Perfusion parameters of dynamic contrast-enhanced magnetic resonance imaging predict outcomes of hepatocellular carcinoma receiving radiotherapy with or without thalidomide

Abstract

Signal parameters of DCEMRI over tumor and liver parenchyma correlated with tumor response and survival, respectively, in HCC patients receiving radiotherapy.

Optimal combination of antiangiogenic therapy for hepatocellular carcinoma

“…However, the addition of thalidomide at current dosage and schedule did not change the signal parameters significantly compared to the 22 patients receiving radiotherapy only [87] . The inconsistency between serum biomarker and DCEMRI parameter was reported in a study using ribonucleotide reductase M2 inhibitor with radiation in pancreatic cancer patients [95] .…”

“…The observation was validated in another fortythree patients. Signal parameters of baseline as well as week 2 during radiotherapy were higher in patients with responsive tumor [87] . Multivariate analysis, however, showed signal parameters over liver parenchyma, but not over tumor, independently predicted PFS and OS [87] .…”

“…Signal parameters of baseline as well as week 2 during radiotherapy were higher in patients with responsive tumor [87] . Multivariate analysis, however, showed signal parameters over liver parenchyma, but not over tumor, independently predicted PFS and OS [87] . In line with the observation, univariate analysis showed ChildPugh classification B and poor liver function predicted shorter PFS.…”

“…With the a priori DECMRI study in HCC patients receiving radiotherapy, we evaluated the combination effect of thalidomide to radiotherapy within the same population of patients with identical image acquisition and analysis protocols [87,89] . Thalidomide, an angiogenesis inhibitor, was noted to radiosensitize tumors by reducing interstitial fluid pressure, increase perfusion and tumor reoxygenation [90] .…”

Value of dynamic contrast enhanced MRI in predicting outcomes of HCC receiving radiotherapy

“…In particular, DCEMRI is used to evaluate changes of vascularity or hemodynamics in HCC nodules, similar to dynamic CT. A feature of DCEMRI that is different from dynamic CT is its ability to precisely measure the properties of the microcirculation using special analytic methods. In this issue of Hepatology International, Liang et al [7] attempted to calculate semiquantitative perfusion parameters, such as initial first-pass enhancement slopes (Slope) and peak enhancement ratios (Peak), which represent microcirculation and permeability to contrast medium in the evaluation of treatment response to RT. Slope is more closely related to the vascular density of the tissue, whereas Peak represents a complex process involving blood flow, transit, and permeability that affect the contrast media concentration in the total extracellular space.…”