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Imaging appearance of residual HCC following incomplete trans-arterial chemoembolization on contrast-enhanced imaging

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to describe changes in contrast agent kinetics in HCC following incomplete trans-arterial chemoembolization (TACE) on contrast-enhanced ultrasound (CEUS) and MRI/CT.

Methods

Patients with residual HCC proven by biopsy, retreatment angiography, or 4–8 month MRI demonstrating tumor progression were identified. Pre-treatment and 4–6-week follow-up CE-MRI/CT and CEUS exams were collected for blinded reads by two experienced readers for each modality to evaluate arterial phase hyper-enhancement (APHE) and washout within the residual HCC. A third reader provided tie-breaking decisions for any disagreements.

Results

Contrast-enhanced imaging data were collected from 29 patients with residual HCC post-TACE. On CEUS, 84.2% of patients with baseline APHE demonstrated APHE post-TACE (p = 0.25). On CE-MRI/CT, 57.1% of patients with baseline APHE later demonstrated APHE (p = 0.004). As for washout, on CEUS 33.3% of patients with baseline washout retained washout post-TACE (p = 0.01), while on CE-MRI/CT only 18.8% of patients with baseline washout later demonstrated washout (p < 0.001). Among CEUS readers, reader agreement was 100% for baseline APHE, 66.7% for baseline washout (K = 0.35), 84.2% for post-TACE APHE (K = 0.35), and 57.9% for post-TACE washout (K = − 0.09). On CE-MRI/CT, reader agreement was 65.5% for baseline APHE (K = 0.19), 55.2% for baseline washout (K = 0.12), 48.3% for post-TACE APHE (K = − 0.07), and 58.6% for post-TACE washout (K = 0.04).

Conclusion

Common diagnostic features of treatment-naïve HCC like APHE and washout can be substantially altered by TACE and should be considered when diagnosing residual disease on contrast-enhanced imaging.

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Data availability

Not applicable.

Code availability

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Abbreviations

HCC:

Hepatocellular carcinoma

BCLC:

Barcelona Clinic Liver Cancer

TACE:

Trans-arterial chemoembolization

c-TACE:

Conventional TACE

DEB-TACE:

Drug-eluting bead TACE

CE-MRI:

Contrast-enhanced magnetic resonance imaging

CT:

Computed tomography

CEUS:

Contrast-enhanced ultrasound

APHE:

Arterial phase hyper-enhancement

LI-RADS:

Liver Imaging Reporting and Data System

IRB:

Institutional review board

MI:

Mechanical index

SSFSE:

Single-shot fast spin echo

THRIVE:

T1 high-resolution isotropic volume examination

SD:

Standard deviation

IQR:

Inter-quartile range

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Acknowledgements

Contrast-enhanced ultrasound data were obtained from an ongoing clinical trial (NCT#02764801) which received ultrasound contrast agent from Lantheus Medical Imaging (N. Billerica, MA) and equipment support from GE Healthcare (Milwaukee, WI).

Funding

Research funding was provided by NIH R01 CA194307 and NIH R01 CA215520.

Author information

Authors and Affiliations

  1. Department of Radiology, Thomas Jefferson University, 132 South 10thSt, 796E Main Building, Philadelphia, PA, 19107, USA

    Adam Polikoff, Corinne E. Wessner, Rashmi Balasubramanya, Susan Dulka, Ji-Bin Liu, Priscilla Machado, Esika Savsani, Andrej Lyshchik, Colette M. Shaw & John R. Eisenbrey

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  1. Adam Polikoff
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  2. Corinne E. Wessner
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  3. Rashmi Balasubramanya
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  4. Susan Dulka
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  5. Ji-Bin Liu
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  7. Esika Savsani
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  8. Andrej Lyshchik
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  10. John R. Eisenbrey
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Corresponding author

Correspondence to John R. Eisenbrey.

Ethics declarations

Conflict of interest

CEW declares that he is a consultant in Bracco Imaging. AL declares that he is a research supporter in GE Healthcare, Bracco Diagnostics, Siemens Healthineers, and Canon Medical Systems, is a member of advisory board in Bracco Diagnostics, is a consultant in GE Healthcare, Bioclinica, and WorldCare Clinical, and is one of the members of speaker panel in GE Healthcare, and has book royalties in Elsevier. JRE received grant and equipment support from GE Healthcare, equipment support from Siemens, and drug support and speaker honorarium from Lantheus Medical Imaging. All other authors have no conflict of interest to declare.

Ethical approval

This study was approved by the university’s Institutional Review Board.

Consent to participate

All patients in this trial provided informed consent to participate in the initial contrast-enhanced ultrasound study.

Consent for publication

Consent to publish de-identified images and data were included in the informed consent process.

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Polikoff, A., Wessner, C.E., Balasubramanya, R. et al. Imaging appearance of residual HCC following incomplete trans-arterial chemoembolization on contrast-enhanced imaging. Abdom Radiol 47, 152–160 (2022). https://doi.org/10.1007/s00261-021-03298-z

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  • DOI: https://doi.org/10.1007/s00261-021-03298-z

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