Four-dimensional Transcatheter Intraarterial Perfusion MR Imaging for Monitoring Chemoembolization of Hepatocellular Carcinoma: Preliminary Results

Ron C. Gaba, Dingxin Wang, Robert J. Lewandowski, Robert K. Ryu, Kent T. Sato, Laura M. Kulik, Mary F. Mulcahy, Andrew C. Larson, Riad Salem, Reed A. Omary*

*Corresponding author for this work

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Abstract

Purpose: Angiographic endpoints for chemoembolization of hepatocellular carcinoma (HCC) are subjective, and optimal endpoints remain unknown. Transcatheter intraarterial perfusion (TRIP) magnetic resonance (MR) imaging, when performed in a combined MR/interventional radiology (MR-IR) suite, offers an objective method to quantify intraprocedural tumor perfusion changes, but was previously limited to two spatial dimensions. This study prospectively tested the hypothesis that a new volumetric acquisition over time, four-dimensional TRIP MR imaging, can measure HCC perfusion changes during chemoembolization. Materials and Methods: Seven men (mean age, 53 years; range, 42-65 y) with eight tumors (mean size, 2.5 × 2.4 cm2; diameter range, 1.5-5.2 cm) underwent chemoembolization in an MR-IR suite between February and December 2007, with intraprocedural tumor perfusion reductions monitored with four-dimensional TRIP MR imaging. Microcatheter chemoembolization was performed with a 1:1 mixture of chemotherapy agent and emulsifying contrast agent, followed by the administration of gelatin microspheres. Pre- and post-chemoembolization time-intensity curves were generated for each tumor. Semiquantitative measures of tumor perfusion, including area under the curve (AUC), peak signal intensity (SI), time to peak SI, and maximum upslope (MUS), were calculated, and mean differences before and after chemoembolization were compared with paired t tests. Results: Four-dimensional TRIP MR imaging-monitored chemoembolization was successful in all cases. Calculated AUCs before and after chemoembolization (439 vs 221, P = .004, 50% reduction), peak SI (32 vs 19, P = .012, 41% reduction), and MUS (11 vs 3, P = .028, 73% reduction) showed significant reductions after chemoembolization. Time to peak SI did not significantly change (23 sec vs 36 sec, P = .235, 57% increase). Conclusions: Four-dimensional TRIP MR imaging can successfully measure semiquantitative changes in HCC perfusion during MR-IR-monitored chemoembolization. Future studies may correlate changes in these objective functional parameters with tumor response.

Original languageEnglish (US)
Pages (from-to)1589-1595
Number of pages7
JournalJournal of Vascular and Interventional Radiology
Volume19
Issue number11
DOIs
StatePublished - Nov 1 2008

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Magnetic Resonance Angiography
Hepatocellular Carcinoma
Perfusion
Neoplasms
Magnetic Resonance Spectroscopy
Area Under Curve
Emulsifying Agents
Interventional Radiology
Gelatin
Microspheres
Contrast Media
Drug Therapy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{d499639e38494b2c81da0772b0f618c8,
title = "Four-dimensional Transcatheter Intraarterial Perfusion MR Imaging for Monitoring Chemoembolization of Hepatocellular Carcinoma: Preliminary Results",
abstract = "Purpose: Angiographic endpoints for chemoembolization of hepatocellular carcinoma (HCC) are subjective, and optimal endpoints remain unknown. Transcatheter intraarterial perfusion (TRIP) magnetic resonance (MR) imaging, when performed in a combined MR/interventional radiology (MR-IR) suite, offers an objective method to quantify intraprocedural tumor perfusion changes, but was previously limited to two spatial dimensions. This study prospectively tested the hypothesis that a new volumetric acquisition over time, four-dimensional TRIP MR imaging, can measure HCC perfusion changes during chemoembolization. Materials and Methods: Seven men (mean age, 53 years; range, 42-65 y) with eight tumors (mean size, 2.5 × 2.4 cm2; diameter range, 1.5-5.2 cm) underwent chemoembolization in an MR-IR suite between February and December 2007, with intraprocedural tumor perfusion reductions monitored with four-dimensional TRIP MR imaging. Microcatheter chemoembolization was performed with a 1:1 mixture of chemotherapy agent and emulsifying contrast agent, followed by the administration of gelatin microspheres. Pre- and post-chemoembolization time-intensity curves were generated for each tumor. Semiquantitative measures of tumor perfusion, including area under the curve (AUC), peak signal intensity (SI), time to peak SI, and maximum upslope (MUS), were calculated, and mean differences before and after chemoembolization were compared with paired t tests. Results: Four-dimensional TRIP MR imaging-monitored chemoembolization was successful in all cases. Calculated AUCs before and after chemoembolization (439 vs 221, P = .004, 50{\%} reduction), peak SI (32 vs 19, P = .012, 41{\%} reduction), and MUS (11 vs 3, P = .028, 73{\%} reduction) showed significant reductions after chemoembolization. Time to peak SI did not significantly change (23 sec vs 36 sec, P = .235, 57{\%} increase). Conclusions: Four-dimensional TRIP MR imaging can successfully measure semiquantitative changes in HCC perfusion during MR-IR-monitored chemoembolization. Future studies may correlate changes in these objective functional parameters with tumor response.",
author = "Gaba, {Ron C.} and Dingxin Wang and Lewandowski, {Robert J.} and Ryu, {Robert K.} and Sato, {Kent T.} and Kulik, {Laura M.} and Mulcahy, {Mary F.} and Larson, {Andrew C.} and Riad Salem and Omary, {Reed A.}",
year = "2008",
month = "11",
day = "1",
doi = "10.1016/j.jvir.2008.08.010",
language = "English (US)",
volume = "19",
pages = "1589--1595",
journal = "Journal of Vascular and Interventional Radiology",
issn = "1051-0443",
publisher = "Elsevier Inc.",
number = "11",

