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. 2018 Dec;25(12):1588-1594.
doi: 10.1016/j.acra.2018.02.027. Epub 2018 Mar 27.

Does Enhancement or Perfusion on Preprocedure CT Predict Outcomes After Embolization of Hepatocellular Carcinoma?

Alessandra Borgheresi  1 , Adrian Gonzalez-Aguirre  2 , Karen T Brown  2 , George I Getrajdman  2 , Joseph P Erinjeri  2 , Anne Covey  2 , Hooman Yarmohammadi  2 , Etay Ziv  2 , Constantinos T Sofocleous  2 , Franz Edward Boas  3
Affiliations

Does Enhancement or Perfusion on Preprocedure CT Predict Outcomes After Embolization of Hepatocellular Carcinoma?

Alessandra Borgheresi et al. Acad Radiol. 2018 Dec.

Abstract

Rationale and objective: The objective of this study was to evaluate whether quantitative enhancement or perfusion measurements on preprocedure triphasic computed tomography (CT) can be used to predict response or overall survival after embolization of hepatocellular carcinoma.

Materials and methods: The institutional review board approved this retrospective review of 63 patients with hepatocellular carcinoma treated with particle embolization between March 2009 and December 2014. Quantitative enhancement and perfusion measurements were performed on the target tumor and the background liver on the triphasic CT performed before treatment. Microvascular invasion (MVI) and degree of differentiation were determined from a core biopsy specimen. Quantitative enhancement and perfusion values were then correlated with pathology (two-tailed t test), response to embolization on modified Response Evaluation Criteria In Solid Tumors (two-tailed t test), and overall survival after embolization (Cox proportional hazards model).

Results: Arterial enhancement did not predict immediate response or overall survival after embolization. The degree of differentiation or presence of MVI also did not predict immediate response or overall survival after embolization. However, high hepatic artery coefficient or low portal vein coefficient, both in the tumor (P = .011 and P = .004) and in the background liver (P = .015 and P = .009), were associated with worse survival. Hepatic artery coefficient, both in the tumor (P = .025) and in the background liver (P = .013), were independent predictors of survival in a multivariate model including the Child-Pugh score and the BCLC stage.

Conclusions: Tumor and liver perfusion parameters estimated from preprocedure triphasic CT were predictive of survival after embolization. Arterial-phase enhancement and histology (degree of differentiation or MVI) did not predict immediate response or overall survival after particle embolization.

Keywords: Hepatocellular carcinoma; blood supply; cirrhosis; hypovascular; perfusion.

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Figures

Figure 1
Figure 1
Tumor arterial enhancement did not predict response to embolization or overall survival. Examples show that hypervascular HCC can fail to respond to embolization, and hypovascular HCC can respond to embolization. A. 67-year-old male with HCC, which appears hypervascular on arterial phase CT. B. This tumor progressed after embolization. C. 62-year-old male with HCC, which appears hypovascular on arterial phase CT. D. This tumor appears necrotic after embolization.
Figure 2
Figure 2
Histology (microvascular invasion and degree of differentiation from a core biopsy) did not predict overall survival after embolization. A. Red: no microvascular invasion, Blue: microvascular invasion (p=0.45). B. Red: well differentiated HCC, Blue: moderate or poorly differentiated HCC (p=0.87).
Figure 3
Figure 3
Perfusion parameters in both the HCC and the background liver are independent predictors of overall survival (see Table 3 for p values). A. Red: tumor HAC ≤ −0.07, Blue: tumor HAC > −0.07. B. Red: liver HAC ≤ −0.21, Blue: liver HAC > −0.21.
See this image and copyright information in PMC

References

    1. Salem R, Gordon AC, Mouli S, et al. Y90 Radioembolization Significantly Prolongs Time to Progression Compared With Chemoembolization in Patients With Hepatocellular Carcinoma. Gastroenterology. 2016;151(6):1155–63e2. - PMC - PubMed
    1. Vilgrain V, Bouattour M, Sibert A, et al. SARAH: A randomised controlled trial comparing efficacy and safety of selective internal radiation therapy (with yttrium-90 microspheres) and sorafenib in patients with locally advanced hepatocellular carcinoma. Journal of Hepatology. 2017;66(1, Supplement):S85–6.
    1. Brown KT, Do RK, Gonen M, et al. Randomized Trial of Hepatic Artery Embolization for Hepatocellular Carcinoma Using Doxorubicin-Eluting Microspheres Compared With Embolization With Microspheres Alone. J Clin Oncol. 2016;34(17):2046–53. - PMC - PubMed
    1. Biederman DM, Titano JJ, Tabori NE, et al. Outcomes of Radioembolization in the Treatment of Hepatocellular Carcinoma with Portal Vein Invasion: Resin versus Glass Microspheres. J Vasc Interv Radiol. 2016;27(6):812–21e2. - PubMed
    1. Katyal S, Oliver JH, Peterson MS, Chang PJ, Baron RL, Carr BI. Prognostic significance of arterial phase CT for prediction of response to transcatheter arterial chemoembolization in unresectable hepatocellular carcinoma: a retrospective analysis. AJR Am J Roentgenol. 2000;175(6):1665–72. - PubMed

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