Dataset Information

Contrast-Enhanced Ultrasound in Residual Tumor of Hepatocellular Carcinoma following Transarterial Chemoembolization: Is It Helpful for Tumor Response?

ABSTRACT: Aim:To investigate the enhancement pattern of residual tumor on contrast-enhanced ultrasonography (CEUS) in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Methods:Our study initially included 76 patients with HCC, 73 of which were finally allocated into two groups: group 1 (43 patients, post-TACE group) and group 2 (30 patients, untreated HCC group). All patients were performed with CEUS using SonoVue, and qualitative and quantitative enhancement characteristics (rise time, peak time, and washout time) were evaluated for the residual tumors. T test or ?2 test was used to estimate for differences between two groups. Results:In group 1, the mean rise time, peak time, and washout times in group 1 were 16.1±2.7?sec, 31.3±3.1?sec, and 191.0±31.3?sec, respectively. In group 2, these were 15.1±3.5?sec, 30.9±3.2?sec, and 142.6±16.1?sec, respectively. The differences in rise time and peak time were not statistically significant (P=0.09 and 0.30, respectively), but the washout time was significantly prolonged in group 1 (P<0.01). The enhanced pattern in arterial phase was inhomogeneous (n=11), regular homogeneous (n=11), partial (n=12), peripheral (n=7), and peripheral rim-like (n=2) in group 1. The average of the longest tumor size of the whole lesion in the 5 types was 4.7±1.3cm, 2.9±1.0cm, 3.1±1.7cm, 2.5±0.6cm, and 2.1?cm. Conclusion:It suggested that the washout time of post-TACE residual lesions was prolonged compared with untreated HCC nodules on CEUS imaging. Combined with the triple-phase enhancement pattern seen on CEUS, the washout time may provide additional information to guide further treatment for residual tumors.

SUBMITTER: Jiang T

PROVIDER: S-EPMC6098931 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Contrast-Enhanced Ultrasound in Residual Tumor of Hepatocellular Carcinoma following Transarterial Chemoembolization: Is It Helpful for Tumor Response?

Jiang Tian'an T Zhao Qiyu Q Huang Min M Sun Junhui J Tian Guo G

BioMed research international 20180802

<h4>Aim</h4>To investigate the enhancement pattern of residual tumor on contrast-enhanced ultrasonography (CEUS) in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE).<h4>Methods</h4>Our study initially included 76 patients with HCC, 73 of which were finally allocated into two groups: group 1 (43 patients, post-TACE group) and group 2 (30 patients, untreated HCC group). All patients were performed with CEUS using SonoVue, and qualitative and quantita ...[more]

PMID: 30175147

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Project description:PurposeTo investigate the role of contrast-enhanced magnetic resonance imaging (CE-MRI) radiomics for pretherapeutic prediction of the response to transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC).MethodsOne hundred and twenty-two HCC patients (objective response, n = 63; non-response, n = 59) who received CE-MRI examination before initial TACE were retrospectively recruited and randomly divided into a training cohort (n = 85) and a validation cohort (n = 37). All HCCs were manually segmented on arterial, venous and delayed phases of CE-MRI, and total 2367 radiomics features were extracted. Radiomics models were constructed based on each phase and their combination using logistic regression algorithm. A clinical-radiological model was built based on independent risk factors identified by univariate and multivariate logistic regression analyses. A combined model incorporating the radiomics score and selected clinical-radiological predictors was constructed, and the combined model was presented as a nomogram. Prediction models were evaluated by receiver operating characteristic curves, calibration curves, and decision curve analysis.ResultsAmong all radiomics models, the three-phase radiomics model exhibited better performance in the training cohort with an area under the curve (AUC) of 0.838 (95% confidence interval (CI), 0.753 - 0.922), which was verified in the validation cohort (AUC, 0.833; 95% CI, 0.691 - 0.975). The combined model that integrated the three-phase radiomics score and clinical-radiological risk factors (total bilirubin, tumor shape, and tumor encapsulation) showed excellent calibration and predictive capability in the training and validation cohorts with AUCs of 0.878 (95% CI, 0.806 - 0.950) and 0.833 (95% CI, 0.687 - 0.979), respectively, and showed better predictive ability (P = 0.003) compared with the clinical-radiological model (AUC, 0.744; 95% CI, 0.642 - 0.846) in the training cohort. A nomogram based on the combined model achieved good clinical utility in predicting the treatment efficacy of TACE.ConclusionCE-MRI radiomics analysis may serve as a promising and noninvasive tool to predict therapeutic response to TACE in HCC, which will facilitate the individualized follow-up and further therapeutic strategies guidance in HCC patients.

