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Prediction of post-TACE necrosis of hepatocellular carcinoma usingvolumetric enhancement on MRI and volumetric oil deposition on CT, with pathological correlation

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objective

To investigate whether volumetric enhancement on baseline MRI and volumetric oil deposition on unenhanced CT would predict HCC necrosis and response post-TACE.

Method

Of 115 retrospective HCC patients (173 lesions) who underwent cTACE, a subset of 53 HCC patients underwent liver transplant (LT). Semiautomatic volumetric segmentation of target lesions was performed on dual imaging to assess the accuracy of predicting tumour necrosis after TACE in the whole cohort and at pathology in the LT group. Predicted percentage tumour necrosis is defined as 100 % - (%baseline MRI enhancement - %CT oil deposition).

Results

Mean predicted tumour necrosis by dual imaging modalities was 61.5 % ± 31.6%; mean percentage tumour necrosis on follow-up MRI was 63.8 % ± 31.5 %. In the LT group, mean predicted tumour necrosis by dual imaging modalities was 77.6 % ± 27.2 %; mean percentage necrosis at pathology was 78.7 % ± 31.5 %. There was a strong significant correlation between predicted tumour necrosis and volumetric necrosis on MRI follow-up (r = 0.889, p<0.001) and between predicted tumour necrosis and pathological necrosis (r = 0.871, p<0.001).

Conclusion

Volumetric pre-TACE enhancement on MRI and post-TACE oil deposition in CT may accurately predict necrosis in treated HCC lesions.

Key Points

• Imaging-based tumour response can assist in therapeutic decisions.

• Lipiodol retention as carrier agent in cTACE is a tumour necrosis biomarker.

• Predicting tumour necrosis with dual imaging potentially obviates immediate post-treatment MRI.

• Predicting tumour necrosis would facilitate further therapeutic decisions in HCC post-cTACE.

• Pre-TACE MRI and post-TACE CT predict necrosis in treated HCC.

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Abbreviations

ADC:

Apparent diffusion coefficient

CI:

Confidence interval

CT:

Computed tomography

cTACE:

Conventional TACE

DEB-TACE:

Drug-eluting bead-TACE

EASL:

European Association for Study of Liver Disease

HAP:

Hepatic arterial phase

HCC:

Hepatocellular carcinoma

ICC:

Intra-class Correlation Coefficient

LT:

Liver transplant

mRECIST:

modified RECIST

MRI:

Magnetic resonance imaging

PVP:

Portal venous phase

RECIST:

Response Evaluation Criteria in Solid Tumors

SD:

Standard deviation

TACE:

Transarterial chemoembolization

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

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Authors and Affiliations

  1. The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA

    Farnaz Najmi Varzaneh, Ankur Pandey, Mounes Aliyari Ghasabeh, Nannan Shao, Pegah Khoshpouri, Pallavi Pandey, Manijeh Zarghampour, Daniel Fouladi, Robert Liddell & Ihab R. Kamel

  2. Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA

    Robert Albert Anders

Authors
  1. Farnaz Najmi Varzaneh
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Corresponding author

Correspondence to Ihab R. Kamel.

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The scientific guarantor of this publication is Ihab R Kamel.

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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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Methodology

• retrospective

• diagnostic study

• performed at one institution

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Najmi Varzaneh, F., Pandey, A., Aliyari Ghasabeh, M. et al. Prediction of post-TACE necrosis of hepatocellular carcinoma usingvolumetric enhancement on MRI and volumetric oil deposition on CT, with pathological correlation . Eur Radiol 28, 3032–3040 (2018). https://doi.org/10.1007/s00330-017-5198-9

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  • DOI: https://doi.org/10.1007/s00330-017-5198-9

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