Arterial Blood Supply of Hepatocellular Carcinoma and Histologic Grading: Radiologic-Pathologic Correlation

Asayama, Yoshiki; Yoshimitsu, Kengo; Nishihara, Yunosuke; Irié, Hiroyuki; Aishima, Shinichi; Taketomi, Akinobu; Honda, Hiroshi

doi:10.2214/ajr.07.2117

Cited by 134 publications

(99 citation statements)

References 20 publications

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“…First, further protocol simplification may be possible. For example, our finding (29). Lastly, ED 18 F-FDG PET could be evaluated in cirrhosis assessment, a purpose for which blood flow measurement by CE ultrasonography or CE MR imaging has been applied (30).…”

Section: Discussionmentioning

confidence: 71%

Early Dynamic ¹⁸F-FDG PET to Detect Hyperperfusion in Hepatocellular Carcinoma Liver Lesions

et al. 2013

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In addition to angiographic data on vascularity and vascular access, demonstration of hepatocellular carcinoma (HCC) liver nodule hypervascularization is a prerequisite for certain intrahepatic antitumor therapies. Early dynamic (ED) 18 F-FDG PET/ CT could serve this purpose when the current standard method, contrast-enhanced (CE) CT, or other CE morphologic imaging modalities are unsuitable. A recent study showed ED 18 F-FDG PET/CT efficacy in this setting but applied a larger-thanstandard 18 F-FDG activity and an elaborate protocol likely to hinder routine use. We developed a simplified protocol using standard activities and easily generated visual and descriptive or quantitative endpoints. This pilot study assessed the ability of these endpoints to detect HCC hyperperfusion and, thereby, evaluated the suitability in of the protocol everyday practice. Methods: Twenty-seven patients with 34 HCCs (diameter $ 1.5 cm) with hypervascularization on 3-phase CE CT underwent liver ED 18 F-FDG PET for 240 s, starting with 18 F-FDG (250-MBq bolus injection). Four frames at 15-s intervals, followed by 3 frames at 60-s intervals were reconstructed. Endpoints included focal tracer accumulation in the first 4 frames (60 s), subsequent focal washout, and visual and quantitative differences between tumor and liver regions of interest in maximum and mean ED standardized uptake value (ED SUVmax and ED SUVmean, respectively) 240-s time-activity curves. Results: All 34 lesions were identified by early focal 18 F-FDG accumulation and faster time-to-peak ED SUVmax or ED SUVmean than in nontumor tissue. Tumor peak ED SUVmax and ED SUVmean exceeded liver levels in 85% and 53%, respectively, of lesions. Nadir tumor signal showed no consistent pattern relative to nontumor signal. HCC had a significantly shorter time to peak and significantly faster rate to peak for both ED SUVmax and ED SUVmean curves and a significantly higher peak ED SUVmax but not peak ED SUVmean than the liver. Conclusion: This pilot study provided proof of principle that our simplified ED 18 F-FDG PET/CT protocol includes endpoints that effectively detect HCC hypervascularization; this finding suggests that the protocol can be used routinely.

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Section: Discussionmentioning

confidence: 71%

Early Dynamic ¹⁸F-FDG PET to Detect Hyperperfusion in Hepatocellular Carcinoma Liver Lesions

et al. 2013

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“…However, it could be that it is insufficient for achieving a complete response in large advanced HCCs (23). In fact, hepatic artery perfusion, which is related to successful TACE, is negatively correlated with 18 F-FDG uptake of HCC and has been found to significantly decrease in aggressive HCC (24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of¹⁸F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study

Lee

Chung

et al. 2016

J Nucl Med

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This study aimed to assess the prognostic value of 18 F-FDG uptake in hepatocellular carcinoma (HCC) patients who had transarterial chemoembolization (TACE) or concurrent intraarterial chemotherapy with external-beam radiotherapy (CCRT) and to compare the prognosis between patients treated with TACE and those with CCRT according to 18 F-FDG uptake. Methods: Two hundred fourteen intermediateto-advanced-stage HCC patients without extrahepatic metastasis who underwent staging 18 F-FDG PET/CT before TACE (153 patients) or CCRT (61 patients) were recruited from 7 hospitals. Progressionfree survival (PFS) and overall survival (OS) were compared using an optimal cutoff value for tumor-to-normal liver uptake ratio (TLR). Further, PFS and OS were compared according to treatment modalities (TACE vs. CCRT) using the same TLR cutoff value. Results: On multivariate analysis, age and TLR were independent prognostic factors for PFS (P , 0.050). For OS, Child-Pugh classification and TLR were independent prognostic factors (P , 0.050). When the TLR was greater than 2.0, patients treated with CCRT showed significantly better PFS and OS than those treated with TACE after adjusting for tumor size and number (P 5 0.014, for all). In contrast, there was no significant difference in PFS and OS between patients treated with TACE or CCRT when the TLR was 2.0 or less. Conclusion: 18 F-FDG uptake was an independent prognostic factor for PFS and OS in HCC patients treated with TACE or CCRT. Especially, in HCCs with high 18 F-FDG uptake, patients treated with CCRT showed better survival than those treated with TACE.

