CardioVascular and Interventional Radiology

, Volume 41, Issue 9, pp 1373–1383 | Cite as

Response Assessment by Volumetric Iodine Uptake Measurement: Preliminary Experience in Patients with Intermediate-Advanced Hepatocellular Carcinoma Treated with Yttrium-90 Radioembolization

  • Irene Bargellini
  • Laura Crocetti
  • Francesca Maria Turini
  • Giulia Lorenzoni
  • Giuseppe Boni
  • Antonio Claudio Traino
  • Davide Caramella
  • Roberto Cioni
Clinical Investigation



To retrospectively compare early response to yttrium-90 radioembolization (Y90) according to volumetric iodine uptake (VIU) changes, Response Evaluation Criteria In Solid Tumor 1.1 (RECIST 1.1) and modified RECIST (mRECIST) in patients with intermediate-advanced hepatocellular carcinoma (HCC) and to explore their association with survival.

Materials and Methods

Twenty-four patients treated with Y90 and evaluated with dual-energy computed tomography before and 6 weeks after treatment were included. VIU was measured on late arterial phase spectral images; 6-week VIU response was defined as: complete response (CR, absence of enhancing tumor), partial response (PR, ≥ 15% VIU reduction), progressive disease (PD, ≥ 10% VIU increase) and stable disease (criteria of CR/PR/PD not met). RECIST 1.1 and mRECIST were evaluated at 6 weeks and 6 months. Responders included CR and PR. Overall survival (OS) was evaluated by Kaplan–Meier analysis and compared by Cox regression analysis.


High intraobserver and interobserver agreements were observed in VIU measurements (k > 0.98). VIU identified a higher number of responders (18 patients, 75%), compared to RECIST 1.1 (12.5% at 6 weeks and 23.8% at 6 months) and mRECIST (29.2% at 6 weeks and 61.9% at 6 months). There was no significant correlation between OS and RECIST 1.1 (P = 0.45 at 6 weeks; P = 0.21 at 6 months) or mRECIST (P = 0.38 at 6 weeks; P = 0.79 at 6 months); median OS was significantly higher in VIU responders (17.2 months) compared to non-responders (7.4 months) (P = 0.0022; HR 8.85; 95% CI 1.29–88.1).


VIU is highly reproducible; as opposite to mRECIST and RECIST 1.1, early VIU response correlates with OS after Y90 in intermediate-advanced HCC patients.


Hepatocellular carcinoma Tumor response Survival Yttrium-90 Radioembolization Computed tomography Dual energy 


Compliance with Ethical Standards

Conflict of interest

Irene Bargellini received honoraria from GE Healthcare, Biocompatibles UK LTD, Sirtex, Bayer Spa; Laura Crocetti received honoraria from GE Healthcare; the remaining authors have no conflict of interests to declare.

Ethical Approval

All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed Consent

For this type of study, informed consent was waived by the Local Ethical Committee.

Supplementary material

270_2018_1962_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 19 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional RadiologyPisa University HospitalPisaItaly
  2. 2.Department of Nuclear MedicinePisa University HospitalPisaItaly
  3. 3.Department of Health PhysicsPisa University HospitalPisaItaly

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