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Hur J, Lee ES, Park HJ, Choi W, Park SB. Diagnostic performance of dual-energy computed tomography for HCC after transarterial chemoembolization: Utility of virtual unenhanced and low keV virtual monochromatic images. Medicine (Baltimore) 2022; 101:e31171. [PMID: 36281184 PMCID: PMC9592529 DOI: 10.1097/md.0000000000031171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this study is to evaluate the usefulness of virtual unenhanced (VUE) and low keV virtual monochromatic images (VMI) for diagnosing viable hepatocellular carcinomas (HCC) after transarterial chemoembolization (TACE). This retrospective study included 53 patients with suspected viable HCC after TACE who underwent multiphasic liver computed tomography including true unenhanced (TUE) phase and conventional (CV) enhanced phases on a dual-energy scanner. VUE images, 40 keV and 55 keV VMIs of enhanced phases were reconstructed using dual-energy computed tomography data. For every patient, six combination image sets (TUE-CV; TUE-55; TUE-40; VUE-CV; VUE-55; VUE-40) were evaluated by two readers and compared with the reference standard.There was no statistically significant difference (P > .05) in sensitivity or specificity among all image combinations. In most combinations, interobserver agreements were almost perfect. The diagnostic odds ratio showed a higher trend in combinations with conventional images. Currently, with regards to diagnostic performance, liver computed tomography including TUE and CV enhanced phases is recommended for tumor surveillance after TACE because VUE and VMIs do not have a distinct advantage compared to conventional images.
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Affiliation(s)
- Joonho Hur
- Department of Radiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Gyeonggi-do, Korea
- Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Sun Lee
- Chung-Ang University College of Medicine, Seoul, Korea
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
- *Correspondence: Eun Sun Lee, Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul 06973, Korea (e-mail: )
| | - Hyun Jeong Park
- Chung-Ang University College of Medicine, Seoul, Korea
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Woosun Choi
- Chung-Ang University College of Medicine, Seoul, Korea
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Sung Bin Park
- Chung-Ang University College of Medicine, Seoul, Korea
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
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Mao X, Guo Y, Wen F, Liang H, Sun W, Lu Z. Applying arterial enhancement fraction (AEF) texture features to predict the tumor response in hepatocellular carcinoma (HCC) treated with Transarterial chemoembolization (TACE). Cancer Imaging 2021; 21:49. [PMID: 34384496 PMCID: PMC8359085 DOI: 10.1186/s40644-021-00418-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background To evaluate the application of Arterial Enhancement Fraction (AEF) texture features in predicting the tumor response in Hepatocellular Carcinoma (HCC) treated with Transarterial Chemoembolization (TACE) by means of texture analysis. Methods HCC patients treated with TACE in Shengjing Hospital of China Medical University from June 2018 to December 2019 were retrospectively enrolled in this study. Pre-TACE Contrast Enhanced Computed Tomography (CECT) and imaging follow-up within 6 months were both acquired. The tumor responses were categorized according to the modified RECIST (mRECIST) criteria. Based on the CECT images, Region of Interest (ROI) of HCC lesion was drawn, the AEF calculation and texture analysis upon AEF values in the ROI were performed using CT-Kinetics (C.K., GE Healthcare, China). A total of 32 AEF texture features were extracted and compared between different tumor response groups. Multi-variate logistic regression was performed using certain AEF features to build the differential models to predict the tumor response. The Receiver Operator Characteristic (ROC) analysis was implemented to assess the discriminative performance of these models. Results Forty-five patients were finally enrolled in the study. Eight AEF texture features showed significant distinction between Improved and Un-improved patients (p < 0.05). In multi-variate logistic regression, 9 AEF texture features were applied into modeling to predict “Improved” outcome, and 4 AEF texture features were applied into modeling to predict “Un-worsened” outcome. The Area Under Curve (AUC), diagnostic accuracy, sensitivity, and specificity of the two models were 0.941, 0.911, 1.000, 0.826, and 0.824, 0.711, 0.581, 1.000, respectively. Conclusions Certain AEF heterogeneous features of HCC could possibly be utilized to predict the tumor response to TACE treatment.
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Affiliation(s)
- Xiaonan Mao
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Yan Guo
- GE Healthcare (China), Shanghai, China
| | - Feng Wen
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Hongyuan Liang
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Wei Sun
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Zaiming Lu
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China.
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Role of dynamic contrast-enhanced and diffusion weighted MRI in evaluation of necrosis of hepatocellular carcinoma after chemoembolization. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Lee DH, Lee JM, Klotz E, Kim SJ, Kim KW, Han JK, Choi BI. Detection of recurrent hepatocellular carcinoma in cirrhotic liver after transcatheter arterial chemoembolization: value of quantitative color mapping of the arterial enhancement fraction of the liver. Korean J Radiol 2012; 14:51-60. [PMID: 23323031 PMCID: PMC3542303 DOI: 10.3348/kjr.2013.14.1.51] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/11/2012] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate the additional diagnostic value of color mapping of the hepatic arterial enhancement fraction (AEF) for detecting recurrent or residual hepatocellular carcinoma (HCC) in patients treated with transcatheter arterial chemoembolization (TACE). Materials and Methods Seventy-six patients with 126 HCCs, all of whom had undergone previous TACE, and subsequently, underwent follow-up multiphasic liver CT scans, were included in this study. Quantitative color maps of the AEF of the whole liver were created, by using prototype software with non-rigid registration. The AEF was defined as the ratio of the attenuation increment during the arterial phase to the attenuation increment during the portal phase. Two radiologists independently analyzed the two image sets at a two-week interval, i.e., the multiphasic CT image set and the second image set of the AEF color maps and the CT images. The additional diagnostic value of the AEF color mapping was determined, by the use of the jackknife-alternative free-response receiver-operating-characteristic analysis. The sensitivity and positive predictive values for detecting HCCs of each image set were also evaluated and compared. Results The reader-averaged figures of merit were 0.699 on the initial interpretation of the MDCT image set, and 0.831 on the second interpretation of the combined image set; the difference between the two interpretations was significant (p value < 0.001). The mean sensitivity for residual or recurrent HCC detection increased from 62.7% on the initial analysis to 82.1% on the second analysis using the AEF color maps (p value < 0.001). The mean positive predictive value for HCC detection was 74.5% on the initial analysis using MDCT, and 71.6% on the second analysis using AEF color mapping. Conclusion Quantitative color mapping of the hepatic AEF may have the possibility to increase the diagnostic performance of MDCT for the detection of recurrent or residual HCC without the potential risk of radiation-related hazards.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul 110-744, Korea
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Abstract
Surgical hepatectomy or liver transplantation are considered as curative treatment modalities for hepatocellular carcinoma (HCC). However, many patients are not surgical candidates at the time of diagnosis. Great improvements in locoregional therapies including local ablative therapy [radiofrequency (RF) ablation or ethanol ablation] and transarterial techniques (transarterial embolization or transarterial radioembolization) have made possible local control of HCC. For unresectable HCC, a targeted therapy with sorafenib may improve survival. Unlike treatment of other oncologic tumor, the locoregional therapies are mainstay in the treatment of HCC. Therefore, the application of classical criteria such as the World Health Organization (WHO) guideline may not be suitable for accurate treatment response assessment of locoregional therapies or targeted therapy of HCC. An understanding of the imaging features of post-treatment imaging after various treatment modalities for HCC is crucial for treatment response assessment and for determining further therapy. In this article, we review the role of various imaging modalities in assessing treatment response of locoregional therapies and the targeted molecular therapy.
