A Comparison of Chemoembolization Endpoints Using Angiographic versus Transcatheter Intraarterial Perfusion/MR Imaging Monitoring

Robert J. Lewandowski*, Dingxin Wang, James Gehl, Bassel Atassi, Robert K. Ryu, Kent Sato, Albert A. Nemcek, Frank H. Miller, Mary F. Mulcahy, Laura Kulik, Andrew C. Larson, Riad Salem, Reed A. Omary

*Corresponding author for this work

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Abstract

Purpose: Transcatheter arterial chemoembolization (TACE) is an established treatment for unresectable liver cancer. This study was conducted to test the hypothesis that angiographic endpoints during TACE are measurable and reproducible by comparing subjective angiographic versus objective magnetic resonance (MR) endpoints of TACE. Materials and Methods: The study included 12 consecutive patients who presented for TACE for surgically unresectable HCC or progressive hepatic metastases despite chemotherapy. All procedures were performed with a dedicated imaging system. Angiographic series before and after TACE were reviewed independently by three board-certified interventional radiologists. A subjective angiographic chemoembolization endpoint (SACE) classification scheme, modified from an established angiographic grading system in the cardiology literature, was designed to assist in reproducibly classifying angiographic endpoints. Reproducibility in SACE classification level was compared among operators, and MR imaging perfusion reduction was compared with SACE levels for each observer. Results: Twelve patients successfully underwent 15 separate TACE sessions. SACE levels ranged from I through IV. There was moderate agreement in SACE classification (κ = 0.46 ± 0.12). There was no correlation between SACE level and MR perfusion reduction (r = 0.16 for one operator and 0.02 for the other two). Conclusions: Angiographic endpoints during TACE vary widely, have moderate reproducibility among operators, and do not correlate with functional MR imaging perfusion endpoints. Future research should aim to determine ideal angiographic and functional MR imaging endpoints for TACE according to outcome measures such as imaging response, pathologic response, and survival.

Original languageEnglish (US)
Pages (from-to)1249-1257
Number of pages9
JournalJournal of Vascular and Interventional Radiology
Volume18
Issue number10
DOIs
StatePublished - Oct 1 2007

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Magnetic Resonance Angiography
Magnetic Resonance Spectroscopy
Perfusion
Magnetic Resonance Imaging
Liver Neoplasms
Cardiology
Outcome Assessment (Health Care)
Neoplasm Metastasis
Drug Therapy
Survival
Liver
Therapeutics

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{e32de46c320a4c90b199f1664baf31ca,
title = "A Comparison of Chemoembolization Endpoints Using Angiographic versus Transcatheter Intraarterial Perfusion/MR Imaging Monitoring",
abstract = "Purpose: Transcatheter arterial chemoembolization (TACE) is an established treatment for unresectable liver cancer. This study was conducted to test the hypothesis that angiographic endpoints during TACE are measurable and reproducible by comparing subjective angiographic versus objective magnetic resonance (MR) endpoints of TACE. Materials and Methods: The study included 12 consecutive patients who presented for TACE for surgically unresectable HCC or progressive hepatic metastases despite chemotherapy. All procedures were performed with a dedicated imaging system. Angiographic series before and after TACE were reviewed independently by three board-certified interventional radiologists. A subjective angiographic chemoembolization endpoint (SACE) classification scheme, modified from an established angiographic grading system in the cardiology literature, was designed to assist in reproducibly classifying angiographic endpoints. Reproducibility in SACE classification level was compared among operators, and MR imaging perfusion reduction was compared with SACE levels for each observer. Results: Twelve patients successfully underwent 15 separate TACE sessions. SACE levels ranged from I through IV. There was moderate agreement in SACE classification (κ = 0.46 ± 0.12). There was no correlation between SACE level and MR perfusion reduction (r = 0.16 for one operator and 0.02 for the other two). Conclusions: Angiographic endpoints during TACE vary widely, have moderate reproducibility among operators, and do not correlate with functional MR imaging perfusion endpoints. Future research should aim to determine ideal angiographic and functional MR imaging endpoints for TACE according to outcome measures such as imaging response, pathologic response, and survival.",
author = "Lewandowski, {Robert J.} and Dingxin Wang and James Gehl and Bassel Atassi and Ryu, {Robert K.} and Kent Sato and Nemcek, {Albert A.} and Miller, {Frank H.} and Mulcahy, {Mary F.} and Laura Kulik and Larson, {Andrew C.} and Riad Salem and Omary, {Reed A.}",
year = "2007",
month = "10",
day = "1",
doi = "10.1016/j.jvir.2007.06.028",
language = "English (US)",
volume = "18",
pages = "1249--1257",
journal = "Journal of Vascular and Interventional Radiology",
issn = "1051-0443",
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number = "10",

