Assessing tumor response after loco-regional liver cancer therapies: the role of 3D MRI

Chapiro, Julius; Lin, Ming De; Durán, Rafael; Schernthaner, Rüdiger; Geschwind, Jean François H.

doi:10.1586/14737140.2015.978861

Cited by 34 publications

(20 citation statements)

References 33 publications

(46 reference statements)

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“…A strong correlation of imaging-based measurements of tumor response to TACE with tumor pathology provides critical foundation to link radiological findings with actual therapeutic effect. However, current tumor response methods, such as mRECIST and the European Association for the study of the Liver (EASL) guidelines have limitations in practice[25]. One of which is that they need upwards of 2 months after TACE to assess tumor response on follow-up imaging and so they can’t provide immediate feedback[26].…”

Section: Discussionmentioning

confidence: 99%

Intraprocedural 3D Quantification of Lipiodol Deposition on Cone-Beam CT Predicts Tumor Response After Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma

Wang

Chen

Durán

et al. 2015

Cardiovasc Intervent Radiol

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Purpose To evaluate whether intraprocedural 3D quantification of Lipiodol deposition on cone-beam computed tomography (CBCT) can predict tumor response on follow-up contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE). Materials and Methods This IRB approved, retrospective analysis included 36 patients with 51 HCC target lesions, who underwent cTACE with CBCT. CE-MRI was acquired at baseline and 1 month after cTACE. Overall tumor volumes as well as intra-tumoral Lipiodol volumes on CBCT were measured and compared with the overall and necrotic (non-enhancing) tumor volumes on CE-MRI using the paired student’s t-test. Tumor response on CE-MRI was assessed using modified Response Evaluation Criteria in Solid Tumors (mRECIST). A linear regression model was used to correlate tumor volumes, Lipiodol volumes and the percentage of Lipiodol deposition on CBCT with the corresponding parameters on CE-MRI. Nonparametric spearman rank order correlation and trend test were used to correlate the percentage of Lipiodol deposition in the tumor with tumor response. Result A strong correlation between overall tumor volumes on CBCT and CE-MRI was observed (R2=0.986). In addition, a strong correlation was obtained between the volume of Lipiodol deposition on CBCT and tumor necrosis (in cm3) on CE-MRI (R2=0.960); and between the percentage of Lipiodol deposition and tumor necrosis (R2=0.979). Importantly, the extent of Lipiodol deposition (in percentage of total tumor volume) correlated strongly with tumor response on CE-MRI (Spearman rho=0.84, p<0.001). Conclusions Intraprocedural 3D quantification of Lipiodol deposition on CBCT can be used to predict tumor response on follow-up CE-MRI.

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Section: Discussionmentioning

confidence: 99%

Intraprocedural 3D Quantification of Lipiodol Deposition on Cone-Beam CT Predicts Tumor Response After Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma

Wang

Chen

Durán

et al. 2015

Cardiovasc Intervent Radiol

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“…Furthermore, they are surrogates of the overall tumor volume and do not reflect its actual extent (22,23). The advent of new automated and semiautomated tumor segmentation methods has contributed to the shift away from one- and two-dimensional methods toward three-dimensional (3D) quantitative image analysis (24–26). Initial works established the feasibility and accuracy of 3D quantitative enhancement-based analysis to assess liver tumors after local-regional therapy (27,28).…”

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Comparison of Existing Response Criteria in Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization Using a 3D Quantitative Approach

Tacher¹,

Lin²,

Durán³

et al. 2016

Radiology

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Purpose To compare currently available non-three-dimensional methods (Response Evaluation Criteria in Solid Tumors [RECIST], European Association for Study of the Liver [EASL], modified RECIST [mRECIST[) with three-dimensional (3D) quantitative methods of the index tumor as early response markers in predicting patient survival after initial transcatheter arterial chemoembolization (TACE). Materials and Methods This was a retrospective single-institution HIPAA-compliant and institutional review board–approved study. From November 2001 to November 2008, 491 consecutive patients underwent intraarterial therapy for liver cancer with either conventional TACE or TACE with drug-eluting beads. A diagnosis of hepatocellular carcinoma (HCC) was made in 290 of these patients. The response of the index tumor on pre- and post-TACE magnetic resonance images was assessed retrospectively in 78 treatment-naïve patients with HCC (63 male; mean age, 63 years ± 11 [standard deviation]). Each response assessment method (RECIST, mRECIST, EASL, and 3D methods of volumetric RECIST [vRECIST] and quantitative EASL [qEASL]) was used to classify patients as responders or nonresponders by following standard guidelines for the uni- and bidimensional measurements and by using the formula for a sphere for the 3D measurements. The Kaplan-Meier method with the log-rank test was performed for each method to evaluate its ability to help predict survival of responders and nonresponders. Uni- and multivariate Cox proportional hazard ratio models were used to identify covariates that had significant association with survival. Results The uni- and bidimensional measurements of RECIST (hazard ratio, 0.6; 95% confidence interval [CI]: 0.3, 1.0; P = .09), mRECIST (hazard ratio, 0.6; 95% CI: 0.6, 1.0; P = .05), and EASL (hazard ratio, 1.1; 95% CI: 0.6, 2.2; P = .75) did not show a significant difference in survival between responders and nonresponders, whereas vRECIST (hazard ratio, 0.6; 95% CI: 0.3, 1.0; P = .04), qEASL (Vol) (hazard ratio, 0.5; 95% CI: 0.3, 0.9; P = .02), and qEASL (%) (hazard ratio, 0.3; 95% CI: 0.15, 0.60; P < .001) did show a significant difference between these groups. Conclusion The 3D-based imaging biomarkers qEASL and vRECIST were tumor response criteria that could be used to predict patient survival early after initial TACE and enabled clear identification of nonresponders.