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Kim S, Mannelli L, Hajdu CH, Babb JS, Clark TW, Hecht EM, Taouli B. Hepatocellular carcinoma: Assessment of response to transarterial chemoembolization with image subtraction. J Magn Reson Imaging 2010; 31:348-55. [DOI: 10.1002/jmri.22038] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Kim SJ, Choi MS, Kang JY, Choi DI, Park CK, Gwak GY, Lee JH, Koh KC, Paik SW, Yoo BC. Prediction of complete necrosis of hepatocellular carcinoma treated with transarterial chemoembolization prior to liver transplantation. Gut Liver 2009; 3:285-91. [PMID: 20431762 PMCID: PMC2852730 DOI: 10.5009/gnl.2009.3.4.285] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 09/21/2009] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Compact lipiodol uptake without enhancement on multiphasic helical computed tomography (CT) has been suggested as a radiologic response criterion in hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE) and subsequent partial hepatectomy. However, its usefulness has not been fully investigated in the explanted liver. METHODS Between 1998 and 2007, 81 patients with HCC underwent 1-9 sessions of TACE followed by liver transplantation (LT). Thirty-nine tumors in 29 patients showed a radiologic response on CT performed prior to LT. The radiologic response criteria and the duration of the response were evaluated to predict total necrosis in the explanted liver. RESULTS Among the 39 tumors, 34 nodules (87.2%) exhibited total pathological necrosis. While 13 out of 16 tumors (81.3%) with a radiologic response for 6 months or less were completely necrotic, 21 out of 23 tumors (91.3%) with a radiologic response of longer than 6 months showed total necrosis. CONCLUSIONS Our results suggested that the radiologic response criteria based on serial CT images might be useful for predicting total necrosis of TACE-pretreated HCC in LT.
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Affiliation(s)
- Sue Jin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Yu JS, Kim JH, Chung JJ, Kim KW. Added value of diffusion-weighted imaging in the MRI assessment of perilesional tumor recurrence after chemoembolization of hepatocellular carcinomas. J Magn Reson Imaging 2009; 30:153-60. [PMID: 19557734 DOI: 10.1002/jmri.21818] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To investigate the additional value of diffusion-weighted imaging (DWI) in the MRI assessment of perilesionally recurrent hepatocellular carcinomas (HCCs) after transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS For gadopentetate dimeglumine-enhanced multiphasic dynamic images with precontrast T1- and T2-weighted images of 23 patients treated with TACE, two radiologists independently sorted the confidence levels for the presence of a viable tumor in the vicinity of the treated lesions into five grades. In another session, images from DWI (b factor = 50, 400, and 800 s/mm(2)) were added to the previously reviewed images and the same radiologists sorted the confidence levels. RESULTS A total of 26 lesions (0.7-3.5 cm) from 16 patients were confirmed to be perilesional recurrences of HCC. The area under the receiver operating characteristic curve (A(z)) for the second interpretation session (0.826) was not significantly different (P = 0.299) from that of the first session (0.859). The overall sensitivity was increased from 85% to 92%, but the specificity decreased from 65% to 50% after adding DWI. CONCLUSION The addition of DWI has the potential to improve sensitivity, but not the overall diagnostic accuracy, in the assessment of perilesional recurrence of HCCs after chemoembolization.
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Affiliation(s)
- Jeong-Sik Yu
- Department of Radiology and the Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Gangnam-Gu, Seoul, Republic of Korea.
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Ji SK, Cho YK, Ahn YS, Kim MY, Park YO, Kim JK, Kim WT. Multivariate analysis of the predictors of survival for patients with hepatocellular carcinoma undergoing transarterial chemoembolization: focusing on superselective chemoembolization. Korean J Radiol 2009; 9:534-40. [PMID: 19039270 PMCID: PMC2627241 DOI: 10.3348/kjr.2008.9.6.534] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objective While the prognostic factors of survival for patients with hepatocellular carcinoma (HCC) who underwent transarterial chemoembolization (TACE) are well known, the clinical significance of performing selective TACE for HCC patients has not been clearly documented. We tried to analyze the potential factors of disease-free survival for these patients, including the performance of selective TACE. Materials and Methods A total of 151 patients with HCC who underwent TACE were retrospectively analyzed for their disease-free survival (a median follow-up of 23 months, range: 1-88 months). Univariate and multivariate analyses were performed for 20 potential factors by using the Cox proportional hazard model, including 19 baseline factors and one procedure-related factor (conventional versus selective TACE). The parameters that proved to be significant on the univariate analysis were subsequently tested with the multivariate model. Results Conventional or selective TACE was performed for 40 and 111 patients, respectively. Univariate and multivariate analyses revealed that tumor multiplicity, venous tumor thrombosis and selective TACE were the only three independent significant prognostic factors of disease-free survival (p = 0.002, 0.015 and 0.019, respectively). Conclusion In our study, selective TACE was a favorable prognostic factor for the disease-free survival of patients with HCC who underwent TACE.
