Korean J Radiol.  2019 Mar;20(3):449-458. 10.3348/kjr.2018.0469.

Evaluation of Early Response to Treatment of Hepatocellular Carcinoma with Yttrium-90 Radioembolization Using Quantitative Computed Tomography Analysis

• Kim S
• Kim DY
• An C
• Han K
• Won JY
• Kim GM
• Kim MJ
• Choi JY

• KMID: 2438275
• DOI: http://doi.org/10.3348/kjr.2018.0469

Abstract

OBJECTIVE
To identify an imaging predictor for the assessment of early treatment response to yttrium-90 transarterial radioembolization (TARE) in patients with hepatocellular carcinoma (HCC), using a quantitative assessment of dynamic computed tomography (CT) images.
MATERIALS AND METHODS
Dynamic contrast-enhanced CT was obtained pre- and 4 weeks post-TARE in 44 patients (34 men, 10 women; mean age, 60 years) with HCC. Computer software was developed for measuring the percentage increase in the combined delayed-enhancing area and necrotic area (pD + N) and the percentage increase in the necrotic area (pNI) in the tumor-containing segments pre- and post-TARE. Local progression-free survival (PFS) was compared between patient groups using Cox regression and Kaplan-Meier analyses.
RESULTS
Post-TARE HCC with pD + N ≥ 35.5% showed significantly longer PFS than those with pD + N < 35.5% (p = 0.001). The local tumor progression hazard ratio was 17.3 (p = 0.009) for pD + N < 35.5% versus pD + N ≥ 35.5% groups. HCCs with a high pNI tended to have longer PFS, although this difference did not reach statistical significance.
CONCLUSION
HCCs with a larger pD + N are less likely to develop local progression after TARE.

Keyword

Hepatocellular carcinoma; Computed tomography; Treatment outcome; Response; Yttrium radioisotopes; Quantitative analysis

MeSH Terms

Carcinoma, Hepatocellular*
Disease-Free Survival
Female
Humans
Male
Tomography, X-Ray Computed
Treatment Outcome
Yttrium Radioisotopes
Yttrium Radioisotopes

Figure

• 

  Fig. 1 Flowchart shows inclusion and exclusion criteria for present study.*SIR-Spheres; Sirtex Medical. CT = computed tomography, HCC = hepatocellular carcinoma, TARE = transarterial radioembolization, 90Y = yttrium-90

• 

  Fig. 2 Serial steps in quantitative measurement of pD + N pre- and post-TARE, pre-treatment images (A–E), post-treatment images (F–J).(A, F) Pre-contrast, (B, G) delayed phase, (C, H) subtraction image from pre-contrast and delayed phase images, (D, I) map of delayed enhancement after removing area below threshold. Freehand-drawn ROI (yellow dot line) was placed along boundary of tumor-containing hepatic segments in map of delayed enhancement (C, H), then software automatically selected same regions in other processed images (D, E, I, J). This ROI was commonly used to measure combined delayed-enhancing area and necrotic area in each map. (E, J) map of non–enhancing area. pD + N = percentage increase in combined delayed-enhancing area and necrotic area, ROI = region of interest

• 

  Fig. 3 PFS curves according to parameters of quantitative analysis.DAE = largest diameter of arterial enhancing portion, PFS = local progression-free survival, pNI = percentage increase in necrotic area

• 

  Fig. 4 Liver CT images of 53-year-old woman with HCC before TARE (A–D) and 4 weeks after treatment (E–H).(A, E) Delayed phase, (B, F) subtraction image from pre-contrast and delayed phase images, (C, G) map of delayed enhancement. (D, H) map of necrosis. Measured value of pD + N in tumor-containing segments was 94.9%. Maximal diameter of tumor and maximal DAE in tumor were decreased only 1.9% and 2.1%, respectively. Tumor did not recur until 19 months.

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