767130 DOI: 10.1007/s00595-020-02095-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/15/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The precise role of downstaging or bridge therapy for cirrhotic patients with hepatocellular carcinoma (HCC) beyond or within the Milan criteria (MC) before living donor liver transplantation (LDLT) remains undefined. METHODS We conducted a single-center, retrospective cohort study of 40 cirrhotic patients with HCC who underwent LDLT from 2000 to 2018. Dynamic computed tomography images at the initial presentation and immediately before LDLT as well as the final histopathological findings were reviewed to determine whether they met or exceeded MC. RESULTS Overall, 29 patients underwent various pre-transplant HCC treatments, including ablation and embolization (bridge therapy, n = 20; downstaging, n = 9). Of the 9 patients who were initially beyond the MC, 4 (44.4%) were successfully downstaged to within the MC. Five patients beyond the MC immediately before LDLT demonstrated a significantly worse 5-year overall survival rate than patients within the MC (16.7% vs. 82.2%, P = 0.004), regardless of the radiological HCC stage at presentation or the final pathological tumor status. All 3 recurrent patients had HCC beyond the MC immediately before transplant and died of their disease at 13, 24, and 50 months after transplantation. CONCLUSIONS Successful downstaging for HCC cases beyond the MC provides similar outcomes to those within the MC at presentation, regardless of the histopathological findings.
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Correlation of Y90-absorbed radiation dose to pathological necrosis in hepatocellular carcinoma: confirmatory multicenter analysis in 45 explants. Eur J Nucl Med Mol Imaging 2020; 48:580-583. [DOI: 10.1007/s00259-020-04976-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/27/2020] [Indexed: 01/13/2023]
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Gabr A, Ranganathan S, Mouli SK, Riaz A, Gates VL, Kulik L, Ganger D, Maddur H, Moore C, Hohlastos E, Katariya N, Caicedo JC, Kalyan A, Lewandowski RJ, Salem R. Streamlining radioembolization in UNOS T1/T2 hepatocellular carcinoma by eliminating lung shunt estimation. J Hepatol 2020; 72:1151-1158. [PMID: 32145255 DOI: 10.1016/j.jhep.2020.02.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/04/2020] [Accepted: 02/09/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Pre-treatment Tc-99m macroaggregated albumin (MAA) scans are routinely performed prior to transarterial radioembolization (TARE) to estimate lung shunt fraction (LSF) and lung dose. In this study, we investigate LSF observed in early hepatocellular carcinoma (HCC) and provide the scientific rationale for eliminating this step from routine practice. METHODS Patients with HCC who underwent Y90 from 2004 to 2018 were reviewed. Inclusion criteria were early stage HCC (UNOS T1/T2/Milan criteria: solitary ≤5 cm, 3 nodules ≤3 cm). LSF was determined using MAA in all patients. Associations between LSF and baseline characteristics were investigated. A "no-MAA" paradigm was then proposed based on a homogenous group that expressed very low LSF. RESULTS Of 1,175 patients with HCC treated with TARE, 448 patients met inclusion criteria. Mean age was 65.6 years and 303 (68%) were males. A total of 352 (79%) had solitary lesions and 406 (91%) unilobar disease. Two-hundred and forty-three (54%), 178 (40%) and 27 (6%) patients were Child-Pugh class A, B and C, respectively. Median LSF was 3.9% (IQR 2.4-6%). Median administered activity was 0.9 GBq (IQR 0.6-1.4), for a median segmental volume of 170 cm3 (range: 60-530). Median lung dose was 1.9 Gy (IQR: 1.0-3.3). The presence of a transjugular intrahepatic portosystemic shunt (TIPS; n = 38) was associated with LSF >10% (odds ratio 12.2; 95% CI 5.2-28.6; p <0.001). Median LSF was 3.8% (IQR: 2.4-5.7%) and 6% (IQR: 3.8-15.3%) in no-TIPS vs. TIPS patients (p <0.001). CONCLUSION LSF is clinically negligible in patients with UNOS T1/T2 HCC without TIPS. When segmental injections are planned, this step can be eliminated, thereby reducing time-to-treatment, number of procedures, and improving convenience for patients traveling from faraway. LAY SUMMARY Transarterial radioembolization is a microembolic transarterial treatment for hepatocellular carcinoma. In our study, we found that early stage patients, where segmental injections are planned, exhibited low lung shunting, effectively eliminating the risk of radiation pneumonitis. We propose that the lung shunt study be eliminated in this subgroup, thus leading to fewer procedures, a cost reduction and improved convenience for patients.
