Early survival prediction after intra-arterial therapies: a 3D quantitative MRI assessment of tumour response after TACE or radioembolization of colorectal cancer metastases to the liver

Abstract

Objectives This study evaluated the predictive role of 1D, 2D and 3D quantitative, enhancement-based MRI regarding overall survival (OS) in patients with colorectal liver metastases (CLM) following intra-arterial therapies (IAT). Methods This retrospective analysis included 29 patients who underwent transarterial chemoembolization (TACE) or radioembolization and received MRI within 6 weeks after therapy. Tumour response was assessed using 1D and 2D criteria (such as European Association for the Study of the Liver guidelines [EASL] and modified Response Evaluation Criteria in Solid Tumors [mRECIST]). In addition, a segmentation-based 3D quantification of overall (volumetric [v] RECIST) and enhancing lesion volume (quantitative [q] EASL) was performed on portal venous phase MRI. Accordingly, patients were classified as responders (R) and non-responders (NR). Survival was evaluated using Kaplan–Meier analysis and compared using Cox proportional hazard ratios (HR). Results Only enhancement-based criteria identified patients as responders. EASL and mRECIST did not predict patient survival (P = 0.27 and P = 0.44, respectively). Using uni- and multivariate analysis, qEASL was identified as the sole predictor of patient survival (9.9 months for R, 6.9 months for NR; P = 0.038; HR 0.4). Conclusion The ability of qEASL to predict survival early after IAT provides evidence for potential advantages of 3D quantitative tumour analysis.

Imaging Biomarkers of Tumor Response in Neuroendocrine Liver Metastases Treated with Transarterial Chemoembolization: Can Enhancing Tumor Burden of the Whole Liver Help Predict Patient Survival?

“…Second, a volumetric assessment addresses the discordance between lesion diameter or area and volume of tumor tissue—a limitation associated with one-and two-dimensional enhancement-based criteria (mRECIST and EASL, respectively) (14,15,39). Both criteria examine one axial section, which often is not representative of the entire tumor and could explain why mRECIST and EASL were poor biomarkers for survival in our study and other studies (11,14,17,18). Volumetric enhancement–based criteria, however, measure the entire tumor and can account for the heterogeneous, nonspherical necrosis that embolotherapy induces (15,39).…”

“…Volumetric measurements of tumor enhancement are more representative of tumor necrosis and have been shown to help predict survival (11,14,17,18). In general, volumetric analysis has been applied on a lesion-by-lesion basis.…”

3D Quantitative tumour burden analysis in patients with hepatocellular carcinoma before TACE: comparing single-lesion vs. multi-lesion imaging biomarkers as predictors of patient survival

“…Though 1D, diameter-based measurements are workflow efficient; however, the caveat of such simplistic tumour assessments is their inherent inaccuracy, especially when applied to tumours that are frequently inhomogeneous in shape. This clinically underappreciated limitation has been recently recognized in the framework of tumour response assessment, which resulted in the development of 3D quantitative tumour and whole liver assessment techniques [11–16]. However, the ability to more accurately assess liver lesions using 3D methods has just recently been applied for staging purposes [17].…”

The impact of antiangiogenic therapy combined with Transarterial Chemoembolization on enhancement based quantitative tumor response assessment in patients with hepatocellular carcinoma

“…It also increases robustness and reproducibility by subtracting the registered pre-contrast image from the arterial phase image and setting a lesion-specific threshold for tumor enhancement, hence removing background enhancement contribution, and mitigating variances introduced by segmentation [10]. This study (among others) demonstrates the high inter-reader agreement achieved by qEASL [19]. This criterion is also applicable in cases evading certain uni-dimensional and bi-dimensional measurements, like RECIST, mRECIST, WHO and EASL.…”