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

Research output: Contribution to journalArticlepeer-review

64 Scopus citations


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
Issue number10
StatePublished - Oct 2007

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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