Enhancement patterns of hepatocellular carcinoma after. In total, 64 patients with bclcc hcc that treated with demtace using. Hccs with incomplete lipiodol retention after a first ctace session have a high. Few studies reported the value of prognostic factors influencing survival after chemoembolization. Multicenter phase ii clinical trial of sorafenib combined. Imaging of hepatocellular carcinoma response after 90y. Predictive imaging for tumor response to drugeluting. Ct and mri ct is commonly used as the standard imaging technique for evaluating the therapeutic response in patients with hcc after tace. Transarterial chemoembolization tace is the current standard of care for patients with intermediatestage hepatocellular carcinoma hcc 1. Taylor and tina sanghvi department of radiology, university of minnesota, minneapolis, mn, usa abstract imaging plays a crucial role in the diagnosis of hepatocellular. Mapping drug dose distribution on ct images following. Package for the social sciences software, version 20. Imaging appearance of treated hepatocellular carcinoma. Tace causes acute ischemic damage to the hcc and results in coagulative necrosis because hcc is nourished only by the hepatic artery.
Hepatocellular carcinoma hcc is one of the most common malignancies in the world and the third most common cause of death from cancer 1, 2. Inflammatory markers as prognostic factors of survival in. Survival benefit of transarterial chemoembolization in. Dwi is also increasingly used to evaluate tumor response to locoregional therapy. Tace is also the most common bridge therapy in patients waiting for liver transplantation. Color coded perfusion imaging with contrast enhanced ultrasound. Importance hepatocellular carcinoma hcc has the secondhighest cancerrelated mortality rate in the world because most patients are diagnosed at an intermediate to advanced stage when surgery is not suitable.
Efficacy and cost of a hepatocellular carcinoma screening program at an. Ct scan of the abdomen post transarterial chemoembolization tace show the typical expected result in treated lesions, which appear hyperdense. Making sense of hepatic tumor posttherapy imaginglimitations of recist frank miller, m. An objective response after treatment has been identified as an independent prognostic factor 2, 3. Current mri techniques for assessing treatment response in hcc posttace are based primarily on contrastenhanced t1weighted imaging ce t1wi. Statistical analysis was performed using spss software spss for.
The primary endpoint was defined as the rate of completion of the treatment protocol i. Our exhibit will familiarize the reader with normal and abnormal post treatment imaging findings using ct. Imaging features of hepatocellular carcinoma after. The accumulation pattern of the iodized oil and enhancement pattern of the mass is to be observed to evaluate the response to the treatment. To investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid gdeobdtpaenhanced magnetic resonance imaging mri and di. The capacity to estimate the spatial distribution of drug dose after debtace could. The highest accuracy for complete response cr group and the noncomplete response ncr was 0. This metaanalysis was performed to assess the efficacy of diffusion weighted imaging dwi with the quantitative apparent diffusion coefficient adc value in diagnosing residual or recurrent. Comparison of treatment response to chemoembolization for hepatocellular carcinoma in patients with and without a transjugular intrahepatic portosystemic shunt, author kuo, yuochen and kohi, maureen p. Imaging patterns were compared directly with hcc findings in a matched group of cirrhotic patients. Tracking navigation imaging of transcatheter arterial. Post locoregional therapy treatment imaging in hepatocellular.
Studies have found mdct perfusion evaluation to be effective for detecting residual tumor following tace for hcc and it is a viable modality for the assessment of treatment response, 14. Lipiodol as an imaging biomarker of tumor response after. The choice of imaging modality in treatment response is chosen according to. Pre and postprocedural imaging characteristics were analysed by two. Imaging plays a crucial role in the diagnosis of hepatocellular carcinoma hcc as well. Lipiodol retention pattern after tace for hcc is a. Carm conebeam ct parenchymal blood volume imaging for. There are several reports about the use of dwi to evaluate hcc response to tace 23,25,38.
Early assessment of tace effectiveness and monitoring of tumor response are crucial for identifying failed procedures, guiding therapy, and determining the optimal interval for repeat treatments. The study concluded that bcs patients with inferior vena cava block and stricture of hepatic. Material and methods study design from january 2015 until june 2018, 31 patients 26 males, 5 females, age 3482 years, mean 62. Arterial a and portal venous b phase computed tomography ct obtained 1 mo after transarterial chemoembolization tace shows that hepatocellular carcinoma hcc is entirely replaced by lipiodol accumulation arrow. Diffusionweighted imaging dwi dwi has recently shown potential for hcc detection compared to or combined to contrastenhanced t1weighted imaging 35,36. Detection of hcc in surveillance programs has markedly improved, but patients with hcc are often diagnosed in. However, rapid software development using fully or semiautomatic. The hepatocellular carcinoma nourishes on the hepatic artery, transcatheter arterial chemoembolization tace using iodized oil and anticancer drug is an effective treatment for small hepatocellular carcinoma.
However, advancements in radiotherapy rt have resulted in. The liver is cirrhotic and small volume of ascites is visible. The purpose of the present study was to investigate the use of hypoxiainducible factor1 alpha hif1. Transarterial chemoembolization tace is a good choice for hepatocellular carcinoma hcc treatment when surgery and liver transplantation are not feasible. Unfortunately the pretace ct were not available for comparison. Despite recent progress in the treatment of hepatocellular carcinoma hcc. 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. The postembolization defect in ceus original images shows. Post procedural imaging is generally advised after 34 weeks, either triple phase ct, dynamic mri or contrastenhanced usg. The tace procedure can be carried out with less chance of going astray in patients with complicated vessels of the liver by virtually colorcoding the feeding vessels. Accurate and early diagnosis of residual tumors or intrahepatic recurrences after tace is critically needed for determining the success of treatments and for guiding subsequent therapeutic planning. Further followup imaging was done at week 22 and every 3 months thereafter. Imagingguided treatments for patients with unresectable hcc.
