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Can volumetric ADC measurement help predict response to Y90 radioembolization in HCC?

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Abstract

Aim: To compare changes in RECIST, anatomical volume, mRECIST, and volumetric diffusion-weighted Imaging parameters (3D apparent diffusion coefficient (ADC) measurements), with pathological analysis of hepatocellular carcinoma (HCC) treated by 90Yttrium radioembolization (Y90). Methods: 21 patients were treated by Y90 as a sole treatment modality for solitary, >2 cm HCC that underwent liver transplantation. MRI at baseline, 1 and 3 months post-Y90, and tumor pathological findings on explants were reviewed in all patients. Results: Compared to baseline (RECIST/volume: 3.6 cm/17.7 cm3), RECIST and volume were not modified after Y90 (1 month, p = 0.28/0.09 RECIST/tumor volume; 3 months, p = 0.28/0.54). In contrast, mRECIST (3.3–1.4 cm, p < 0.001), mean ADC (0.185–1.093 mm2/s × 10−3, p = 0.04), and ADC standard deviation (STD) (0.041–0.201 mm2/s × 10−3, p = 0.0496) changed as earlier as 1 month post-Y90. ADC STD % change was higher in ADC responding lesions than non-responding lesions at 1 month (p = 0.002) and 3 months (p = 0.008). All lesions exhibited necrosis on pathological analysis (11 partially viable, 10 complete pathological necrosis (CPN)) but no imaging criterion was able to predict CPN. mRECIST (±ADC) at 1 (κ ± ADC = 0.08/0.06) or 3 months (κ = −0.06/−0.06) were poor predictors of pathological response. Conclusion: As soon as 1 month post-treatment, mRECIST and volumetric ADC performed better than traditional size RECIST or volumetric parameters in detecting imaging response to Y90; however, CPN cannot be predicted by any criteria. Improvements in methodologies to assess response and identification of better surrogates are awaited.

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Fig. 1

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Abbreviations

ADC:

Apparent diffusion coefficient

cTACE:

Conventional transarterial chemoembolization

CPN:

Complete pathological necrosis

DWI:

Diffusion-weighted imaging

GRE:

Gradient echo

(m)RECIST:

(Modified) response criteria in solid tumors

MRI:

Magnetic resonance imaging

IQR:

Interquartile range

99Tc-MAA:

99Technetium-macroaggregated albumin

STD:

Standard deviation

Y90:

90Yttrium radioembolization

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Acknowledgment

There was no funding provided for this study.

Conflict of interest

None of the other authors have any conflict of interest.

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Authors and Affiliations

  1. Section of Interventional Radiology and Division of Interventional Oncology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA

    Michael Vouche, Riad Salem & Robert J. Lewandowski

  2. Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA

    Riad Salem

  3. Division of Transplantation, Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA

    Riad Salem

  4. Department of Radiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 676 North Saint Clair Street Suite 800, Chicago, IL, 60611, USA

    Frank H. Miller

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  1. Michael Vouche
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Correspondence to Frank H. Miller.

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Vouche, M., Salem, R., Lewandowski, R.J. et al. Can volumetric ADC measurement help predict response to Y90 radioembolization in HCC?. Abdom Imaging 40, 1471–1480 (2015). https://doi.org/10.1007/s00261-014-0295-6

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