Baseline parenchymal blood volume is a potential prognostic imaging biomarker in patients with malignant liver tumors treated with transarterial chemoembolization

Abstract

Purpose: To assess the prognostic value of Parenchymal Blood Volume (PBV) in predicting survival, tumor response, and PBV response after transarterial chemoembolization (TACE).

Methods: A total of 137 patients with malignant liver tumors who were treated with TACE between 07/2016 and 07/2018 were evaluated. Computed tomography illustrations were reworked at a dedicated workstation to create a PBV map which was overlapped with the associated magnetic resonance image to determine tumor diameter and PBV. Patients were divided into two groups according to their initial PBV value: PBV < 50 or ≥ 50 ml/l.

Results: Retrospectively, for patients with at least 2 TACE and initial PBV < 50 ml/l (n = 27), the tumor volume, regardless of the primary tumor type, decreased by 13.26%, and PBV showed a decrease of 23.11%. For 84 patients with PBV ≥ 50 ml/l, the tumor volume decreased by 24.01%, and PBV showed a more substantial decrease of 44.69% (both p < 0.001). In the overall study population (n = 137), patients with an initial PBV ≥ 50 ml/l (n = 101) survived for an average of 15.05 months, while patients with an initial PBV < 50 ml/l (n = 36) survived for 10.01 months (p < 0.002). Subgroup analysis indicated that median survival in the HCC group was longer at PBV ≥ 50 ml/l. For CRC and other primary tumors, the survival time for high and low initial PBV was almost identical.

Conclusion: Our study reveals a noteworthy correlation between high initial PBV values and a significant reduction in both relative and absolute tumor volume. This association suggests a potential prognostic indicator, indicating that elevated PBV may signify a more favorable response to transarterial chemoembolization (TACE). Additionally, patients with high initial PBV values experienced an extended overall survival time. Notably, the subgroup analysis highlighted a prolonged survival time in the HCC group with elevated initial PBV values. These findings underscore the potential significance of assessing PBV as a predictive factor in the context of TACE, especially in specific tumor entities such as HCC. Further investigations are essential to validate and extrapolate these observations to optimize patient outcomes.

Keywords: Liver cancer; Parenchymal blood volume; Survival; Syngo Artis Pheno; Syngo Artis Zeego; TACE; Transarterial chemoembolization.

Fig. 1

Study design

Fig. 2

A Creation of a PBV image. B Schematic presentation of the acquisition protocol and measurement of parenchymal blood volume

Fig. 3

Patient with HCC after 3 TACE-sessions and 3 PBV-measurements. From left to right site you see first to third TACE. The upper row shows MRI images, in the middle row the associated fusion images are presented and generated PBV images are shown in the lower row

Fig. 4

Boxplot A PBV differences all measurements (%) and B tumor size difference all measurements (%). This Box plots depicting the differences in PBV (%) between patients with initial PBV values > and < 50 ml/l (A) and the corresponding differences in tumor volume (%) in patients with PBV values > and < 50 ml/l (B). Statistical significance was observed with p < 0.001 for both PBV and tumor size differences

Fig. 5

A Overall survival of all patients in month. B Difference overall survival of all patients in month related to initial PBV subgroups (< 50 ml/l and ≥ 50 ml/l) measured in the first TACE session

Fig. 6

A Survival rate (%) related to time in month for different tumor entities. B Survival of patients with HCC divided in the two subgroups initial PBV < 50 ml/l and ≥ 50 ml/l. C Survival of patients with other primary tumor divided in the two subgroups initial PBV < 50 ml/l and ≥ 50 ml/l. D Survival of patients with CRC divided in the two subgroups initial PBV < 50 ml/l and ≥ 50 ml/l