}

TY - JOUR

T1 - A Comparison of Chemoembolization Endpoints Using Angiographic versus Transcatheter Intraarterial Perfusion/MR Imaging Monitoring

AU - Lewandowski, Robert J.

AU - Wang, Dingxin

AU - Gehl, James

AU - Atassi, Bassel

AU - Ryu, Robert K.

AU - Sato, Kent

AU - Nemcek, Albert A.

AU - Miller, Frank H.

AU - Mulcahy, Mary F.

AU - Kulik, Laura

AU - Larson, Andrew C.

AU - Salem, Riad

AU - Omary, Reed A.

PY - 2007/10/1

Y1 - 2007/10/1

N2 - Purpose: Transcatheter arterial chemoembolization (TACE) is an established treatment for unresectable liver cancer. This study was conducted to test the hypothesis that angiographic endpoints during TACE are measurable and reproducible by comparing subjective angiographic versus objective magnetic resonance (MR) endpoints of TACE. Materials and Methods: The study included 12 consecutive patients who presented for TACE for surgically unresectable HCC or progressive hepatic metastases despite chemotherapy. All procedures were performed with a dedicated imaging system. Angiographic series before and after TACE were reviewed independently by three board-certified interventional radiologists. A subjective angiographic chemoembolization endpoint (SACE) classification scheme, modified from an established angiographic grading system in the cardiology literature, was designed to assist in reproducibly classifying angiographic endpoints. Reproducibility in SACE classification level was compared among operators, and MR imaging perfusion reduction was compared with SACE levels for each observer. Results: Twelve patients successfully underwent 15 separate TACE sessions. SACE levels ranged from I through IV. There was moderate agreement in SACE classification (κ = 0.46 ± 0.12). There was no correlation between SACE level and MR perfusion reduction (r = 0.16 for one operator and 0.02 for the other two). Conclusions: Angiographic endpoints during TACE vary widely, have moderate reproducibility among operators, and do not correlate with functional MR imaging perfusion endpoints. Future research should aim to determine ideal angiographic and functional MR imaging endpoints for TACE according to outcome measures such as imaging response, pathologic response, and survival.

AB - Purpose: Transcatheter arterial chemoembolization (TACE) is an established treatment for unresectable liver cancer. This study was conducted to test the hypothesis that angiographic endpoints during TACE are measurable and reproducible by comparing subjective angiographic versus objective magnetic resonance (MR) endpoints of TACE. Materials and Methods: The study included 12 consecutive patients who presented for TACE for surgically unresectable HCC or progressive hepatic metastases despite chemotherapy. All procedures were performed with a dedicated imaging system. Angiographic series before and after TACE were reviewed independently by three board-certified interventional radiologists. A subjective angiographic chemoembolization endpoint (SACE) classification scheme, modified from an established angiographic grading system in the cardiology literature, was designed to assist in reproducibly classifying angiographic endpoints. Reproducibility in SACE classification level was compared among operators, and MR imaging perfusion reduction was compared with SACE levels for each observer. Results: Twelve patients successfully underwent 15 separate TACE sessions. SACE levels ranged from I through IV. There was moderate agreement in SACE classification (κ = 0.46 ± 0.12). There was no correlation between SACE level and MR perfusion reduction (r = 0.16 for one operator and 0.02 for the other two). Conclusions: Angiographic endpoints during TACE vary widely, have moderate reproducibility among operators, and do not correlate with functional MR imaging perfusion endpoints. Future research should aim to determine ideal angiographic and functional MR imaging endpoints for TACE according to outcome measures such as imaging response, pathologic response, and survival.

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U2 - 10.1016/j.jvir.2007.06.028

DO - 10.1016/j.jvir.2007.06.028

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AN - SCOPUS:34548824812

VL - 18

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JO - Journal of Vascular and Interventional Radiology

JF - Journal of Vascular and Interventional Radiology

SN - 1051-0443

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