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Parametric response mapping of contrast-enhanced biphasic CT for evaluating tumour viability of hepatocellular carcinoma after TACE

  • Vascular-Interventional
  • Published:
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Abstract

Objectives

To determine the feasibility and role of parametric response mapping (PRM) for quantitative assessment of regional contrast-enhancement patterns in hepatocellular carcinoma (HCC).

Methods

Biphasic CT of 19 patients receiving repetitive conventional transarterial chemoembolisation (cTACE) for intermediate stage HCC were retrospectively analysed at baseline and follow-up at 3, 6, and 9 months. Voxel-based registration of arterial and porto-venous phases, with segmentation of the largest target lesion was performed. Frequency distribution plots of density-pairs of segmented voxels were generated. To differentiate necrotic, hypervascular and non-hypervascular tumour, and lipiodol/calcification, thresholds of 30, 100, and 300 HU were applied. Changes in density frequency plots over time were analysed and compared to response and assessment criteria (WHO, RECIST, EASL, mRECIST) and survival.

Results

PRM was feasible in all cases. Tumour volumes and hypervascular/non-hypervascular volume ratio showed significant longitudinal decrease (p < 0.05). Hypervascular volume at baseline was inversely correlated to survival (R = -0.57, p = 0.005). The only predictive parameter following cTACE to show significant survival difference was the change of the viable/non-viable ratio (p = 0.044), whereas common response assessment criteria showed no significant difference in survival.

Conclusions

PRM allows a quantitative and more precise assessment of regional tumour vascularisation patterns and may be helpful for TACE treatment planning and response assessment.

Key Points

• PRM allows more precise assessment of tumour vascularisation compared to conventional evaluation

• PRM is beneficial for cTACE treatment planning and response assessment

• PRM allows a quantitative assessment of regional contrast enhancement patterns

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Abbreviations

BCLC:

Barcelona Clinic Liver Cancer Score

CT:

Computed tomography

cTACE:

conventional transarterial chemoembolisation

EASL:

European Association for the Study of Liver

HCC:

Hepatocellular carcinoma

HU:

Hounsfield unit

IR:

Interventional radiology

MDCT:

Multi-detector computed tomography

mRECIST:

modified Response Evaluation Criteria in Solid Tumours

MRI:

Magnetic resonance imaging

PRM:

Parametric response mapping

ROI:

Region of interest

RECIST:

Response Evaluation Criteria in Solid Tumours

SIRT:

Selective internal radiotherapy

TACE:

Transarterial chemoembolization

WHO:

World Health Organization

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Acknowledgements

This study was presented in parts at the ECR 2015. The scientific guarantor of this publication is Frank Wacker. The authors of this manuscript declare relationships with the following companies: Siemens Healthcare and ProMedicus (Bernhard Meyer, Frank Wacker; outside the submitted work).

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. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. None study subjects or cohorts have been previously reported.

Methodology: retrospective, experimental, intra-individual comparison, performed at one institution.

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    Authors and Affiliations

    1. Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

      Jan B. Hinrichs, Hoen-Oh Shin, Daniel Kaercher, Davut Hasdemir, Till Kaireit, Carolin Lutat, Bernhard C. Meyer, Frank K. Wacker & Thomas Rodt

    2. Department of Diagnostic and Interventional Radiology, Beaumont Hospital, Dublin, Ireland

      Tim Murray

    3. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany

      Arndt Vogel

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    1. Jan B. Hinrichs
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    Correspondence to Jan B. Hinrichs.

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    Jan B. Hinrichs and Hoen-Oh Shin contributed equally to this work.

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    Hinrichs, J.B., Shin, HO., Kaercher, D. et al. Parametric response mapping of contrast-enhanced biphasic CT for evaluating tumour viability of hepatocellular carcinoma after TACE. Eur Radiol 26, 3447–3455 (2016). https://doi.org/10.1007/s00330-015-4203-4

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