Assessment of Therapy Response to Transarterial Radioembolization for Liver Metastases by Means of Post-treatment MRI-Based Texture Analysis
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To determine whether post-treatment magnetic resonance imaging (MRI)-based texture analysis of liver metastases (LM) may be suited predicting therapy response to transarterial radioembolization (TARE) during follow-up.
Materials and Methods
Thirty-seven patients with LM treated by TARE (mean age 63.4 years) between January 2006 and December 2014 were identified in this retrospective feasibility study. They underwent dynamic contrast-enhanced and hepatocellular phase MRI after TARE (mean 2.2 days). Response was evaluated on follow-up imaging scheduled in intervals of 3 months (median follow-up, 7.3 months) based on response evaluation criteria in solid tumors 1.1 (RECIST 1.1). Results of texture analysis [mean, standard deviation, skewness (s), kurtosis (k), entropy and uniformity] were compared between patients with progressive disease (PD) and patients with stable disease (SD), partial or complete response (PR/CR). Receiver operating characteristics including the area under the curve (AUC) and cutoff values including the sensitivity and specificity were calculated.
According to RECIST 1.1, 24 patients (64.9%) had PD, 8 SD (21.6%) and 5 PR (13.5%). MRI-based texture analysis showed an earlier differentiation between patients with and without PD when compared with RECIST 1.1. Median k (2.88 vs. 2.35) in arterial phase MRI and median s (0.48 vs. 0.25) and k (2.85 vs. 2.25) in venous phase MRI were significantly different (p < 0.05). The AUC for k derived from arterial phase MRI was 0.73 (cutoff = 2.55, sensitivity = 0.83, specificity = 0.62) (p < 0.05). The AUC for s and k in venous phase MRI was 0.76 (cutoff = 0.35, sensitivity = 0.71, specificity = 0.85) (p > 0.05) and 0.83 (cutoff = 2.50, sensitivity = 0.75, specificity = 0.85) (p < 0.05).
This study indicates the potential of MRI-based texture analysis at arterial and venous phase MRI for the early prediction of PD after TARE.
Level of Evidence
KeywordsLiver metastases Radioembolization Magnetic resonance imaging Texture analysis Radiomics
The authors thank Prof. Dr. Nina Timmesfeld (Philipps-University, Marburg, Germany) for statistical advice, Dr. Matthias Baumhauer (Mint Medical GmbH, Dossenheim, Germany) for technical support and Dr. Andrew McIntyre (Städtisches Klinikum Karlsruhe, Germany) for language editing. Our special thanks go to the liver tumor board at Klinikum Karlsruhe and the interventional section of the Institute of Diagnostic and Interventional Radiology.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
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.
The requirement to obtain an additional informed consent was waived by the ethics committee of Philipps-University, Marburg, Germany.
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