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Affiliation(s)
- Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Srirajkumar Ranganathan
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Samdeep K Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Vanessa L Gates
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Laura Kulik
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL
| | - Daniel Ganger
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL
| | - Haripriya Maddur
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL
| | - Christopher Moore
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL
| | - Elias Hohlastos
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Nitin Katariya
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL
| | - Juan Carlos Caicedo
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL
| | - Aparna Kalyan
- Department of Medicine, Division of Medical Oncology, Northwestern University, Chicago, IL
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL; Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL; Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL; Department of Medicine, Division of Medical Oncology, Northwestern University, Chicago, IL.
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Serrablo A, Paliogiannis P, Paradisi C, Hörndler C, Sarría L, Tejedor L, Serrablo L, Azoulay D. Radio-Pathological Correlations in Patients with Liver Metastases for Colorectal Cancer. Dig Surg 2020; 37:383-389. [PMID: 32224622 DOI: 10.1159/000506105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 01/22/2020] [Indexed: 12/10/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the most frequent gastrointestinal cancer. The liver is the organ most commonly affected by CRC metastases. Synchronous CRC liver metastases (CRCLM) are present in 15-25% at diagnosis, and metastases are confined to the liver in 70-80% of these cases. The aim of the present study was to investigate the existence of significant correlations between the pathological features and computed tomography scan morpho-densitometric findings. SUMMARY A retrospective study of prospectively collected data has been performed; all patients underwent curative-intent hepatic resection from January 2004 to December 2012 and had histologically confirmed CRCLM. Key Messages: Thirty-four (57%) patients were males; the mean age was 64.4 (±10.2) years. Statistically significant differences have been found with the percentages of intra-tumoral fibrosis (p = 0.038) and necrosis (p = 0.007); the values of fibrosis are higher in the absence of a peri-lesional ring, while those of necrosis are higher in the presence of a peri-lesional ring.There was a correlation between the histopathological response to treatments and the global attenuation levels observed in the computed tomography scan of CRCLM. Furthermore, the presence of a radiologically evidenced peripheral ring was associated with the amount of viable tumor cells in the periphery of the tumor, and with responses predominated by necrosis. More studies are needed to clarify the radiological and histological correlation and to be able to better select patients who are going to undergo surgery.
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Affiliation(s)
- Alejandro Serrablo
- HPB Surgical Division, Miguel Servet University Hospital, Zaragoza, Spain,
| | - Panagiotis Paliogiannis
- Experimental Pathology and Oncology, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Carlos Paradisi
- Radiology Department, Clinic University Hospital, Zaragoza, Spain
| | - Carlos Hörndler
- Pathological Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis Sarría
- Radiology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis Tejedor
- General Surgery Department Puerta Europa Hospital, Algeciras, Spain
| | | | - Daniel Azoulay
- The Center of Liver Diseases, Sheba Medical Center, Tel Aviv, Israel
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Kim S, Kim DY, An C, Han K, Won JY, Kim GM, Kim MJ, Choi JY. Evaluation of Early Response to Treatment of Hepatocellular Carcinoma with Yttrium-90 Radioembolization Using Quantitative Computed Tomography Analysis. Korean J Radiol 2019; 20:449-458. [PMID: 30799576 PMCID: PMC6389807 DOI: 10.3348/kjr.2018.0469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/10/2018] [Indexed: 12/11/2022] Open
Abstract
Objective To identify an imaging predictor for the assessment of early treatment response to yttrium-90 transarterial radioembolization (TARE) in patients with hepatocellular carcinoma (HCC), using a quantitative assessment of dynamic computed tomography (CT) images. Materials and Methods Dynamic contrast-enhanced CT was obtained pre- and 4 weeks post-TARE in 44 patients (34 men, 10 women; mean age, 60 years) with HCC. Computer software was developed for measuring the percentage increase in the combined delayed-enhancing area and necrotic area (pD + N) and the percentage increase in the necrotic area (pNI) in the tumor-containing segments pre- and post-TARE. Local progression-free survival (PFS) was compared between patient groups using Cox regression and Kaplan-Meier analyses. Results Post-TARE HCC with pD + N ≥ 35.5% showed significantly longer PFS than those with pD + N < 35.5% (p = 0.001). The local tumor progression hazard ratio was 17.3 (p = 0.009) for pD + N < 35.5% versus pD + N ≥ 35.5% groups. HCCs with a high pNI tended to have longer PFS, although this difference did not reach statistical significance. Conclusion HCCs with a larger pD + N are less likely to develop local progression after TARE.
