Can angiogenesis inhibitor therapy cause changes in imaging features of hepatic hemangioma- Initial study

Abstract

Background: To observe whether anti-angiogenesis therapy can induce changes in size and enhancement characteristics of hepatic hemangioma.

Method: 133 patients with hepatic hemangioma lesions were analyzed and classified into a Bevacizumab group (n=65) and the control group (n=68). The parameters (Volume, CT enhancement ratio, enhancement patterns) of pre-and post-treatment in the bevacizumab and control groups independently calculated and compared by two radiologists. Correlation among the systolic blood pressure, diastolic blood pressure, heart rate with the hemangioma volume was evaluated using Pearson's correlation analysis.

Results: The hepatic hemangioma volume was significantly decreased after treatment in the Bevacizumab group (8.6 ± 18.7mL vs.7.3 ± 16.3mL, P<0.05), and there was no significant change in the control group (15.1 ± 19.8mL vs.15.4 ± 20.7mL, P = 0.504). A significant difference in enhancement patterns of hepatic hemangiomas was observed after treatment with Bevacizumab (P<0.01). There was no significant difference in arterial phase (AP)enhancement rate and arterial phase-portal venous phase (AP-PVP) enhancement ratios after treatment in the Bevacizumab and control groups (Ps>0.05).The Pearson correlation results showed that blood pressure, heart rate, and hemangioma volume were unrelated or weakly related before and after bevacizumab treatment under the control of factors including weight, contrast injection scheme and CT scanning scheme.

Conclusions: Anti-angiogenesis therapy can cause changes in enhancement pattern and volume of hepatic hemangioma. Radiologists should pay more attention to the reexamination of tumor patients treated with anti-angiogenesis therapy.

Keywords: angiogenesis inhibitor; bevacizumab; computed tomography; hemangioma; tumor; vascular endothelial growth factor.

Figure 1

Flow chart of Bevacizumab group and control group.

Figure 2

Box plot of the Hemangioma volume, AP, AP-PVP before and after treatment. (A, B) Comparison of hemangioma volume before and after treatment of the Bevacizumab and Control group. (C–F) Comparison of hemangioma AP, AP-PVP before and after treatment of the Bevacizumab and Control group.

Figure 3

50-year-old male with lung cancer who received 5 cycles of treatment with bevacizumab. (A, B) Pre-treatment CT scan showed a typical hemangioma located at the liver segment 6. (C) The volume of this hemangioma measured 29.69 ml. (D–F) After treatment with Bevacizumab, the volume of this hemangioma decreased and measured 16.29 ml.

Figure 4

(A–D) A round low-density mass in the left inner lobe of the liver was shown in the plain CT. The lesions demonstrate peripheral nodular discontinuous enhancement in the arterial phase and centripetal filling in the portal and delayed phases. (E–H) After treatment with Bevacizumab, the lesions showed insignificant enhancement.

Figure 5

(A–D) A round low-density mass in the right lobe of the liver was shown in the plain CT. The lesions demonstrate peripheral nodular discontinuous enhancement in the arterial phase and centripetal filling in the portal and delayed phases. (E–H) After treatment with Bevacizumab, the lesions showed circular enhancement.

Figure 6

(A–C) the correlation results of systolic blood pressure, diastolic blood pressure, heart rate and hemangioma volume before bevacizumab treatment. (D–F) the correlation results of systolic blood pressure, diastolic blood pressure, heart rate and hemangioma volume after bevacizumab treatment. (G–I) the correlation results of changes in systolic blood pressure, diastolic blood pressure, heart rate and changes in hemangioma volume after bevacizumab treatment.