Evaluation of HCC response to locoregional therapy: Validation of MRI-based response criteria versus explant pathology
- PMID: 28823713
- DOI: 10.1016/j.jhep.2017.07.030
Evaluation of HCC response to locoregional therapy: Validation of MRI-based response criteria versus explant pathology
Abstract
Background and aims: This study evaluates the performance of various magnetic resonance imaging (MRI) response criteria for the prediction of complete pathologic necrosis (CPN) of hepatocellular carcinoma (HCC) post locoregional therapy (LRT) using explant pathology as a reference.
Methods: We included 61 patients (male/female 46/15; mean age 60years) who underwent liver transplantation after LRT with transarterial chemoembolization plus radiofrequency or microwave ablation (n=56), or 90Yttrium radioembolization (n=5). MRI was performed <90days before liver transplantation. Three independent readers assessed the following criteria: RECIST, EASL, modified RECIST (mRECIST), percentage of necrosis on subtraction images, and diffusion-weighted imaging (DWI), both qualitative (signal intensity) and quantitative (apparent diffusion coefficient [ADC]). The degree of necrosis was retrospectively assessed at histopathology. Intraclass correlation coefficient (ICC) and Cohen's kappa were used to assess inter-reader agreement. Logistic regression and receiver operating characteristic analyses were used to determine imaging predictors of CPN. Pearson correlation was performed between imaging criteria and pathologic degree of tumor necrosis.
Results: A total of 97HCCs (mean size 2.3±1.3cm) including 28 with CPN were evaluated. There was excellent inter-reader agreement (ICC 0.77-0.86, all methods). EASL, mRECIST, percentage of necrosis and qualitative DWI were all significant (p<0.001) predictors of CPN, while RECIST and ADC were not. EASL, mRECIST and percentage of necrosis performed similarly (area under the curves [AUCs] 0.810-0.815) while the performance of qualitative DWI was lower (AUC 0.622). Image subtraction demonstrated the strongest correlation (r=0.71-0.72, p<0.0001) with pathologic degree of tumor necrosis.
Conclusions: EASL/mRECIST criteria and image subtraction have excellent diagnostic performance for predicting CPN in HCC treated with LRT, with image subtraction correlating best with pathologic degree of tumor necrosis. Thus, MR image subtraction is recommended for assessing HCC response to LRT.
Lay summary: The assessment of hepatocellular carcinoma (HCC) tumor necrosis after locoregional therapy is essential for additional treatment planning and estimation of outcome. In this study, we assessed the performance of various magnetic resonance imaging (MRI) response criteria (RECIST, mRECIST, EASL, percentage of necrosis on subtraction images, and diffusion-weighted imaging) for the prediction of complete pathologic necrosis of HCC post locoregional therapy on liver explant. Patients who underwent liver transplantation after locoregional therapy were included in this retrospective study. All patients underwent routine liver MRI within 90days of liver transplantation. EASL/mRECIST criteria and image subtraction had excellent diagnostic performance for predicting complete pathologic necrosis in treated HCC, with image subtraction correlating best with pathologic degree of tumor necrosis.
Keywords: Diffusion-weighted imaging; EASL criteria; Image subtraction; RECIST; mRECIST.
Copyright © 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Similar articles
-
Assessment of HCC response to Yttrium-90 radioembolization with gadoxetate disodium MRI: correlation with histopathology.Eur Radiol. 2022 Sep;32(9):6493-6503. doi: 10.1007/s00330-022-08732-4. Epub 2022 Apr 5. Eur Radiol. 2022. PMID: 35380226
-
Correlation of tumor response on computed tomography with pathological necrosis in hepatocellular carcinoma treated by chemoembolization before liver transplantation.Liver Transpl. 2016 Nov;22(11):1491-1500. doi: 10.1002/lt.24615. Liver Transpl. 2016. PMID: 27543821
-
Radiological-pathological analysis of WHO, RECIST, EASL, mRECIST and DWI: Imaging analysis from a prospective randomized trial of Y90 ± sorafenib.Hepatology. 2013 Nov;58(5):1655-66. doi: 10.1002/hep.26487. Epub 2013 Oct 1. Hepatology. 2013. PMID: 23703789 Free PMC article. Clinical Trial.
-
Evolution from WHO to EASL and mRECIST for hepatocellular carcinoma: considerations for tumor response assessment.Expert Rev Gastroenterol Hepatol. 2015 Mar;9(3):335-48. doi: 10.1586/17474124.2015.959929. Epub 2014 Nov 5. Expert Rev Gastroenterol Hepatol. 2015. PMID: 25370168 Review.
-
Assessment of tumor response on MR imaging after locoregional therapy.Tech Vasc Interv Radiol. 2006 Sep;9(3):125-32. doi: 10.1053/j.tvir.2007.02.004. Tech Vasc Interv Radiol. 2006. PMID: 17561215 Review.
Cited by
-
Drug-Off Criteria in Patients with Hepatocellular Carcinoma Who Achieved Clinical Complete Response after Combination Immunotherapy Combined with Locoregional Therapy.Liver Cancer. 2023 Jul 28;12(4):289-296. doi: 10.1159/000532023. eCollection 2023 Sep. Liver Cancer. 2023. PMID: 37901198 Free PMC article. No abstract available.
-
Early post-treatment MRI predicts long-term hepatocellular carcinoma response to radiation segmentectomy.Eur Radiol. 2024 Jan;34(1):475-484. doi: 10.1007/s00330-023-10045-z. Epub 2023 Aug 4. Eur Radiol. 2024. PMID: 37540318 Free PMC article.
-
Intratumoral Immunotherapy: Is It Ready for Prime Time?Curr Oncol Rep. 2023 Aug;25(8):857-867. doi: 10.1007/s11912-023-01422-4. Epub 2023 May 2. Curr Oncol Rep. 2023. PMID: 37129706 Review.
-
Semiautomated segmentation of hepatocellular carcinoma tumors with MRI using convolutional neural networks.Eur Radiol. 2023 Sep;33(9):6020-6032. doi: 10.1007/s00330-023-09613-0. Epub 2023 Apr 18. Eur Radiol. 2023. PMID: 37071167
-
The prognostic role of early tumor shrinkage in patients with hepatocellular carcinoma undergoing immunotherapy.Cancer Imaging. 2022 Sep 24;22(1):54. doi: 10.1186/s40644-022-00487-x. Cancer Imaging. 2022. PMID: 36153569 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical