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LI-RADS treatment response algorithm after first-line DEB-TACE: reproducibility and prognostic value at initial post-treatment CT/MRI

  • Hepatobiliary
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Abstract

Purpose

To evaluate the inter-reader reproducibility and prognostic accuracy of the Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (LR-TR) at the time of initial post-treatment evaluation following drug-eluting beads transarterial chemoembolization (DEB-TACE) for hepatocellular carcinoma (HCC).

Methods

This retrospective study included patients with HCC who underwent first-line DEB-TACE between January 2011 and December 2015. Six readers (three fellowship-trained radiologists and three radiology trainees) independently assessed lesion-level response in up to two treated lesions per LR-TR and modified Response Evaluation Criteria in Solid Tumors (mRECIST)-target criteria, as well as patient-level response per mRECIST-overall criteria, on the initial post-treatment CT/MRI. Inter-reader agreement was calculated by Fleiss’ multi-reader κ. We tested whether LR-TR, mRECIST-target, and mRECIST-overall response were associated with overall survival using Kaplan–Meier and Cox proportional hazard model analyses.

Results

A total of 82 patients with 113 treated target lesions were included. Inter-reader agreement was moderate for LR-TR and mRECIST-overall (κ range 0.42–0.57), and substantial for mRECIST-target (κ range 0.62–0.66), among all three reader-groups: all readers, experienced readers, and less-experienced readers. LR-TR and mRECIST-target response were not significantly associated with overall survival regardless of reader experience (P > 0.05). In contrast, mRECIST-overall response was significantly associated with overall survival when assessed by all readers (P = 0.02) and experienced readers (P = 0.03), but not by the less-experienced readers (P = 0.35).

Conclusion

Although LR-TR algorithm has moderate inter-reader reproducibility, it alone may not predict overall survival on the initial post-treatment CT/MRI after first-line DEB-TACE for HCC.

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Funding

Drs. Singal and Yokoo are in part supported by NIH U01 C230694.

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Authors and Affiliations

  1. Radiology, University of Wisconsin-Madison, 1111 Highland Ave, WIMR II, Room 2423, Madison, WI, 53705, USA

    Ali Pirasteh

  2. Medical Physics, University of Wisconsin-Madison, Madison, WI, USA

    Ali Pirasteh

  3. Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Ali Pirasteh, E. Aleks Sorra, Hector Marquez, Robert C. Sibley, Julia R. Fielding, Abhinav Vij, Gaurav Khatri & Takeshi Yokoo

  4. Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Adam C. Yopp

  5. Digestive and Liver Diseases, Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Nicole E. Rich, Ana Arroyo & Amit G. Singal

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  1. Ali Pirasteh
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Correspondence to Ali Pirasteh.

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Conflict of interest

Ali Pirasteh: GE Healthcare, institutional research support agreement (University of Wisconsin-Madison). Dr. Pirasteh has served as consultant on advisory board for Sanofi Genzyme. E. Aleks Sorra, Hector Marquez, Carson R. Sibley, Julia R. Fielding, Abhinav Vij, Nicole E. Rich, Ana Arroyo, Adam C. Yopp, Gaurav Khatri, Takeshi Yokoo: No disclosures. Amit G. Singal: Dr. Singal has served as consultant or on advisory boards for Bayer, Eisai, Genentech, BMS, Exelixis, AstraZeneca, Wako Diagnostics, Exact Sciences, Roche, Glycotest, GRAIL, and TARGET Pharmasolutions. Dr. Singal also serves on the LI-RADS Steering Committee.

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Pirasteh, A., Sorra, E.A., Marquez, H. et al. LI-RADS treatment response algorithm after first-line DEB-TACE: reproducibility and prognostic value at initial post-treatment CT/MRI. Abdom Radiol 46, 3708–3716 (2021). https://doi.org/10.1007/s00261-021-03043-6

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