Hepatocellular carcinoma: response to TACE assessed with semiautomated volumetric and functional analysis of diffusion-weighted and contrast-enhanced MR imaging data.

PURPOSE To determine the association of early changes in posttreatment apparent diffusion coefficient (ADC) and venous enhancement (VE) with tumor size change after transarterial chemoembolization (TACE) by using an investigational semiautomated software. MATERIALS AND METHODS This retrospective HIPAA-compliant study was approved by the institutional review board, with waiver of informed consent. Patients underwent magnetic resonance (MR) imaging at 1.5 T before TACE, as well as 1 and 6 months after TACE. Volumetric analysis of change in ADC and VE 1 month after TACE compared with pretreatment values was performed in 48 patients with 71 hepatocellular carcinoma (HCC) lesions. Diagnostic accuracy was evaluated with receiver operating characteristic (ROC) analysis, using tumor response at 6 months according to Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST as end points. RESULTS According to RECIST criteria, 6 months after TACE, 30 HCC lesions showed partial response (PR), 35 showed stable disease (SD), and six showed progressive disease (PD). Increase in ADC and decrease in VE 1 month after TACE were significantly different between PR, SD, and PD. At area under the ROC curve (AUC) analysis of the ADC increase, there was an AUC of 0.78 for distinguishing PR from SD and PD and an AUC of 0.89 for distinguishing PR and SD from PD. The AUC for decrease in VE was 0.73 for discrimination of PR from SD and PD and 0.90 for discrimination of PR and SD from PD. CONCLUSION Volumetric analysis of increase in ADC and decrease in VE 1 month after TACE can provide an early assessment of response to treatment. Volumetric analysis of multiparametric MR imaging data may have potential as a prognostic biomarker for patients undergoing local-regional treatment of liver cancer.

[1]  D. Bluemke,et al.  The role of functional MR imaging in the assessment of tumor response after chemoembolization in patients with hepatocellular carcinoma. , 2006, Journal of vascular and interventional radiology : JVIR.

[2]  David A Bluemke,et al.  Unresectable hepatocellular carcinoma: serial early vascular and cellular changes after transarterial chemoembolization as detected with MR imaging. , 2009, Radiology.

[3]  D. Bluemke,et al.  Diffusion-Weighted and Gd-EOB-DTPA-Contrast-Enhanced Magnetic Resonance Imaging for Characterization of Tumor Necrosis in an Animal Model , 2009, Journal of computer assisted tomography.

[4]  Jordi Rimola,et al.  Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma , 2009, Cancer.

[5]  M. van Glabbeke,et al.  New guidelines to evaluate the response to treatment in solid tumors , 2000, Journal of the National Cancer Institute.

[6]  Simina C. Fluture,et al.  Small pulmonary nodules: reproducibility of three-dimensional volumetric measurement and estimation of time to follow-up CT. , 2004, Radiology.

[7]  F. Miller,et al.  Diffusion-weighted MR imaging for determination of hepatocellular carcinoma response to yttrium-90 radioembolization. , 2006, Journal of vascular and interventional radiology : JVIR.

[8]  Olivier D. Faugeras,et al.  Flows of diffeomorphisms for multimodal image registration , 2002, Proceedings IEEE International Symposium on Biomedical Imaging.

[9]  Timothy D Johnson,et al.  The parametric response map is an imaging biomarker for early cancer treatment outcome , 2009, Nature Medicine.

[10]  L Pagliaro,et al.  Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. , 2001, Journal of hepatology.

[11]  A. Padhani,et al.  Diffusion MR imaging for monitoring of treatment response. , 2011, Magnetic resonance imaging clinics of North America.

[12]  Timothy D Johnson,et al.  Functional diffusion map as an early imaging biomarker for high-grade glioma: correlation with conventional radiologic response and overall survival. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  A. Reeves,et al.  Automated detection of small pulmonary nodules in whole lung CT scans. , 2007, Academic radiology.

[14]  B. Carr.  Hepatic artery chemoembolization for advanced stage HCC: experience of 650 patients. , 2002, Hepato-gastroenterology.

[15]  A. Padhani,et al.  Multiparametric imaging of tumor response to therapy. , 2010, Radiology.