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Affiliation(s)
- Suk Kyeong Ji
- Department of Radiology, Seoul Veterans Hospital, Seoul, Korea
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Hunt SJ, Yu W, Weintraub J, Prince MR, Kothary N. Radiologic Monitoring of Hepatocellular Carcinoma Tumor Viability after Transhepatic Arterial Chemoembolization: Estimating the Accuracy of Contrast-enhanced Cross-sectional Imaging with Histopathologic Correlation. J Vasc Interv Radiol 2009; 20:30-8. [DOI: 10.1016/j.jvir.2008.09.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 09/25/2008] [Accepted: 09/26/2008] [Indexed: 12/12/2022] Open
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Kim EY, Choi D, Lim DH, Lee WJ, Yoo BC, Paik SW. Change in contrast enhancement of HCC on 1-month follow-up CT after local radiotherapy: an early predictor of final treatment response. Eur J Radiol 2008; 72:440-6. [PMID: 18819767 DOI: 10.1016/j.ejrad.2008.07.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 06/26/2008] [Accepted: 07/25/2008] [Indexed: 12/22/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the change in contrast enhancement of HCC on 1-month follow-up CT after local radiotherapy (RT) as an early predictor of final treatment response. MATERIALS Fifty patients who underwent local RT for HCCs had both pre-RT and post-RT CT scans including 1-month follow-up CT. We assessed the final treatment response by using the change in maximal tumor size on 6-12-month follow-up CT scan after RT. We also evaluated the change in tumor enhancement between pre-RT and 1-month follow-up CT scans. RESULTS A final treatment response was achieved in 27 (54%) of 50 patients, who showed either a complete response (n=11) or a partial response (n=16). Compared with non-responsive patients (n=23), responsive patients showed a significant decrease in tumor enhancement on 1-month follow-up CT after RT in both objective and subjective analyses (each P<0.001). CONCLUSION The change in contrast enhancement of HCC seen on the 1-month follow-up CT in patients after local RT may be used as an early predictor of final treatment response.
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Affiliation(s)
- Eun Young Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-Ku, Seoul 135-710, Republic of Korea
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Youn BJ, Chung JW, Son KR, Kim HC, Jae HJ, Lee JM, Song IC, Kim IO, Park JH. Diffusion-weighted MR: therapeutic evaluation after chemoembolization of VX-2 carcinoma implanted in rabbit liver. Acad Radiol 2008; 15:593-600. [PMID: 18423316 DOI: 10.1016/j.acra.2007.10.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 10/29/2007] [Accepted: 10/29/2007] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The study goal was to evaluate the ability of diffusion-weighted imaging (DWI) in assessing the viability of rabbit liver VX-2 tumor after transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS VX-2 tumors were grown in the livers of 19 rabbits, and chemoembolization was performed. MR imaging was acquired 1 week after TACE. The rabbits were killed for histologic investigation immediately after MR imaging, and the proportion of viable tumor was calculated based on histopathologic examination. Apparent diffusion coefficient (ADC) values were measured in viable and necrotic tumor portion, and were compared using the paired Student's t test. RESULTS Viable tumors were absent (n = 3), less than 5% (n = 6), and 5% or more (n = 10) at pathology examination. On DWI, three tumors with no viable portion were interpreted as having no viable portion, but three of six tumors with a viable portion of less than 5% were considered as having no viable portion. The mean ADC values of necrotic and viable tumor were 1.653 +/- 0.126 mm(2)/sec and 0.883 +/- 0.407 mm(2)/sec (b = 1000 sec/mm(2)), respectively, and the ADC values of necrotic tumors were significantly greater than those in viable tumors (p < .01). CONCLUSION Although DWI is a useful tool for assessing tumor viability, viable tumor may not be detected on DWI when it is too small.
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Affiliation(s)
- Byung Jae Youn
- Department of Radiology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
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Yu JS. Hepatocellular carcinoma after transcatheter arterial chemoembolization: difficulties on imaging follow-up. Korean J Radiol 2006; 6:134-5. [PMID: 16145287 PMCID: PMC2685035 DOI: 10.3348/kjr.2005.6.3.134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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