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Parametric response mapping cut-off values that predict survival of hepatocellular carcinoma patients after TACE

  • Classics in Abdominal Imaging
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Abstract

Purpose

Parametric response mapping (PRM) is a novel image-analysis technique applicable to assess tumor viability and predict intrahepatic recurrence of hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE). However, to date, the prognostic value of PRM for prediction of overall survival in HCC patients undergoing TACE is unclear. The objective of this explorative, single-center study was to identify cut-off values for voxel-specific PRM parameters that predict the post TACE overall survival in HCC patients.

Methods

PRM was applied to biphasic CT data obtained at baseline and following 3 TACE treatments of 20 patients with HCC tumors ≥ 2 cm. The individual portal venous phases were registered to the arterial phases followed by segmentation of the largest lesion, i.e., the region of interest (ROI). Segmented voxels with their respective arterial and portal venous phase density values were displayed as a scatter plot. Voxel-specific PRM parameters were calculated and compared to patients’ survival at 1, 2, and 3 years post treatment to identify the maximal predictive parameters.

Results

The hypervascularized tissue portion of the ROI was found to represent an independent predictor of the post TACE overall survival. For this parameter, cut-off values of 3650, 2057, and 2057 voxels, respectively, were determined to be optimal to predict overall survival at 1, 2, and 3 years after TACE. Using these cut points, patients were correctly classified as having died with a sensitivity of 80, 92, and 86% and as still being alive with a specificity of 60, 75, and 83%, respectively. The prognostic accuracy measured by area under the curve (AUC) values ranged from 0.73 to 0.87.

Conclusion

PRM may have prognostic value to predict post TACE overall survival in HCC patients.

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Notes

  1. Voxels with clear non-vital characteristics (density values > 300 HU arterial and > 100 HU portal venous) were filtered out [15].

Abbreviations

AUC:

Area under the curve

BCLC:

Barcelona Clinic Liver Cancer (staging system)

cm:

Centimeter

CT:

Computed tomography

CI:

Confidence interval

TACE:

Transarterial chemoembolization

DEB:

Drug-eluting beads

EC:

Ethics committee

et al.:

And others

i.e.,:

That means

EASL:

European Association for the Study of Liver

EORTC:

European Organisation for Research and Treatment of Cancer

FOV:

Field of view

HCC:

Hepatocellular carcinoma

HU:

Hounsfield unit

kVp:

Kilovoltage peak

mAs:

Milliampere second

MDCT:

Multi-detector computed tomography

Mm:

Millimeter

(m)RECIST:

(modified) Response Evaluation Criteria in Solid Tumors

MRI:

Magnetic resonance imaging

PRM:

Parametric Response Mapping

ROC:

Receiver operating characteristic

ROI:

Region of interest

S:

Second

SD:

Standard deviation

SEN:

Sensitivity

SIRT:

Selective internal radiotherapy

SPE:

Specificity

VIF:

Variance inflation factor

WHO:

World Health Organization

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Acknowledgements

We would like to thank Philip D. Walson, MD, Visiting Professor, Department of Clinical Pharmacology, University Medical Center Göttingen, Germany for providing English language editing of draft versions of the manuscript.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    Aventinus Nörthen, Hoen-Oh Shin, Jan B. Hinrichs, Thomas Werncke, Frank K. Wacker & Thomas Rodt

  2. Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073, Göttingen, Germany

    Thomas Asendorf

  3. Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    Arndt Vogel & Martha M. Kirstein

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Correspondence to Thomas Rodt.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with animals performed by any of the authors.

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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. For this type of study formal consent was not required.

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Informed consent was obtained from all individual participants included in the study for the medical and radiologic procedures performed.

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Nörthen, A., Asendorf, T., Shin, HO. et al. Parametric response mapping cut-off values that predict survival of hepatocellular carcinoma patients after TACE. Abdom Radiol 43, 3288–3300 (2018). https://doi.org/10.1007/s00261-018-1610-4

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