Project description:Patients with HCC receiving TACE have various clinical outcomes. Several prognostic models have been proposed to predict clinical outcomes for patients with hepatocellular carcinomas (HCC) undergoing transarterial chemoembolization (TACE), but establishing an accurate prognostic model remains necessary. We aimed to develop a radiomics signature from pretreatment CT to establish a combined radiomics-clinic (CRC) model to predict survival for these patients. We compared this CRC model to the existing prognostic models in predicting patient survival. This retrospective study included multicenter data from 162 treatment-naïve patients with unresectable HCC undergoing TACE as an initial treatment from January 2007 and March 2017. We randomly allocated patients to a training cohort (n = 108) and a testing cohort (n = 54). Radiomics features were extracted from intra- and peritumoral regions on both the arterial phase and portal venous phase CT images. A radiomics signature (Rad-signature) for survival was constructed using the least absolute shrinkage and selection operator method in the training cohort. We used univariate and multivariate Cox regressions to identify associations between the Rad- signature and clinical factors of survival. From these, a CRC model was developed, validated, and further compared with previously published prognostic models including four-and-seven criteria, six-and-twelve score, hepatoma arterial-embolization prognostic scores, and albumin-bilirubin grade. The CRC model incorporated two variables: The Rad-signature (composed of features extracted from intra- and peritumoral regions on the arterial phase and portal venous phase) and tumor number. The CRC model performed better than the other seven well-recognized prognostic models, with concordance indices of 0.73 [95% confidence interval (CI) 0.68-0.79] and 0.70 [95% CI 0.62-0.82] in the training and testing cohorts, respectively. Among the seven models tested, the six-and-12 score and four-and-seven criteria performed better than the other models, with C-indices of 0.64 [95% CI 0.58-0.70] and 0.65 [95% CI 0.55-0.75] in the testing cohort, respectively. The CT radiomics signature represents an independent biomarker of survival in patients with HCC undergoing TACE, and the CRC model displayed improved predictive performance.

Project description:PURPOSE:The purpose of this study is to evaluate the use of density measurements in the diagnosis of an underlying residual tumor beyond iodine depositions after Lipiodol-based conventional transarterial chemoembolization (cTACE). METHOD AND MATERIALS:Thirty follow-up CT scans of 20 patients 6-12 weeks after Lipiodol-based cTACE, receiving a digital subtraction angiography at the same time, were analyzed. Reference for the detection of a residual tumor was the angiography, and a visible contrast enhancement was categorized as a residual tumor (n = 16 with residual tumor; n = 14 without residual tumor). The density of the iodine depositions was measured in all containing slices in non-contrast-, arterial- and portal venous-phase CT scans, with a slice thickness of 5.00 mm. The mean density of the iodine deposition during the portal venous phase was subtracted from the mean density of the arterial phase to calculate the density changes (a positive enhancement score represents washout in the portal venous phase). In addition, a quotient relating to the non-contrast measurement was evaluated. RESULTS:Patients with a residual tumor displayed significantly higher enhancement scores in favor of density reduction between the arterial and portal venous phases, compared to patients without a residual tumor (1.41 ± 3.59, n = 14 vs. -13.97 ± 2.88, n = 16; p-value < 0.01). Furthermore, 87.75% of patients with an enhancement score higher than -1.00 (n = 9) had a residual tumor, whereas 100.00% of patients with an enhancement score lower than -20.00 (n = 6) were shown to be tumor-free. The enhancement score quotient resulted in similar findings. CONCLUSION:After cTACE in patients with hepatocellular carcinoma (HCC), the presence of a viable tumor correlated with enhancement scores based on the density measurements of iodine depositions in different phases of the CT scan. Low enhancement scores were associated with completely treated tumors and can aid the decision process to avoid possibly unnecessary angiographies.

Dataset Information

Contrast-Enhanced Ultrasound in Residual Tumor of Hepatocellular Carcinoma following Transarterial Chemoembolization: Is It Helpful for Tumor Response?

Publications

Contrast-Enhanced Ultrasound in Residual Tumor of Hepatocellular Carcinoma following Transarterial Chemoembolization: Is It Helpful for Tumor Response?

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