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Affiliation(s)
- Sungwon Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chansik An
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Yun Won
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong Jin Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Choi
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea.
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Yang K, Sung PS, You YK, Kim DG, Oh JS, Chun HJ, Jang JW, Bae SH, Choi JY, Yoon SK. Pathologic complete response to chemoembolization improves survival outcomes after curative surgery for hepatocellular carcinoma: predictive factors of response. HPB (Oxford) 2019; 21:1718-1726. [PMID: 31171489 DOI: 10.1016/j.hpb.2019.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/09/2019] [Accepted: 04/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND We identified the predictive factors and prognostic significance of transarterial chemoembolization (TACE) for achieving pathologic complete response (pCR) before curative surgery for hepatocellular carcinoma (HCC) in hepatitis B-endemic areas. METHODS Among 753 HCC patients treated with surgery, 124 patients underwent preoperative TACE before liver resection (LR), and 166 before liver transplantation (LT) between 2005 and 2016. Overall survival (OS) and recurrence-free survival (RFS) were analyzed. Pathologic response (PR) was defined as the mean percentage of necrotic area, and pCR was defined as the absence of viable tumor. RESULTS A total of 34 (27%) and 38 (23%) patients had pCR before LR and LT, respectively. Alpha-fetoprotein (AFP) < 100 ng/mL and single tumor were significant preoperative predictors of pCR. OS and RFS were significantly improved in patients with pCR or a PR ≥ 90%, but not in patients with PR ≥ 50% after LR and LT. On multivariate analyses, PR ≥ 90% remained an independent predictor of better OS and RFS in LR and LT groups. CONCLUSION Overall, our data clearly demonstrate that pCR predicts favorable prognosis after curative surgery for HCC, and predictors of pCR are AFP <100 ng/mL and single tumor.
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Affiliation(s)
- Keungmo Yang
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Pil S Sung
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Young K You
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Dong G Kim
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Jung S Oh
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Ho J Chun
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Jeong W Jang
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Si H Bae
- Department of Internal Medicine, St. Paul's Hospital, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, 02559, Republic of Korea
| | - Jong Y Choi
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Seung K Yoon
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
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Riaz A, Salem R. Laboratory and Imaging Prognostic Indicators following Arterial Locoregional Therapies for Hepatocellular Carcinoma Survival. J Vasc Interv Radiol 2019; 30:1893-1894. [PMID: 31757337 DOI: 10.1016/j.jvir.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ahsun Riaz
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 800, Chicago, IL 60611
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 800, Chicago, IL 60611; Division of Transplant Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 800, Chicago, IL 60611; Division of Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 800, Chicago, IL 60611.
