Radiologic-pathologic analysis of quantitative 3D tumour enhancement on contrast-enhanced MR imaging: a study of ROI placement
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To investigate the influence of region-of-interest (ROI) placement on 3D tumour enhancement [Quantitative European Association for the Study of the Liver (qEASL)] in hepatocellular carcinoma (HCC) patients treated with transcatheter arterial chemoembolization (TACE).
Phase 1: 40 HCC patients had nine ROIs placed by one reader using systematic techniques (3 ipsilateral to the lesion, 3 contralateral to the lesion, and 3 dispersed throughout the liver) and qEASL variance was measured. Intra-class correlations were computed. Phase 2: 15 HCC patients with histosegmentation were selected. Six ROIs were systematically placed by AC (3 ROIs ipsilateral and 3 ROIs contralateral to the lesion). Three ROIs were placed by 2 radiologists. qEASL values were compared to histopathology by Pearson’s correlation, linear regression, and median difference.
Phase 1: The dispersed method (abandoned in phase 2) had low consistency and high variance. Phase 2: qEASL correlated strongly with pathology in systematic methods [Pearson’s correlation coefficient = 0.886 (ipsilateral) and 0.727 (contralateral)] and in clinical methods (0.625 and 0.879). However, ipsilateral placement matched best with pathology (median difference: 5.4 %; correlation: 0.89; regression CI: [0.904, 0.1409]).
qEASL is a robust method with comparable values among tested placements. Ipsilateral placement showed high consistency and better pathological correlation.
• Ipsilateral and contralateral ROI placement produces high consistency and low variance.
• Both ROI placement methods produce qEASL values that correlate well with histopathology.
• Ipsilateral ROI placement produces best correlation to pathology along with high consistency.
KeywordsTumour segmentation MRI Hepatocellular carcinoma TACE ROI
The scientific guarantor of this publication is Jean-François Geschwind. The authors of this manuscript declare relationships with the following companies: Dr. Geschwind reports grants from NIH, grants from Philips Medical, during the conduct of the study; personal fees from Consultant to Nordion, personal fees from Consultant to Biocompatibles/BTG, personal fees from Consultant to Bayer HealthCare, grants from DOB, grants from Biocompatibles/BTG, grants from Bayer HealthCare, grants from Nordion, grants from Context Vision, grants from SIR, grants from RSNA, grants from Guerbet, outside the submitted work. Dr. Lin reports grants from NIH, during the conduct of the study; and is a Philips employee.
All other authors do not have any conflicts of interest to disclose. Our study has received funding by NIH/NCI R01 CA160771, P30 CA006973, Philips Research North America, Briarcliff Manor, NY, USA.
Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board.
Our study follows our recently published manuscript to European Radiology where qEASL was shown to predict survival in patients with colorectal metastases to the liver better than the uni- dimensional and bi-dimensional measurements (mRECIST, RECIST, WHO, EASL): Julius Chapiro, Rafael Duran, MingDe Lin, et al. (2015) Early Survival Prediction after Intra-arterial Therapies: A 3D quantitative MRI assessment of Tumour Response after TACE or Radioembolization of Colorectal Cancer Metastases to the Liver. Eur Radiol DOI 10.1007/s00330-015-3595-5.
Methodology: retrospective, experimental, performed at one institution.
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