Intraprocedural Transcatheter Intra-arterial Perfusion MRI as a Predictor of Tumor Response to Chemoembolization for Hepatocellular Carcinoma

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

*Corresponding author for this work

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Rationale and Objectives: To prospectively test the hypothesis that transcatheter intraarterial perfusion magnetic resonance imaging (TRIP-MRI) measured semiquantitative perfusion reductions during transcatheter arterial chemoembolization of hepatocellular carcinoma (HCC) are associated with tumor response. Materials and Methods: Twenty-eight patients (mean age 63 years; range 47-87 years) with 29 tumors underwent chemoembolization in a combined magnetic resonance interventional radiology suite. Intraprocedural tumor perfusion reductions during chemoembolization were monitored using TRIP-MRI. Pre- and postchemoembolization semiquantitative area under the time-signal enhancement curve (AUC) tumor perfusion was measured. Mean tumor perfusion pre- and postchemoembolization were compared using a paired t-test. Imaging follow-up was performed 1-3 months after chemoembolization. We studied the relationship between short-term tumor imaging response and intraprocedural perfusion reductions using univariate and multivariate analysis. Results: Intraprocedural AUC perfusion value decreased significantly after chemoembolization (342.1 vs. 158.6 arbitrary unit, P < 001). Twenty-six patients with 27 HCCs (n = 27) had follow-up imaging at mean 39 days postchemoembolization. Favorable response was present in 67% of these treated tumors according to necrosis criteria. Fifteen of 16 (94%) tumors with 25%-75% perfusion reductions showed necrosis treatment response compared to only 3 of 11 (27%) tumors with perfusion reductions outside the above range (P = 001). Multivariate logistic regression indicated that intraprocedural tumor perfusion reduction and Child-Pugh class were independent factors associated significantly with tumor response (P = 012 and .047, respectively). Conclusion: TRIP-MRI can successfully measure semiquantitative changes in HCC perfusion during chemoembolization. Intraprocedural tumor perfusion reductions are associated with future tumor response.

Original languageEnglish (US)
Pages (from-to)828-836
Number of pages9
JournalAcademic Radiology
Volume18
Issue number7
DOIs
StatePublished - Jul 1 2011

Keywords

  • Functional embolic endpoint
  • Hepatocellular carcinoma (HCC)
  • Transcatheter arterial chemoembolization
  • Transcatheter intraarterial perfusion magnetic resonance imaging (TRIP-MRI)
  • Tumor response

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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