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Crookston NR, Pasciak AS, Abiola G, Donahue D, Weiss CR, Frey EC. Verification of a method to detect glass microspheres via micro-CT. Med Phys 2019; 46:5623-5636. [PMID: 31621918 DOI: 10.1002/mp.13874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/12/2019] [Accepted: 09/19/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The ability to determine the microscopic distribution of glass microspheres in 90 Y radioembolization has important applications in post-treatment microdosimetry and cluster analysis. Current methods are time-intensive and labor-intensive and thus are typically only applied to small samples. MATERIALS AND METHODS A high-resolution micro-CT image with a voxel size of 8.74 µm was acquired of phantoms containing ~25 µm-diameter glass microspheres embedded in tissue-equivalent materials that were optically transparent, which allowed true microsphere locations to be determined using transmission light microscopy. A 3-stage algorithm was developed to estimate the number and locations of microspheres in tissue regions. The stages are thresholding the CT image and discarding regions with insufficient voxels, estimating the number of microspheres in each region using the values of the detected and neighboring region voxels and estimating locations for each microsphere using the outputs of the previous two stages. Two different methods for estimating the number of microspheres in each region were derived, as were five methods for localizing microspheres. Metrics for each stage were computed, and the mean absolute error (MAE) between the dose to 72 µm voxels of the true and estimated dose maps created from the microsphere locations was used as the figure of merit for overall algorithm performance. Microsphere locations identified in the optical micrograph were used as the gold standard for the metrics of all stages. The method's utility was then demonstrated using a specimen from a human neuroendocrine tumor (NET) treated with glass 90 Y microspheres. RESULTS The stage detecting regions containing microspheres found 100% of microspheres inside regions. The number of incorrectly detected regions without microspheres was 1.5% of the total number of regions. In stage 2, with these parameters, nearly 94% of the actual number of spheres in each region was correctly counted, and only 5% of the estimated sphere quantities in each region were false positives. The MAE between the true dose maps and dose maps estimated using the full algorithm with optimal parameter and method choices was 4.2%. A total of 5,713 glass microspheres were identified as being distributed heterogeneously in the NET specimen with a maximum tumor dose of >2500 Gy and 46% of the specimen receiving <20 Gy. CONCLUSIONS This work developed and evaluated a method to detect and estimate the three-dimensional locations of glass microspheres in whole tissue samples that require less manual effort than traditional methods. This method could be used to gain important insights into the heterogeneity of microsphere distributions that would be useful for improving radioembolization treatment planning.
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Affiliation(s)
- Nathan R Crookston
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | - Godwin Abiola
- Johns Hopkins Medical Institution, Baltimore, MD, USA
| | | | | | - Eric C Frey
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.,Johns Hopkins Medical Institution, Baltimore, MD, USA
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Tada T, Kumada T, Toyoda H, Tsuji K, Hiraoka A, Michitaka K, Deguchi A, Ishikawa T, Imai M, Ochi H, Joko K, Shimada N, Tajiri K, Hirooka M, Koizumi Y, Hiasa Y, Tanaka J. Impact of albumin-bilirubin grade on survival in patients with hepatocellular carcinoma who received sorafenib: An analysis using time-dependent receiver operating characteristic. J Gastroenterol Hepatol 2019; 34:1066-1073. [PMID: 30549320 DOI: 10.1111/jgh.14564] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/20/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Albumin-bilirubin (ALBI) grade was developed as a new method to assess hepatic function. Sorafenib has been confirmed to be effective in improving survival in patients with advanced hepatocellular carcinoma (HCC). In this study, we investigated the impact of ALBI grade versus Child-Pugh classification on survival in HCC patients who received sorafenib. METHODS A total of 567 patients with advanced HCC who received sorafenib were included. We analyzed survival based on Child-Pugh classification or score and ALBI grade or score. We also compared the ability of ALBI and Child-Pugh scores to predict survival using time-dependent receiver operating characteristic analysis. RESULTS Cumulative survival rates at 90, 180, 360, and 720 days were 84.1%, 66.6%, 47.0%, and 23.3%, respectively. Median survival was 316 days (95% confidence interval, 279-377). Both Child-Pugh classification and ALBI grade were independently associated with overall survival in multivariate analyses. In addition, overall survival differed significantly between patients with ALBI grades 1 and 2 (hazard ratio, 1.44; 95% confidence interval, 1.09-1.92, P = 0.011) among patients with a Child-Pugh score of 5. Time-dependent receiver operating characteristic analysis showed that ALBI score predicted overall survival better than Child-Pugh score. CONCLUSIONS Albumin-bilirubin grade is a better predictor of survival in patients with advanced HCC who received sorafenib therapy than Child-Pugh classification.
