Imaging Evaluation Following <sup>90</sup>Y Radioembolization of Liver Tumors: What Radiologists Should Know

Joo, Ijin; Kim, Hyo Cheol; Kim, Gyoung Min; Paeng, Jin Chul

doi:10.3348/kjr.2018.19.2.209

Cited by 32 publications

(20 citation statements)

References 77 publications

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“…This study introduces TNR as a quantitative surrogate on SPECT as a readily applicable predictor for enhancement-based tumor response after TARE in HCC (P 5 0.038). As morphologic changes of the tumors occur gradually and become measurable on anatomic imaging as late as 2-4 mo after TARE, TNR may thus allow for the evaluation of treatment efficacy immediately after treatment (21,22). Such immediate feedback can support timely clinical decision making in rapidly evolving disease processes of liver cancer in a palliative setting.…”

Section: Discussionmentioning

confidence: 99%

“…Hepatic metastases usually show different contrast uptake and washout behavior than HCC (28,29). As the vascular density in metastatic tumors such as colorectal cancer metastases is usually lower than for HCC, metastases may lack contrast enhancement on baseline imaging and distinct alterations of contrast uptake dynamics throughout the course of TARE (22,28). In the present cohort, a high baseline ETV% was predictive of 90 Y distribution to the tumor (P 5 0.039), but 90 Y distribution did not correlate with tumor response (P 5 0.886).…”

Section: Discussionmentioning

confidence: 99%

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Quantitative Imaging Biomarkers for ⁹⁰Y Distribution on Bremsstrahlung SPECT After Resin-Based Radioembolization

et al. 2019

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Our purpose was to identify baseline imaging features in patients with liver cancer that correlate with 90 Y 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 5 23; 18/23 men; mean age, 62.39 ± 8.62 y; 34 dominant tumors) and non-HCC hepatic malignancies (n 5 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 (cm 3) and enhancing tumor volume (ETV [cm 3 ] 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, 90 Y 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 90 Y 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 5 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 5 0.039) but not in non-HCC patients (P 5 0.886). Additionally, Child-Pugh class B patients demonstrated significantly more 90 Y deposition in nontumorous liver than Child-Pugh A patients (P 5 0.021). Conclusion: This study identified ETV% as a quantifiable imaging biomarker on preprocedural MRI and CT to predict 90 Y distribution on postprocedural SPECT in HCC and non-HCC. However, the relationship between the preferential uptake of 90 Y to the tumor and tumor response after radioembolization could be validated only for HCC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Quantitative Imaging Biomarkers for ⁹⁰Y Distribution on Bremsstrahlung SPECT After Resin-Based Radioembolization

et al. 2019

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“…Radioembolization with yttrium-90 ( 90 Y), also referred to as selective internal radiation therapy, is a promising therapeutic option for primary and metastatic liver cancer (1617). 90 Y-loaded microspheres are delivered to the blood vessels supplying the tumor via the hepatic artery, allowing localized high-dose radiation to be delivered to the hepatic tumors.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Radioembolization and Sorafenib for the Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: A Systematic Review and Meta-Analysis of Safety and Efficacy

2019

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Objective To compare the safety and efficacy of radioembolization with that of sorafenib for the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Materials and Methods MEDLINE, EMBASE, and Cochrane databases were searched for studies reporting outcomes in patients with HCC and PVTT treated with radioembolization or sorafenib. Meta-analyses of cumulative overall survival (OS) and Kaplan-Meier survival rates according to the time to progression (TTP) and incidence of adverse events (AEs) were performed. Subgroup analyses were conducted on 1-year OS data. Results Seventeen studies were identified (four involving radioembolization, 10 involving sorafenib, and three comparing both). Pooled OS rates were higher in the radioembolization group, notably at 6 months {76% (95% confidence interval [CI], 64–85%) vs. 54% (95% CI, 45–62%)} and 1 year (47% [95% CI, 38–57%] vs. 24% [95% CI, 18–30%]); TTP was also longer with radioembolization. In patients undergoing radioembolization, the proportion of patients with Eastern Cooperative Oncology Group status 0 ( p < 0.0001), Child-Pugh A ( p < 0.0001), extrahepatic metastasis ( p = 0.0012), and a history of cancer treatment ( p = 0.0048) was identified as a significant source of heterogeneity for the 1-year OS. Radioembolization was associated with a lower incidence of grade 3/4 AEs than sorafenib (9% [95% CI, 3–27%] vs. 28% [95% CI, 17–43%]). Conclusion Compared with sorafenib, radioembolization is a safer and more effective treatment for HCC with PVTT and is associated with prolonged survival, delayed tumor progression, and fewer grade 3/4 AEs.

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“…In cases with persistent area of enhancement, it is important to monitor the enhancing tissue for growth; the absence of growth is compatible with response and observation is appropriate. 72,75,76 Other methods such as perfusion studies, MRI diffusionweighted imaging, are explored to evaluate response but are not currently mature enough for daily practice and remain the object of ongoing research. [77][78][79] Fig .…”

Section: Change In Tumor Morphology Unrelated To Sizementioning

confidence: 99%

Abdominal Manifestations of Neuroendocrine Tumors

et al. 2019

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Despite being rare, the incidence and prevalence of gastroenteropancreatic neuroendocrine tumors (NETs) is rising. They are a heterogeneous group of tumors with differences in clinical presentations, genetics, and imaging features. Advances in pathological classification, imaging (including recent radiotracer approval for functional imaging in the Unites States), and therapy have impacted management of these tumors. It is important in the multidisciplinary approach to patient care to be familiar with the tumor biology, imaging techniques for diagnosis and staging, and therapeutic options. This article will discuss these new developments, particularly focusing on pancreatic and small bowel NETs.

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Imaging Evaluation Following ⁹⁰Y Radioembolization of Liver Tumors: What Radiologists Should Know

Cited by 32 publications

References 77 publications

Quantitative Imaging Biomarkers for ⁹⁰Y Distribution on Bremsstrahlung SPECT After Resin-Based Radioembolization

Quantitative Imaging Biomarkers for ⁹⁰Y Distribution on Bremsstrahlung SPECT After Resin-Based Radioembolization

Comparison of Radioembolization and Sorafenib for the Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: A Systematic Review and Meta-Analysis of Safety and Efficacy

Abdominal Manifestations of Neuroendocrine Tumors

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Imaging Evaluation Following 90Y Radioembolization of Liver Tumors: What Radiologists Should Know

Cited by 32 publications

References 77 publications

Quantitative Imaging Biomarkers for 90Y Distribution on Bremsstrahlung SPECT After Resin-Based Radioembolization

Quantitative Imaging Biomarkers for 90Y Distribution on Bremsstrahlung SPECT After Resin-Based Radioembolization

Comparison of Radioembolization and Sorafenib for the Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: A Systematic Review and Meta-Analysis of Safety and Efficacy

Abdominal Manifestations of Neuroendocrine Tumors

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Imaging Evaluation Following ⁹⁰Y Radioembolization of Liver Tumors: What Radiologists Should Know

Quantitative Imaging Biomarkers for ⁹⁰Y Distribution on Bremsstrahlung SPECT After Resin-Based Radioembolization

Quantitative Imaging Biomarkers for ⁹⁰Y Distribution on Bremsstrahlung SPECT After Resin-Based Radioembolization