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Quantitative volumetric functional MR imaging: an imaging biomarker of early treatment response in hypo-vascular liver metastasis patients after yttrium-90 transarterial radioembolization

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Abstract

Purpose

To evaluate the value of quantitative volumetric functional MR imaging in early assessment of response to yttrium-90-labeled (90Y) transarterial radioembolization (TARE) in patients with hypo-vascular liver metastases.

Materials and methods

Seventy four metastatic lesions in 14 patients with hypo-vascular liver metastases after TARE were included in this retrospective study. Diffusion and contrast-enhanced MR imaging was performed before and early after treatment. All MR images were analyzed by two experienced radiologists. Response by anatomic metrics (RECIST, mRECIST, EASL) and functional metrics (ADC and arterial and venous enhancement) were reported in targeted and non-targeted lesions. A two-sample paired t test was used to compare the changes after TARE. A p value of <0.05 was considered statistically significant.

Results

The anatomic metrics did not show any significant changes in both targeted and non-targeted groups. Targeted lesions demonstrated an increase in mean volumetric ADC (23.4%; p = 0.01), a decrease in arterial and venous enhancement (−22.9% and −6.7%, respectively; p < 0.001 and p = 0.002, respectively) 1 month after treatment. Twenty one responding lesions (42%) by RECIST at 6 months demonstrated a significant increase in volumetric ADC (37.2%; p = 0.01), decrease in arterial and venous enhancement (−58.5% and −23.9%, respectively; p < 0.001) at 1 month post-treatment. Responding lesions did not change significantly by anatomic metrics.

Conclusions

RECIST, mRECIST, and EASL criteria failed to stratify lesions into responders and non-responders early after TARE in hypo-vascular liver metastasis. Quantitative volumetric functional MR imaging could be a promising tool as a biomarker for predicting early response and can potentially be utilized in clinical trials.

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Abbreviations

TARE:

Transarterial radioembolization

90Y:

Yttrium-90

RECIST:

Response evaluation criteria in solid tumors

EASL:

European association for the study of the liver

HCC:

Hepatocellular carcinoma

mRECIST:

Modified RECIST

MRI:

Magnetic resonance imaging

DWI:

Diffusion-weighted imaging

ADC:

Apparent diffusion coefficient

LRT:

Loco-regional therapy

NELM:

Neuroendocrine liver metastases

ICLM:

Islet cell liver metastases

TACE:

Transarterial chemoembolization

HAE:

Hepatic arterial enhancement

PVE:

Portal venous enhancement

CR:

Complete response

PR:

Partial response

SD:

Stable disease

PD:

Progression of disease

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Funding

This study did not receive any funding.

Author information

Authors and Affiliations

  1. The Shandong Medical Imaging Research Institute, Jinan, 250021, Shandong, China

    Xiangyu Zhu

  2. The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St., MRI 143, Baltimore, MD, 21287, USA

    Xiangyu Zhu, Fatemeh Sobhani, Chunmiao Xu, Mounes Aliyari Ghasebeh & Ihab R. Kamel

  3. Siemens Healthcare, Baltimore, MD, 21287, USA

    Li Pan

Authors
  1. Xiangyu Zhu
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  2. Fatemeh Sobhani
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  3. Chunmiao Xu
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  4. Li Pan
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  5. Mounes Aliyari Ghasebeh
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  6. Ihab R. Kamel
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Corresponding author

Correspondence to Ihab R. Kamel.

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Conflict of interest

None of the authors listed (Xiangyu Zhu, Fatemeh Sobhani, Chunmiao Xu; Li Pan, Mounes Aliyari Ghasebeh, Ihab R. Kamel) have conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This study was approved by the IRB. Due to the retrospective nature of this study, informed consent was not obtained.

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Zhu, X., Sobhani, F., Xu, C. et al. Quantitative volumetric functional MR imaging: an imaging biomarker of early treatment response in hypo-vascular liver metastasis patients after yttrium-90 transarterial radioembolization. Abdom Radiol 41, 1495–1504 (2016). https://doi.org/10.1007/s00261-016-0694-y

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  • DOI: https://doi.org/10.1007/s00261-016-0694-y

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