• Dingxin Wang, Ron C Gaba, Brian Jin, Robert J Lewandowski, Ahsun Riaz, Khairuddin Memon, Robert K Ryu, Kent T Sato, Laura M Kulik, Mary F Mulcahy, Andrew C Larson, Riad Salem, and Reed A Omary.
• From the Departments of Radiology (D.W., B.J., R.J.L., A.R., K.M., R.K.R., K.T.S., A.C.L., R.S., R.A.O.), Hepatology (L.M.K.), and Medicine (M.F.M., R.S.), Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center (R.J.L., L.M.K., M.F.M., A.C.L., R.S., R.A.O.), and Biomedical Engineering Department, McCormick School of Engineering (A.C.L., R.A.O.), Northwestern University, Chicago, Ill; Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn (D.W.); and Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Ill (R.C.G.).
• Radiology. 2014 Aug 1; 272 (2): 587-97.

PurposeTo investigate the predictive value of transcatheter intraarterial perfusion (TRIP) magnetic resonance (MR) imaging-measured tumor perfusion changes during transarterial chemoembolization on transplant-free survival (TFS) in patients with unresectable hepatocellular carcinoma (HCC).Materials And MethodsThis HIPAA-compliant prospective study was approved by the institutional review board. Written informed consent was obtained from all patients. Fifty-one consecutive adult patients with surgically unresectable single or multifocal measurable HCC and adequate laboratory parameters who underwent chemoembolization in a combined MR imaging-interventional radiology suite between February 2006 and June 2010 were studied. Tumor perfusion changes during chemoembolization were measured by using TRIP MR imaging with area under the time-signal intensity curve calculation. The end point of the study was TFS. The authors assessed the correlation between the percentage perfusion reduction in the tumor during chemoembolization and TFS by using univariate and multivariate analyses.ResultsFifty patients (mean age, 61 years; 39 men aged 42-87 years [mean age, 61 years] and 11 women aged 49-83 years [mean age, 62 years]) were eligible for the analysis. Patients with 35%-85% intraprocedural tumor area under the time-signal intensity curve reduction (n = 32) showed significantly improved median TFS compared with patients with an area under the time-signal intensity curve reduction outside this range (n = 18) (16.6 months [95% confidence interval: 11.2, 22.0 months] vs 9.3 months [95% confidence interval: 6.6, 12.0 months], respectively; P = .046; hazard ratio: 0.46; 95% confidence interval: 0.21, 1.00). The cumulative TFS rates in the 35%-85% and less than 35% or more than 85% perfusion reduction groups at 1, 2, and 5 years after chemoembolization were 66.4%, 42.2%, and 28.2% versus 33.8%, 16.9%, and 0%, respectively.ConclusionThe study shows evidence of an association between intraprocedural tumor perfusion reduction during chemoembolization and TFS and suggests the utility of TRIP MR imaging- measured tumor perfusion reduction as an intraprocedural imaging biomarker during chemoembolization.

35 keywords...

hide…