Abdominal Radiology

, Volume 41, Issue 4, pp 600–616 | Cite as

Hepatic imaging following intra-arterial embolotherapy

  • Joseph Ralph Kallini
  • Frank H. Miller
  • Ahmed Gabr
  • Riad Salem
  • Robert J. Lewandowski
Pictorial essay
First Online:

Abstract

Purpose

To discuss guidelines and salient imaging findings of solid tumors treated with common intra-arterial procedures used in interventional oncology.

Methods

A meticulous literature search of PubMed-indexed articles was conducted. Key words included “imaging + embolization,” “imaging + TACE,” “imaging + radioembolization,” “imaging + Y90,” “mRECIST,” and “EASL.” Representative post-treatment cross-sectional images were obtained from past cases in this institution.

Results

Intra-arterial therapy (IAT) in interventional oncology includes bland embolization, chemoembolization, and radioembolization. Solid tumors of the liver are the primary focus of these procedures. Cross-sectional CT and/or MR are the main modalities used to image tumors after treatment. Traditional size-based response criteria (WHO and RECIST) alone are of limited utility in determining response to IAT; tumoral necrosis and enhancement must be considered. Specifically for HCC, the EASL and mRECIST guidelines are becoming widely adopted response criteria to assess these factors. DWI, FDG-PET, and CEUS are modalities that play an adjunctive but controversial role.

Conclusions

Radiologists must be aware that the different forms of intra-arterial therapy yield characteristic findings on cross-sectional imaging. Knowledge of these findings is integral to accurate assessment of tumor response and progression.

Keywords

Computed tomography (CT) HCC Intra-arterial embolotherapies Modified RECIST (mRECIST) MR imaging Response assessment 

Abbreviations

AASLD

American Association for the Study of Liver Disease

ADC

Apparent diffusion coefficient

AFP

Alpha-fetoprotein

CEUS

Contrast-enhanced ultrasonography

CT

Computerized tomography

cTACE

Conventional trans-arterial chemoembolization

DEB-TACE

Drug-eluting bead trans-arterial chemoembolization

DECT

Dual-energy computerized tomography

DWI

Diffusion weighted imaging

EASL

European Association for the Study of Liver

FDG-PET

Fluorodeoxyglucose-positron emission tomography

HCC

Hepatocellular carcinoma

IAT

Intra-arterial therapy

LRT

Locoregional therapy

mCRC

Metastatic colorectal carcinoma

MDCT

Multi-detector computed tomography

mRECIST

Modified response evaluation criteria in solid tumors

MRI

Gadolinium-enhanced magnetic resonance imaging

qEASL

Quantitative European Association for the Study of Liver

RECIST

Response Evaluation Criteria in Solid Tumors

ROI

Region of interest

TACE

Trans-arterial chemoembolization

TAE

Trans-arterial embolization

TARE

Trans-arterial radioembolization

UNOS

United Network for Organ Sharing

WHO

World Health Organization

vRECIST

Volumetric Response Evaluation Criteria in Solid Tumors

Y90

Yttrium-90

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Notes

Compliance with ethical standards

Conflict of Interest

RJL and RS are advisors to BTG international. None of the other authors report a conflict of interest.

Ethical approval

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

Funding

There was no funding provided for this study.

Informed consent

Institutional Review Board approval was obtained for cross-sectional imaging included in this review. For this type of study, formal consent is not required.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Joseph Ralph Kallini
    • 1
  • Frank H. Miller
    • 2
  • Ahmed Gabr
    • 1
  • Riad Salem
    • 1
    • 3
    • 4
  • Robert J. Lewandowski
    • 1
  1. 1.Department of Radiology, Section of Interventional RadiologyNorthwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer CenterChicagoUSA
  2. 2.Department of RadiologyNorthwestern University Feinberg School of Medicine, Northwestern Memorial HospitalChicagoUSA
  3. 3.Department of Surgery, Division of Transplantation, Comprehensive Transplant CenterNorthwestern UniversityChicagoUSA
  4. 4.Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer CenterNorthwestern UniversityChicagoUSA

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