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“…The segmentation of liver lesions in MRI examinations is also firmly established and usually involves a semi-automatic, volume-based approach [25,26]. On the other hand, reliable segmentation of liver lesions in CT -with its lower soft-tissue-contrast -is a more demanding task and has been addressed only recently [24,27].…”

Section: Discussionmentioning

confidence: 99%

Response Evaluation of Malignant Liver Lesions After TACE/SIRT: Comparison of Manual and Semi-Automatic Measurement of Different Response Criteria in Multislice CT

Höink

Schülke

Koch

et al. 2017

Fortschr Röntgenstr

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ZUSAMMENFASSUNGZiel Vergleich von Messgenauigkeit und Interobserver-Variabilität in der computertomografischen Beurteilung von hepatozellulären Karzinomen (HCC) und Lebermetastasen vor und nach transarteriellen selektiven Therapien. Material und MethodenRetrospektive Studie an 72 Patienten mit malignen Leberläsionen (42 Metastasen, 30 HCC) vor und nach Therapie mit SIRT (n = 42) oder TACE (n = 29).Etablierte (LAD, SAD, WHO) und Vitalitäts-assoziierte Größenparameter (mRECIST, mLAD, mSAD, EASL) wurden manuell und semiautomatisch von zwei Auswertern bestimmt. Die relative Interobserverdifferenz (RID) und der Intraclass Korrelationskoeffizient (ICC) wurden berechnet.Ergebnisse Die mediane RID der Vitalitäts-assoziierten Parameter war für die semiautomatischen niedriger als für die manuellen Messverfahren, im Einzelnen: für mLAD 3,4 % gegenüber 12,5 %; für mSAD 5,7 % gegenüber 12,7 %; für This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. ABSTR AC TPurpose To compare measurement precision and interobserver variability in the evaluation of hepatocellular carcinoma (HCC) and liver metastases in MSCT before and after transarterial local ablative therapies. Materials and MethodsRetrospective study of 72 patients with malignant liver lesions (42 metastases; 30 HCCs) before and after therapy (43 SIRT procedures; 29 TACE procedures). Established (LAD; SAD; WHO) and vitality-based parameters (mRECIST; mLAD; mSAD; EASL) were assessed manually and semi-automatically by two readers. The relative interobserver difference (RID) and intraclass correlation coefficient (ICC) were calculated.Results The median RID for vitality-based parameters was lower from semi-automatic than from manual measurement of mLAD (manual 12.5 %; semi-automatic 3.4 %), mSAD (manual 12.7 %; semi-automatic 5.7 %) and EASL (manual 10.4 %; semi-automatic 1.8 %). The difference in established parameters was not statistically noticeable (p > 0.05). The ICCs of LAD (manual 0.984; semi-automatic 0.982), SAD (manual 0.975; semi-automatic 0.958) and WHO (manual 0.984; semi-automatic 0.978) are high, both in manual and semi-automatic measurements. The ICCs of manual measurements of mLAD (0.897), mSAD (0.844) and EASL (0.875) are lower. This decrease cannot be found in semi-automatic measurements of mLAD (0.997), mSAD (0.992) and EASL (0.998).Conclusion Vitality-based tumor measurements of HCC and metastases after transarterial local therapies should be performed semi-automatically due to greater measurement precision, thus increasing the reproducibility and in turn the reliability of therapeutic decisions.

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Assessing tumor response after loco-regional liver cancer therapies: the role of 3D MRI

Cited by 34 publications

References 33 publications

Intraprocedural 3D Quantification of Lipiodol Deposition on Cone-Beam CT Predicts Tumor Response After Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma

Intraprocedural 3D Quantification of Lipiodol Deposition on Cone-Beam CT Predicts Tumor Response After Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma

Comparison of Existing Response Criteria in Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization Using a 3D Quantitative Approach

Response Evaluation of Malignant Liver Lesions After TACE/SIRT: Comparison of Manual and Semi-Automatic Measurement of Different Response Criteria in Multislice CT

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