Unresectable Intrahepatic Cholangiocarcinoma: Multiparametric MR Imaging to Predict Patient Survival

Abstract

Purpose To determine the performance of magnetic resonance (MR) imaging-based tumor metrics for evaluation of response to transarterial chemoembolization (TACE) in patients with unresectable intrahepatic cholangiocarcinoma (ICCA). Materials and Methods Ninety-four patients with unresectable ICCA underwent baseline and follow-up MR imaging after TACE and were followed up until death or end of study duration. Lesions were analyzed for anatomic (Response Evaluation Criteria in Solid Tumors [RECIST] and tumor volume) and functional (viable tumor volume, viable tumor burden, and apparent diffusion coefficient [ADC]) volumetric MR parameters by using semiautomatic software. Response was assessed by using changes in viable tumor volume by using modified RECIST (mRECIST)-derived thresholds (three-dimensional mRECIST), viable tumor burden, and ADC. Overall survival was the primary endpoint. Cox-regression and Kaplan-Meier survival analysis were used. Results Tumor volume did not change after TACE (P = .07) whereas RECIST diameter showed a small change (-2.6%; P = .02). There was an increase in ADC (20.7%) and a decrease in viable tumor volume (-29.3%) and viable tumor burden (-29.1%; P < .001 for all). Higher overall survival was noted among responders by using thresholds of 25% increase in ADC, 66% decrease in viable tumor volume, and 50% decrease in viable tumor burden (log-rank test, P < .05). Hazard ratio for nonresponders by using ADC, three-dimensional mRECIST, and viable tumor burden at multivariable analysis was 2.9 (P = .004), 4.1 (P = .009), and 4.0 (P = .002), respectively. Survival differences were noted for patients who showed response by using all three parameters (ADC, three-dimensional mRECIST, and viable tumor burden) versus those who showed response by using either one or two of these parameters versus those who showed no response (P < .001). Conclusion Changes in volumetric ADC, viable tumor volume, and viable tumor burden at MR imaging provide prognostic information among patients with unresectable ICCA who undergo TACE. RSNA, 2018 Online supplemental material is available for this article.

Baseline Volumetric Multiparametric MRI: Can It Be Used to Predict Survival in Patients with Unresectable Intrahepatic Cholangiocarcinoma Undergoing Transcatheter Arterial Chemoembolization?

“…To determine this threshold, 10 tumors not part of our study cohort and confirmed to be completely necrotic at pathologic examination after liver transplant were assessed by using the above-described software and upper limit of venous enhancement parameter was determined to be used as threshold for viability. This has been described in a previous study (17). In summary, the voxel-wise enhancement…”

“…All patients were followed up until death or until December 2017. Ninety-four of the 111 patients have been previously reported on (17). This previous study evaluated the performance of MRI-based tumor metrics in evaluating response to TACE by comparing changes in baseline metrics to those obtained 1 month after TACE.…”

“…These studies have focused especially on volumetric measurements of changes in apparent diffusion coefficients (ADCs) and enhancement. A similar recent study demonstrated the value of changes in volumetric ADC and enhancement-based metrics including viable tumor volume and viable tumor burden at MRI in providing prognostic information among patients with unresectable ICCA (17). The results of these studies are based on the sound pathophysiologic fact that ADC, which helps detect random motion of water molecules, can act as a marker of cell membrane integrity in pathologic tissues and can thus help differentiate viable tumor cells from those that are dead.…”

Preoperative Survival Prediction in Intrahepatic Cholangiocarcinoma Using an Ultrasound‐Based Radiographic‐Radiomics Signature

“…Moreover, prognostic predictions based on preoperative clinical and imaging information may benefit all patients with or without surgery and provide better guidance for individualized stratification for more patients. Predicting prognosis by imaging features is achievable because several studies have addressed the relationship between the imaging features of ICC and the tumor aggressiveness and patient outcome 2,27–30 . Our results showed that beyond the tumor number, other imaging features were correlated with patient outcome.…”

Predicting Overall Survival After Conventional Chemoembolization of Intrahepatic Cholangiocarcinoma: The Role of 3D Quantitative Tumor Analysis

“…A standardized liver MRI protocol was performed in all patients enrolled using a 1.5T scanner (Magnetom Avanto, Siemens) with a phased array torso coil (repetition time ms/echo time ms, 5.77/2.77; eld of view 320-400 mm; matrix 192 x 160; slice thickness 2.5 mm; receiver bandwidth 64 kHz; ip angle 10 o ). The protocol included single-shot breath-held gradient-echo diffusion weighted echo-planar images, axial T2weighted fast spin-echo images, and unenhanced and contrast-enhanced (0.1 mmol/kg intravenous gadopentetate; Magnevist; Bayer) breath-held axial T1-weighted 3D fat-suppressed spoiled gradient-echo images in the hepatic arterial, portal venous and delayed phases (20s, 70s, and 180s, respectively) 24,32,33 .…”