[16]  F. Miller,et al.  Tumor response after yttrium-90 radioembolization for hepatocellular carcinoma: comparison of diffusion-weighted functional MR imaging with anatomic MR imaging. , 2008, Journal of vascular and interventional radiology : JVIR.

[17]  David J Collins,et al.  Technology Insight: water diffusion MRI—a potential new biomarker of response to cancer therapy , 2008, Nature Clinical Practice Oncology.

[18]  Bachir Taouli,et al.  Assessment of tumor necrosis of hepatocellular carcinoma after chemoembolization: diffusion-weighted and contrast-enhanced MRI with histopathologic correlation of the explanted liver. , 2009, AJR. American journal of roentgenology.

[19]  P. Choyke,et al.  Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. , 2009, Neoplasia.

[20]  M Van Glabbeke,et al.  New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. , 2000, Journal of the National Cancer Institute.

[21]  D. Bluemke,et al.  Functional MR imaging assessment of tumor response after 90Y microsphere treatment in patients with unresectable hepatocellular carcinoma. , 2007, Journal of vascular and interventional radiology : JVIR.

[22]  Bradford A Moffat,et al.  The functional diffusion map: an imaging biomarker for the early prediction of cancer treatment outcome. , 2006, Neoplasia.

[23]  Bradford A Moffat,et al.  Evaluation of cancer therapy using diffusion magnetic resonance imaging. , 2003, Molecular cancer therapeutics.

[24]  W. Heindel,et al.  Volumetric measurements of pulmonary nodules at multi-row detector CT: in vivo reproducibility , 2003, European Radiology.

[25]  W. Chapman,et al.  Outcomes of Neoadjuvant Transarterial Chemoembolization to Downstage Hepatocellular Carcinoma Before Liver Transplantation , 2008, Annals of surgery.

[26]  Hirofumi Fujii,et al.  Radiologic measurements of tumor response to treatment: practical approaches and limitations. , 2008, Radiographics : a review publication of the Radiological Society of North America, Inc.

[27]  E. Van Cutsem,et al.  Size quantification of liver metastases in patients undergoing cancer treatment: reproducibility of one-, two-, and three-dimensional measurements determined with spiral CT. , 1997, Radiology.

[28]  A. Padhani,et al.  Antivascular cancer treatments: functional assessments by dynamic contrast-enhanced magnetic resonance imaging , 2005, Abdominal Imaging.

[29]  Anwar R. Padhani,et al.  Diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for monitoring anticancer therapy , 2010, Targeted Oncology.

[30]  Rolf W. Günther,et al.  Semi-Automated Quantification of Hepatic Lesions in a Phantom , 2009, Investigative radiology.

[31]  J Wessling,et al.  [Accuracy of liver lesion assessment using automated measurement and segmentation software in biphasic multislice CT (MSCT)]. , 2009, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[32]  E. Hecht,et al.  Hepatocellular carcinoma: Assessment of response to transarterial chemoembolization with image subtraction , 2010, Journal of magnetic resonance imaging : JMRI.

[33]  M. Okada,et al.  [New response evaluation criteria in solid tumours-revised RECIST guideline (version 1.1)]. , 2009, Gan to kagaku ryoho. Cancer & chemotherapy.

[34]  K. Marten,et al.  Inadequacy of manual measurements compared to automated CT volumetry in assessment of treatment response of pulmonary metastases using RECIST criteria , 2006, European Radiology.

[35]  Michael Sühling,et al.  Semi-automated measurement of hyperdense, hypodense and heterogeneous hepatic metastasis on standard MDCT slices. Comparison of semi-automated and manual measurement of RECIST and WHO criteria , 2008, European Radiology.

[36]  Leo Grady,et al.  Random Walks for Image Segmentation , 2006, IEEE Transactions on Pattern Analysis and Machine Intelligence.

[37]  D. Bluemke,et al.  Role of diffusion-weighted imaging in estimating tumor necrosis after chemoembolization of hepatocellular carcinoma. , 2003, AJR. American journal of roentgenology.

[38]  E. Eisenhauer,et al.  RECIST revisited: a review of validation studies on tumour assessment. , 2006, European journal of cancer.

[39]  M. Revel,et al.  Are two-dimensional CT measurements of small noncalcified pulmonary nodules reliable? , 2004, Radiology.