Post-treatment CT LI-RADS categories: predictors of overall survival in hepatocellular carcinoma post bland transarterial embolization

Ormiston, William; Yarmohammadi, Hooman; Lobaugh, Stephanie; Schilsky, Juliana; Katz, Seth; LaGratta, Maria D.; Velayati, Sara; Zheng, Junting; Capanu, Marinela; Gian, Richard Kinh

doi:10.1007/s00261-020-02775-1

Cited by 9 publications

(5 citation statements)

References 21 publications

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“…Previous studies found that early imaging-based response assessment after LRT may have value in predicting patient outcome [ 15 , 32 , 33 ], which is in line with our results. In our study, sensitivity, specificity, and PPV were fair to excellent for all methods and readers when the initial post-treatment MRI was used to predict CR at 12 months.…”

Section: Discussionsupporting

confidence: 92%

Early post-treatment MRI predicts long-term hepatocellular carcinoma response to radiation segmentectomy

et al. 2023

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Objectives Radiation segmentectomy using yttrium-90 plays an emerging role in the management of early-stage HCC. However, the value of early post-treatment MRI for response assessment is uncertain. We assessed the value of response criteria obtained early after radiation segmentectomy in predicting long-term response in patients with HCC. Materials and methods Patients with HCC who underwent contrast-enhanced MRI before, early, and 12 months after radiation segmentectomy were included in this retrospective single-center study. Three independent radiologists reviewed images at baseline and 1st follow-up after radiation segmentectomy and assessed lesion-based response according to mRECIST, LI-RADS treatment response algorithm (TRA), and image subtraction. The endpoint was response at 12 months based on consensus readout of two separate radiologists. Diagnostic accuracy for predicting complete response (CR) at 12 months based on the 1st post-treatment MRI was calculated. Results Eighty patients (M/F 60/20, mean age 67.7 years) with 80 HCCs were assessed (median size baseline, 1.8 cm [IQR, 1.4–2.9 cm]). At 12 months, 74 patients were classified as CR (92.5%), 5 as partial response (6.3%), and 1 as progressive disease (1.2%). Diagnostic accuracy for predicting CR was fair to good for all readers with excellent positive predictive value (PPV): mRECIST (range between 3 readers, accuracy: 0.763–0.825, PPV: 0.966–1), LI-RADS TRA (accuracy: 0.700–0.825, PPV: 0.983–1), and subtraction (accuracy: 0.775–0.825, PPV: 0.967–1), with no difference in accuracy between criteria (p range 0.053 to > 0.9). Conclusion mRECIST, LI-RADS TRA, and subtraction obtained on early post-treatment MRI show similar performance for predicting long-term response in patients with HCC treated with radiation segmentectomy. Clinical relevance statement Response assessment extracted from early post-treatment MRI after radiation segmentectomy predicts complete response in patients with HCC with high PPV (≥ 0.96). Key Points • Early post-treatment response assessment on MRI predicts response in patients with HCC treated with radiation segmentectomy with fair to good accuracy and excellent positive predictive value. • There was no difference in diagnostic accuracy between mRECIST, LI-RADS, and subtraction for predicting HCC response to radiation segmentectomy.

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Section: Discussionsupporting

confidence: 92%

Early post-treatment MRI predicts long-term hepatocellular carcinoma response to radiation segmentectomy

et al. 2023

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“…A large and growing body of literature has investigated the reliability of the LR-TR algorithm for lesion classification in CT and MRI examinations in patients with HCC [19][20][21][22][23]. A recent meta-analysis by Kim et al showed substantial overall inter-reader agreement when the LR-TR algorithm was used to assess treatment response following locoregional therapies [15].…”

Section: Discussionmentioning

confidence: 99%

Inter-observer agreement using the LI-RADS version 2018 CT treatment response algorithm in patients with hepatocellular carcinoma treated with conventional transarterial chemoembolization

et al. 2021

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Aim To determine inter-reader agreement in categorization of imaging features using the Liver Imaging Reporting and Data System (LI-RADS) treatment response (LR-TR) algorithm in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE). Methods Two radiologists used the LR-TR algorithm to assess 112 computed tomography (CT) examinations of 102 patients treated with cTACE. The inter-observer agreement in categorization of LR-TR features was assessed using kappa (κ) statistics. Results There was substantial inter-observer agreement between the two reviewers using the LR-TR algorithm (κ = 0.70; 95% CI 0.58–0.81). The two reviewers categorized tumors as non-viable in 37 (33.0%) and 39 (34.8%) of 112 examinations, viable in 58 (51.8%) and 62 (55.4%) examinations, and equivocal in 18 (16.1%) and 11 (9.8%) examinations, respectively. There was almost perfect inter-observer agreement for the LR-TR non-viable category (κ = 0.80; 95% CI 0.68–0.92), substantial agreement for the viable category (κ = 0.78 95% CI 0.67–0.90), and fair agreement for the equivocal category (κ = 0.25; 95% CI 0.02–0.49). Conclusion The LR-TR algorithm conveys high degrees of inter-observer agreement for the assessment of CT imaging features in the viable and non-viable categories. Further refinement of indeterminate features may be necessary to improve the correct categorization of equivocal lesions. Graphic abstract

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“…This natural history is different than LR-TR equivocal categorization of lesions treated with nonradiation-based treatment, which frequently progress over time and often require retreatment. [23][24][25][26] This difference is likely a result of the different mechanisms of cell death induced by radiation vs. nonradiation therapies.…”

Section: Expected Imaging Appearance Of Radiation-treated Hccmentioning

confidence: 99%

Updates on LI‐RADS Treatment Response Criteria for Hepatocellular Carcinoma: Focusing on MRI

Patel

Aslam

Parikh

et al. 2023

Magnetic Resonance Imaging

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As the incidence of hepatocellular carcinoma (HCC) and subsequent treatments with liver‐directed therapies rise, the complexity of assessing lesion response has also increased. The Liver Imaging Reporting and Data Systems (LI‐RADS) treatment response algorithm (LI‐RADS TRA) was created to standardize the assessment of response after locoregional therapy (LRT) on contrast‐enhanced CT or MRI. Originally created based on expert opinion, these guidelines are currently undergoing revision based on emerging evidence. While many studies support the use of LR‐TRA for evaluation of HCC response after thermal ablation and intra‐arterial embolic therapy, data suggest a need for refinements to improve assessment after radiation therapy. In this manuscript, we review expected MR imaging findings after different forms of LRT, clarify how to apply the current LI‐RADS TRA by type of LRT, explore emerging literature on LI‐RADS TRA, and highlight future updates to the algorithm. Evidence Level 3. Technical Efficacy Stage 2.

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Post-treatment CT LI-RADS categories: predictors of overall survival in hepatocellular carcinoma post bland transarterial embolization

Cited by 9 publications

References 21 publications

Early post-treatment MRI predicts long-term hepatocellular carcinoma response to radiation segmentectomy

Early post-treatment MRI predicts long-term hepatocellular carcinoma response to radiation segmentectomy

Inter-observer agreement using the LI-RADS version 2018 CT treatment response algorithm in patients with hepatocellular carcinoma treated with conventional transarterial chemoembolization

Updates on LI‐RADS Treatment Response Criteria for Hepatocellular Carcinoma: Focusing on MRI

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