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Affiliation(s)
- Toshifumi Tada
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takashi Kumada
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kunihiko Tsuji
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Atsushi Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Kojiro Michitaka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Akihiro Deguchi
- Department of Gastroenterology, Kagawa-Rosai Hospital, Marugame, Japan
| | - Toru Ishikawa
- Department of Gastroenterology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Michitaka Imai
- Department of Gastroenterology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Hironori Ochi
- Hepato-Biliary Center, Matsuyama Red-Cross Hospital, Matsuyama, Japan
| | - Koji Joko
- Hepato-Biliary Center, Matsuyama Red-Cross Hospital, Matsuyama, Japan
| | - Noritomo Shimada
- Department of Gastroenterology, Otakanomori Hospital, Kashiwa, Japan
| | - Kazuto Tajiri
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Yohei Koizumi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
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Gordic S, Wagner M, Zanato R, Hectors S, Besa C, Kihira S, Kim E, Taouli B. Prediction of hepatocellular carcinoma response to 90Yttrium radioembolization using volumetric ADC histogram quantification: preliminary results. Cancer Imaging 2019; 19:29. [PMID: 31142363 PMCID: PMC6541997 DOI: 10.1186/s40644-019-0216-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/16/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose To assess the predictive value of volumetric apparent diffusion coefficient (vADC) histogram quantification obtained before and 6 weeks (6w) post-treatment for assessment of hepatocellular carcinoma (HCC) response to 90Yttrium radioembolization (RE). Methods In this retrospective study, 22 patients (M/F 15/7, mean age 65y) who underwent lobar RE were included between October 2013 and November 2014. All patients underwent routine liver MRI pre-treatment and 6w after RE. Two readers assessed index tumor response at 6 months after RE in consensus, using mRECIST criteria. vADC histogram parameters of index tumors at baseline and 6w, and changes in vADC (ΔvADC) histogram parameters were calculated. The predictive value of ADC metrics was assessed by logistic regression with stepwise parameter selection and ROC analyses. Results Twenty two HCC lesions (mean size 3.9 ± 2.9 cm, range 1.2–12.3 cm) were assessed. Response at 6 months was as follows: complete response (CR, n = 6), partial response (PR, n = 3), stable disease (SD, n = 12) and progression (PD, n = 1). vADC median/mode at 6w (1.81–1.82 vs. 1.29–1.35 × 10− 3 mm2/s) and ΔvADC median/max (27–44% vs. 0–10%) were significantly higher in CR/PR vs. SD/PD (p = 0.011–0.036), while there was no significant difference at baseline. Logistic regression identified vADC median at 6w as an independent predictor of response (CR/PR) with odds ratio (OR) of 3.304 (95% CI: 1.099–9.928, p = 0.033) and AUC of 0.77. ΔvADC mean was identified as an independent predictor of CR with OR of 4.153 (95%CI: 1.229–14.031, p = 0.022) and AUC of 0.91. Conclusion Diffusion histogram parameters obtained at 6w and early changes in ADC from baseline are predictive of subsequent response of HCCs treated with RE, while pre-treatment vADC histogram parameters are not. These results need confirmation in a larger study. Trial registration This retrospective study was IRB-approved and the requirement for informed consent was waived.
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Affiliation(s)
- Sonja Gordic
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Mathilde Wagner
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sorbonne Universités, UPMC, Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Riccardo Zanato
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Stefanie Hectors
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cecilia Besa
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, 8331150, Santiago, Chile
| | - Shingo Kihira
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA
| | - Edward Kim
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA
| | - Bachir Taouli
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA.