}

TY - JOUR

T1 - Four-dimensional Transcatheter Intraarterial Perfusion MR Imaging for Monitoring Chemoembolization of Hepatocellular Carcinoma

T2 - Preliminary Results

AU - Gaba, Ron C.

AU - Wang, Dingxin

AU - Lewandowski, Robert J.

AU - Ryu, Robert K.

AU - Sato, Kent T.

AU - Kulik, Laura M.

AU - Mulcahy, Mary F.

AU - Larson, Andrew C.

AU - Salem, Riad

AU - Omary, Reed A.

PY - 2008/11/1

Y1 - 2008/11/1

N2 - Purpose: Angiographic endpoints for chemoembolization of hepatocellular carcinoma (HCC) are subjective, and optimal endpoints remain unknown. Transcatheter intraarterial perfusion (TRIP) magnetic resonance (MR) imaging, when performed in a combined MR/interventional radiology (MR-IR) suite, offers an objective method to quantify intraprocedural tumor perfusion changes, but was previously limited to two spatial dimensions. This study prospectively tested the hypothesis that a new volumetric acquisition over time, four-dimensional TRIP MR imaging, can measure HCC perfusion changes during chemoembolization. Materials and Methods: Seven men (mean age, 53 years; range, 42-65 y) with eight tumors (mean size, 2.5 × 2.4 cm2; diameter range, 1.5-5.2 cm) underwent chemoembolization in an MR-IR suite between February and December 2007, with intraprocedural tumor perfusion reductions monitored with four-dimensional TRIP MR imaging. Microcatheter chemoembolization was performed with a 1:1 mixture of chemotherapy agent and emulsifying contrast agent, followed by the administration of gelatin microspheres. Pre- and post-chemoembolization time-intensity curves were generated for each tumor. Semiquantitative measures of tumor perfusion, including area under the curve (AUC), peak signal intensity (SI), time to peak SI, and maximum upslope (MUS), were calculated, and mean differences before and after chemoembolization were compared with paired t tests. Results: Four-dimensional TRIP MR imaging-monitored chemoembolization was successful in all cases. Calculated AUCs before and after chemoembolization (439 vs 221, P = .004, 50% reduction), peak SI (32 vs 19, P = .012, 41% reduction), and MUS (11 vs 3, P = .028, 73% reduction) showed significant reductions after chemoembolization. Time to peak SI did not significantly change (23 sec vs 36 sec, P = .235, 57% increase). Conclusions: Four-dimensional TRIP MR imaging can successfully measure semiquantitative changes in HCC perfusion during MR-IR-monitored chemoembolization. Future studies may correlate changes in these objective functional parameters with tumor response.

AB - Purpose: Angiographic endpoints for chemoembolization of hepatocellular carcinoma (HCC) are subjective, and optimal endpoints remain unknown. Transcatheter intraarterial perfusion (TRIP) magnetic resonance (MR) imaging, when performed in a combined MR/interventional radiology (MR-IR) suite, offers an objective method to quantify intraprocedural tumor perfusion changes, but was previously limited to two spatial dimensions. This study prospectively tested the hypothesis that a new volumetric acquisition over time, four-dimensional TRIP MR imaging, can measure HCC perfusion changes during chemoembolization. Materials and Methods: Seven men (mean age, 53 years; range, 42-65 y) with eight tumors (mean size, 2.5 × 2.4 cm2; diameter range, 1.5-5.2 cm) underwent chemoembolization in an MR-IR suite between February and December 2007, with intraprocedural tumor perfusion reductions monitored with four-dimensional TRIP MR imaging. Microcatheter chemoembolization was performed with a 1:1 mixture of chemotherapy agent and emulsifying contrast agent, followed by the administration of gelatin microspheres. Pre- and post-chemoembolization time-intensity curves were generated for each tumor. Semiquantitative measures of tumor perfusion, including area under the curve (AUC), peak signal intensity (SI), time to peak SI, and maximum upslope (MUS), were calculated, and mean differences before and after chemoembolization were compared with paired t tests. Results: Four-dimensional TRIP MR imaging-monitored chemoembolization was successful in all cases. Calculated AUCs before and after chemoembolization (439 vs 221, P = .004, 50% reduction), peak SI (32 vs 19, P = .012, 41% reduction), and MUS (11 vs 3, P = .028, 73% reduction) showed significant reductions after chemoembolization. Time to peak SI did not significantly change (23 sec vs 36 sec, P = .235, 57% increase). Conclusions: Four-dimensional TRIP MR imaging can successfully measure semiquantitative changes in HCC perfusion during MR-IR-monitored chemoembolization. Future studies may correlate changes in these objective functional parameters with tumor response.

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DO - 10.1016/j.jvir.2008.08.010

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