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European Radiology

, Volume 27, Issue 11, pp 4837–4845 | Cite as

Prognostic value of incidental hypervascular micronodules detected on cone-beam computed tomography angiography of patients with liver metastasis

  • Bruno C. OdisioEmail author
  • Veronica L. Cox
  • Silvana C. Faria
  • Suguru Yamashita
  • Xiao Shi
  • Joe Ensor
  • Aaron K. Jones
  • Armeen Mahvash
  • Sanjay Gupta
  • Alda L. Tam
  • Jean-Nicolas Vauthey
  • Ravi Murthy
Vascular-Interventional

Abstract

Purpose

To determine the clinical relevance of incidentally-found hypervascular micronodules (IHM) on cone-beam computed tomography angiography (CBCTA) in patients with liver metastasis undergoing transarterial (chemo)embolization (TACE/TAE).

Material and methods

This was a HIPAA-compliant institutional review board-approved single-institution retrospective review of 95 non-cirrhotic patients (52 men; mean age, 60 years) who underwent CBCTA prior to (chemo)embolic delivery. IHM were defined by the presence of innumerable subcentimetre hepatic parenchymal hypevascular foci not detected on pre-TACE/TAE contrast-enhanced cross-sectional imaging. Multivariate analysis was performed to compare time to tumour progression (TTP) between patients with and without IHM.

Results

IHM were present in 21 (22%) patients. Patients with IHM had a significantly shorter intrahepatic TTP determined by a higher frequency of developing new liver metastasis (hazard ratio [HR]: 1.99; 95% confidence interval [CI] 1.08–3.67, P= 0.02). Patients with IHM trended towards a shorter TTP of the tumour(s) treated with TACE/TAE (HR: 1.72; 95% CI: 0.98–3.01, P= 0.056). Extrahepatic TTP was not significantly different between the two cohorts (P= 0.27).

Conclusion

Patients with IHM on CBCTA have worse prognosis due to a significantly higher risk of developing new hepatic tumours. Further work is needed to elucidate its underlying mechanisms of pathogenesis.

Key Points

21% of liver metastasis patients undergoing TACE/TAE have IHM on CBTA.

IHM are associated with a high risk of developing new hepatic tumours.

IHA are also associated with a trend toward poorer response to TACE/TAE.

Keywords

Liver metastasis Cone-beam computed tomography Incidental findings Disease progression Embolization 

Abbreviations

CBCTA

Cone-beam computed tomography angiography

IHM

Incidentally-found hypervascular micronodules

mRECIST

Modified Response Evaluation Criteria in Solid Tumours

RECIST

Response Evaluation Criteria in Solid Tumours

TACE/TAE

Transarterial (chemo)embolization

Notes

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Bruno C. Odisio.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

Joe Ensor kindly provided statistical advice for this manuscript.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Methodology

  • retrospective

  • case-control study

  • performed at one institution

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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Bruno C. Odisio
    • 1
    Email author
  • Veronica L. Cox
    • 2
  • Silvana C. Faria
    • 2
  • Suguru Yamashita
    • 3
  • Xiao Shi
    • 4
  • Joe Ensor
    • 5
  • Aaron K. Jones
    • 6
  • Armeen Mahvash
    • 1
  • Sanjay Gupta
    • 1
  • Alda L. Tam
    • 1
  • Jean-Nicolas Vauthey
    • 3
  • Ravi Murthy
    • 1
  1. 1.Department of Interventional Radiology, Division of Diagnostic ImagingThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Diagnostic RadiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Diagnostic RadiologyBaylor College of MedicineHoustonUSA
  5. 5.Biostatistics of the Houston Methodist Cancer CenterHoustonUSA
  6. 6.Imaging PhysicsThe University of Texas MD Anderson Cancer CenterHoustonUSA

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