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Hussein RS, Tantawy W, Abbas YA. MRI assessment of hepatocellular carcinoma after locoregional therapy. Insights Imaging 2019; 10:8. [PMID: 30694398 PMCID: PMC6352610 DOI: 10.1186/s13244-019-0690-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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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Schobert I, Chapiro J, Nezami N, Hamm CA, Gebauer B, Lin M, Pollak J, Saperstein L, Schlachter T, Savic LJ. Quantitative Imaging Biomarkers for 90Y Distribution on Bremsstrahlung SPECT After Resin-Based Radioembolization. J Nucl Med 2019; 60:1066-1072. [PMID: 30655331 DOI: 10.2967/jnumed.118.219691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/19/2018] [Indexed: 12/27/2022] Open
Abstract
Our purpose was to identify baseline imaging features in patients with liver cancer that correlate with 90Y distribution on postprocedural SPECT and predict tumor response to transarterial radioembolization (TARE). Methods: This retrospective study was approved by the institutional review board and included 38 patients with hepatocellular carcinoma (HCC) (n = 23; 18/23 men; mean age, 62.39 ± 8.62 y; 34 dominant tumors) and non-HCC hepatic malignancies (n = 15; 9/15 men; mean age, 61.13 ± 11.51 y; 24 dominant tumors) who underwent 40 resin-based TARE treatments (August 2012 to January 2018). Multiphasic contrast-enhanced MRI or CT was obtained before and Bremsstrahlung SPECT within 2 h after TARE. Total tumor volume (cm3) and enhancing tumor volume (ETV [cm3] and % of total tumor volume), and total and enhancing tumor burden (%), were volumetrically assessed on baseline imaging. Up to 2 dominant tumors per treated lobe were analyzed. After multimodal image registration of baseline imaging and SPECT/CT, 90Y distribution was quantified on SPECT as tumor-to-normal-liver ratio (TNR). Response was assessed according to RECIST1.1 and quantitative European Association for the Study of the Liver criteria. Clinical parameters were also assessed. Statistical tests included Mann-Whitney U, Pearson correlation, and linear regression. Results: In HCC patients, high baseline ETV% significantly correlated with high TNR on SPECT, demonstrating greater 90Y uptake in the tumor relative to the liver parenchyma (P < 0.001). In non-HCC patients, a correlation between ETV% and TNR was observed as well (P = 0.039). Follow-up imaging for response assessments within 1-4 mo after TARE was available for 23 patients with 25 treatments. The change of ETV% significantly correlated with TNR in HCC (P = 0.039) but not in non-HCC patients (P = 0.886). Additionally, Child-Pugh class B patients demonstrated significantly more 90Y deposition in nontumorous liver than Child-Pugh A patients (P = 0.021). Conclusion: This study identified ETV% as a quantifiable imaging biomarker on preprocedural MRI and CT to predict 90Y distribution on postprocedural SPECT in HCC and non-HCC. However, the relationship between the preferential uptake of 90Y to the tumor and tumor response after radioembolization could be validated only for HCC.
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Affiliation(s)
- Isabel Schobert
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.,Institute of Radiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany; and
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Nariman Nezami
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Charlie A Hamm
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.,Institute of Radiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany; and
| | - Bernhard Gebauer
- Institute of Radiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany; and
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.,Visage Imaging Inc., San Diego, California
| | - Jeffrey Pollak
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Lawrence Saperstein
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Todd Schlachter
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Lynn J Savic
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.,Institute of Radiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany; and
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Gabr A, Abouchaleh N, Ali R, Baker T, Caicedo J, Katariya N, Abecassis M, Riaz A, Lewandowski RJ, Salem R. Outcomes of Surgical Resection after Radioembolization for Hepatocellular Carcinoma. J Vasc Interv Radiol 2018; 29:1502-1510.e1. [DOI: 10.1016/j.jvir.2018.06.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 12/16/2022] Open
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47