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“…Li et al (12) and Ippolito et al (13) found that CT could provide sufficient information on tumor-related vessels and thus can be a good tool for evaluating the degree of tumor vascularization. Blood supply from hepatic artery and portal vein can be relatively insufficient during the rapid growth of HCC; as a result, the new vessels continuously form around the tumor, leading to the formation of tumors with good blood supply (14,15). The degree of arterial-phase enhancement on CT or MRI may be an important marker of tumor vascularization.…”

Section: Discussionmentioning

confidence: 99%

Arterial blood supply of hepatocellular carcinoma is associated with efficacy of sorafenib therapy

Zhang¹,

Zhu²,

Li³

et al. 2015

Hepatoma Res

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Results: Among these 38 patients [35 (92.1%) were males] treated with sorafenib, the median age was (53.3±11.1) years. Tumors in 17 patients had good arterial supply while those in the remained 21 patients had poor arterial supply. The median survival time (MST) was 10.7 months (95% CI, 8.7-12.7) and the 1-year overall survival (OS) was 41.0%. The MST and 1-year OS in patients with tumors with good arterial supply were 12 months (range, 4-20 months) and 52.9%, respectively, compared with those of 7 months (range, 1-16 months) and 23.8% in patients with tumors with poor arterial supply (P=0.002). Patients with BCLC stage B tumors had longer MST and higher OS than those with BCLC stage C tumors, although the differences were not statistically significant.Multivariate analysis showed that arterial supply of tumors remained statistically predictive for OS (HR =0.22; 95% CI, 0.07-0.67; P=0.008).Conclusions: Arterial blood supply is an independent predictor for survival in HCC patients treated with sorafenib, and patients with tumors with good arterial supply benefit more than those with tumors with poor arterial supply.Keywords: Hepatocellular carcinoma (HCC); sorafenib; arterial blood supply Submitted Dec 05, 2014. Accepted for publication Dec 05, 2014Dec 05, . doi: 10.3978/j.issn.2305Dec 05, -5839.2015 View this article at: http://dx.doi.org/10.3978/j.issn. 2305-5839.2015.10.24 Introduction Hepatocellular carcinoma (HCC) is a clinically common disease. As the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections increases worldwide, the incidence of HCC also gradually rise. HCC is now the third leading cause of cancer deaths (1). Only about 15% of HCC have a chance to be cured by surgery (e.g., liver resection or transplantation) or minimally invasive local treatment (e.g., radiofrequency ablation). For HCC at advanced stages, radical treatment is impossible and multidisciplinary treatment may be more feasible (2).As a multiple kinase inhibitor, sorafenib can selectively inhibit the vascular endothelial growth factor 2/plateletderived growth factor receptor pathway to prevent tumor angiogenesis and meanwhile suppress cell proliferation by targeting the mitogen-activated protein kinase signaling pathway. Two global phase III clinical trials [SHARP (3) and Asia-Pacific trial (4)] have demonstrated that sorafenib can improve the prognosis of patients with advanced HCC. Among studies focusing on the prognostic factors of HCC patients treated with sorafenib, many of them found that the prognosis of these patients may be associated with the computed tomography (CT) and magnetic resonance imaging (MRI) features (5-10). Hahn et al. (6) found that the area under the contrast concentration vs. time curve 90 s after contrast injection (IAUC90) and the volume transfer constant of contrast agent (Ktrans) are pharmacodynamic biomarkers for sorafenib. Hsu et al. (7) also found that, among the prognostic factors of HCC patients receiving sorafenib and tegafur/uracil treatment, Ktrans was closely cor...

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Arterial Blood Supply of Hepatocellular Carcinoma and Histologic Grading: Radiologic-Pathologic Correlation

Abstract: In the late stage of HCC development, the arterial blood supply significantly decreases as the histologic grade progresses.

Cited by 134 publications

References 20 publications

Early Dynamic ¹⁸F-FDG PET to Detect Hyperperfusion in Hepatocellular Carcinoma Liver Lesions

Early Dynamic ¹⁸F-FDG PET to Detect Hyperperfusion in Hepatocellular Carcinoma Liver Lesions

Prognostic Significance of¹⁸F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study

Arterial blood supply of hepatocellular carcinoma is associated with efficacy of sorafenib therapy

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Arterial Blood Supply of Hepatocellular Carcinoma and Histologic Grading: Radiologic-Pathologic Correlation

Abstract: In the late stage of HCC development, the arterial blood supply significantly decreases as the histologic grade progresses.

Cited by 134 publications

References 20 publications

Early Dynamic 18F-FDG PET to Detect Hyperperfusion in Hepatocellular Carcinoma Liver Lesions

Early Dynamic 18F-FDG PET to Detect Hyperperfusion in Hepatocellular Carcinoma Liver Lesions

Prognostic Significance of18F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study

Arterial blood supply of hepatocellular carcinoma is associated with efficacy of sorafenib therapy

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Product

Resources

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Early Dynamic ¹⁸F-FDG PET to Detect Hyperperfusion in Hepatocellular Carcinoma Liver Lesions

Early Dynamic ¹⁸F-FDG PET to Detect Hyperperfusion in Hepatocellular Carcinoma Liver Lesions

Prognostic Significance of¹⁸F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study