Abstract
Purpose: To demonstrate the feasibility of using chemical shift fat-water MRI methods to visualize and measure intrahepatic delivery of ethiodized oil to liver tumors following conventional transarterial chemoembolization (cTACE). Materials and Methods: Twenty-eight participants (mean age, 66 years ± 8 [SD]; 22 men) with hepatocellular carcinoma (HCC) treated with cTACE were evaluated with follow-up chemical shift MRI in this Health Insurance Portability and Accountability Act–compliant prospective, institutional review board–approved study. Uptake of ethiodized oil was evaluated at 1-month follow-up chemical shift MRI. Measurements of tumor size (MRI and CT), attenuation and enhancement (CT), fat content percentage, and tumor:normal ratio (MRI) were compared by lesion for responders versus nonresponders, as assessed with modified Response Evaluation Criteria in Solid Tumors and European Association for the Study of the Liver (EASL) criteria. Adverse events and overall survival by the Kaplan-Meier method were secondary end points. Results: Focal tumor ethiodized oil retention was 46% (12 of 26 tumors) at 24 hours and 47% (18 of 38 tumors) at 1 month after cTACE. Tumor volume at CT did not differ between EASL-defined responders and nonresponders (P = .06). Tumor ethiodized oil volume measured with chemical shift MRI was statistically significantly higher for EASL-defined nonresponders (P = .02). Doxorubicin dosing (P = .53), presence of focal fat (P = .83), and a combined end point of focal fat and low doxorubicin dosing (P = .97) did not stratify overall survival after cTACE. Conclusion: Chemical shift MRI allowed for assessment of tumor delivery of ethiodized oil out to 1 month after cTACE in participants with HCC and demonstrated tumor ethiodized oil volume as a potential tool for stratification of tumor response by EASL criteria.
| Original language | English (US) |
|---|---|
| Article number | e220019 |
| Journal | Radiology: Imaging Cancer |
| Volume | 5 |
| Issue number | 3 |
| DOIs | |
| State | Published - May 2023 |
Funding
Unpaid voluntary role with Society of Interventional Radiology Executive Council; scientific advisor to ABK, Boston Scientific, and Varian Medical Systems. W.L. No relevant relationships. X.Z. Issued, pending, or planned patents relevant to the fat separation and quantification techniques in this work (with Siemens Medical Solutions USA); stocks in Siemens Healthineers and other relevant Siemens companies; employment with Siemens Medical Solutions USA. S.A.R.K. Stock/ stock options in Siemens and Siemens Healthineers; employment at Siemens Healthcare. F.H.M. No relevant relationships. R.S. Scientific advisor to AstraZen-eca, Becton Dickinson, Boston Scientific, Cook, and Eisai. W.S.R. Consulting fees from Boston Scientific, Varian, Sirtex, BD Bard, Terumo, and AstraZeneca; participation on a Data Safety Monitoring Board or Advisory Board at Boston Scientific, Varian, and BD Bard; Society of Interventional Oncology executive committee and past president. A.C.L. No relevant relationships. S.B.W. Research support from Guerbet; Focused Ultrasound Foundation and RSNA grants; consulting fees from Guerbet, Cook, BD, and TriNav; honoraria from Penumbra; SIO board of directors, JVIR and Radiology editorial boards; receipt of equipment/ materials from Insightec. Funding for this pilot study was provided by Guerbet through an investigator-initiated study. R.S. is supported in part by National Institutes of Health (NIH) grant CA126809. S.B.W. is supported in part by the RSNA Scholar grant and NIH 5 R25 CA132822-03.
Keywords
- CT
- Chemical Shift Imaging
- Ethiodized Oil
- Hepatic Chemoembolization
- MRI
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Oncology