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18F-FCH and 90Y PET/CT data for the early evaluation of HCC radioembolisation. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0295-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mora RA, Ali R, Gabr A, Abouchaleh N, Asadi AA, Kallini JR, Miller FH, Yaghmai V, Mouli S, Thornburg B, Desai K, Riaz A, Lewandowski RJ, Salem R. Pictorial essay: imaging findings following Y90 radiation segmentectomy for hepatocellular carcinoma. Abdom Radiol (NY) 2018; 43:1723-1738. [PMID: 29147766 DOI: 10.1007/s00261-017-1391-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Transarterial radioembolization is a novel therapy that has gained rapid clinical acceptance for the treatment of hepatocellular carcinoma (HCC). Segmental radioembolization [also termed radiation segmentectomy (RS)] is a technique that can deliver high doses (> 190 Gy) of radiation selectively to the hepatic segment(s) containing the tumor. The aim of this comprehensive review is to provide an illustrative summary of the most relevant imaging findings encountered after radiation segmentectomy. A 62-patient cohort of Child-Pugh A patients with solitary HCC < 5 cm in size was identified. A comprehensive retrospective imaging review was done by interventional radiology staff at our institution. Important imaging findings were reported and illustrated in a descriptive account. For the purposes of completeness, specific patients outside our initial cohort with unique educational imaging features that also underwent segmentectomy were included in this pictorial essay. This review shows that response assessment after RS requires a learning curve with common drawbacks that can lead to false-positive interpretations and secondary unnecessary treatments. It is important to recognize that treatment responses and pathological changes both are time dependent. Findings such as benign geographical enhancement and initial benign pathological enhancement can easily be misinterpreted. Capsular retraction and segmental atrophy are some other examples of unique post-RS response that are not seen in any other treatment.
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Affiliation(s)
- Ronald A Mora
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Rehan Ali
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Nadine Abouchaleh
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ali Al Asadi
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Joseph Ralph Kallini
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Frank H Miller
- Department of Radiology, Section of Body Imaging, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Vahid Yaghmai
- Department of Radiology, Section of Body Imaging, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Samdeep Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Kush Desai
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA.
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
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Ahmed AF, Samreen N, Grajo JR, Zendejas I, Sistrom CL, Collinsworth A, Esnakula A, Shah JL, Cabrera R, Geller BS, Toskich BB. Angiosomal radiopathologic analysis of transarterial radioembolization for the treatment of hepatocellular carcinoma. Abdom Radiol (NY) 2018; 43:1825-1836. [PMID: 29052747 DOI: 10.1007/s00261-017-1354-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess the radiopathologic correlation following Yttrium-90 transarterial radioembolization (TARE) of hepatocellular carcinoma (HCC) using variable radiodosimetry to identify imaging surrogates of histologic response. METHODS Twelve patients with HCC underwent ablative (≥ 190 Gy) and/or non-ablative (< 190 Gy) TARE delivered in a segmental, lobar, or combined fashion as a surgical neoadjuvant or bridge to transplantation. Both targeted tumor and treatment angiosome were analyzed before and after TARE utilizing hepatocyte-specific contrast-enhanced MRI or contrast-enhanced CT. Responses were graded using EASL and mRECIST criteria. Histologic findings including percent tumor necrosis and adjacent hepatic substrate effects were correlated with imaging features. RESULTS Complete pathologic necrosis (CPN) was observed in 7/12 tumors post-TARE. Ablative and non-ablative dosing resulted in CPN in 5/6 and 2/6 tumors, respectively. Hyperintensity on T2-weighted imaging, the absence of hepatocyte-specific gadolinium contrast uptake, and plateau or persistent enhancement kinetics in the angiosome correlated with CPN and performed similarly to EASL and mRECIST criteria in predicting CPN. CONCLUSIONS The absence of hepatocyte-specific contrast uptake, increased signal on T2-weighted sequences, and plateau or persistent enhancement in the angiosome may represent MRI surrogates of CPN following TARE of HCC. These findings correlated with EASL and mRECIST response criteria. Further investigation is needed to determine the role of these findings as possible adjuncts to conventional imaging criteria.
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Radioembolization for Hepatocellular Carcinoma: A Nationwide 10-Year Experience. J Vasc Interv Radiol 2018; 29:912-919.e2. [DOI: 10.1016/j.jvir.2018.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/16/2018] [Accepted: 03/16/2018] [Indexed: 02/07/2023] Open
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