Followup imaging and clinical evaluation were done at 30, 90, and 180 days after tace. Two recent publications 8, 9 substantiated the idea that findings at dw imaging and contrastenhanced mr imaging with subtraction technique had significant correlation with the histopathologic findings in the evaluation of hcc necrosis after tace. Mdct and gadobenate dimeglumine enhanced mri were evaluated. Openlabel, nonrandomized, singlearm multicenter phase ii clinical trial. Baseline to up to 12 weeks posttace the following will be longitudinally measured using 3 tesla 3t magnetic resonance imaging mri prior to transarterial chemoembolization tace and 24, 48. Request pdf dualenergy ct to detect recurrent hcc after tace.
The aim of this study was to determine the imaging characteristics that related to favourable treatment response in bclcc hcc patients treated with demtace. Liu et al retrospectively studied 246 consecutive patients with primary buddchiari syndrome bcs with the view to analyze the imaging features of bcsassociated hcc and the results of angioplastystenting of hepatic veinsinferior vena cava and tace. Perfusion imaging in hcc has shown promise but is not currently widely employed. Digital imaging using raster image editing andor image creation software. Digital imaging 1 artc 2 digital imaging 1 artc 2 instructor. Fiftytwo patients with 73 hccs were enrolled in this study retrospectively. The lirads v2018 is now the cornerstone in daily practice for evaluating treatment response of hcc after rfa and tace, based on enhancement criteria of the treated focal lesion which is better correlated with subtracted images to omit posttreatment changes of coagulative necrosis and hemorrhage, because it is an easy and accurate method. Laboratory evaluation, including haematology, coagulation, biochemistry, and afp tests, was done during screening and on day 1, 72 h before debtace, 8 days postdebtace, week 10, and every 6 weeks thereafter.
Carm cbct pbvi relies on the principle that the volume of blood in the. Retrospective evaluation using a perfusion quantification software regarding. Mri assessment of hepatocellular carcinoma after locoregional. Transarterial chemoembolization tace is the reference treatment in patients with intermediate hcc that are not eligible for curative treatment such as ablation, surgery or liver transplantation. Optimal imaging surveillance schedules after liver. The purpose of this study was to evaluate the usefulness of new tracking navigation imaging software for conebeam ct angiography in patients with hcc undergoing treatment with tace. Color coded perfusion imaging with contrast enhanced. Although mrecist has been shown to predict survival post transarterial chemoembolization tace 10,11,12,14, a unified consensus on an early imaging biomarker to assess hcc tumor response and outcome post re has not been reached.
Value of gdeobdtpaenhanced mri and diffusionweighted. In this study, we evaluated whether preoperative inflammatory factors such as neutrophil to lymphocyte ratio and platelet to. Transcatheter arterial chemoembolization plus radiotherapy. Moreover, hcc is the third leading cause of cancerrelated deaths worldwide. While most clinical studies have used ct or ultrasonography for determining treatment success rates 512, several studies have also focused on mri 5,15. The authors suggested that whenever possible, gadolinium contrast enhancement and subtraction imaging or, when gadolinium chelate injection is not possible, dw imaging be used for assessment of tumor necrosis after tace. The most common predisposing risk factors for the development of hcc include chronic infection with hepatitis b and c viruses, nonalcoholic fatty liver disease, and alcoholic liver disease, with. Changes in intratumoral vascularization are specific to hcc and allow for its imagingbased diagnosis. Novel imaging biomarkers of response to transcatheter. Hepatocellular carcinoma hcc accounts for most primary liver malignancies, which are the second most common cause of cancerrelated death worldwide, with more than 740,000 deaths reported in 2012.
Chief, body imaging section and fellowship medical director, mr imaging chief, gi radiology professor of radiology northwestern university, feinberg school of medicine, nmh chicago il. A total of 41 consecutive hcc patients underwent tace were enrolled into this study. Expected imaging findings and complications following tace. On posttace computed tomography imaging, a lack of residual contrast enhancement p patients. The texture analysis based on contrastenhanced magnetic resonance imaging mri before tace may act as imaging biomarkers to predict an early response from patients with hcc. Knowledge of normal appearance after tace and rfa for hcc treatment is critical for accurate differentiation of expected findings from complications or residualrecurrent tumor.
Imaging findings and transarterial chemoembolization, author zhang huojun, email. Predictive imaging for tumor response to drugeluting microsphere. The imaging appearance at mdct and contrastenhanced mri was typical in. Initial experience of colorcoded iodine ct imaging objectives. Diffusionweighted imaging dwi provides information on cell membrane integrity and cellular density.
Treatment of hcc is complex, and according to the staging of the tumor, therapies can be radical or palliative, local, locoregional or systemic. A prospective study was performed on 30 patients with 41 treated hepatic focal lesions. Hepatocellular carcinoma hcc is the most common primary liver cancer and the third. Patients underwent magnetic resonance mr imaging at 1. Transcatheter arterial chemoembolization tace is currently considered a firstline therapy for unresectable hcc. Tace is commonly used in two settings, either in hcc unsuitable for resection. Detection of the value of dce dynamic contrast enhanced mri and dwi diffusionweighted imaging in followup of treatment response for hcc hepatocellular carcinoma lesions post tace transarterial chemoembolization through lirads v2018 algorithmic approach. Although liver transplantation and surgical resection are curative options with good survival rates, locoregional treatment is usually the only option for most patients with hcc 35.
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