Search

To determine if the pattern of retained contrast on immediate postprocedure computed tomography (CT) after particle embolization of hepatic tumors predicts modified Response Evaluation Criteria in Solid Tumors (mRECIST) response.This study was approved by the Institutional Review Board with a waiver of authorization. One hundred four liver tumors were embolized with spherical embolic agents (Embospheres, Bead Block, LC Bead) and polyvinyl alcohol. Noncontrast CT was performed immediately after embolization to assess contrast retention in the targeted tumors, and treatment response was assessed by mRECIST criteria on follow-up CT (average time 9.0 ± 7.7 weeks after embolization). Tumor contrast retention (TCR) was determined based on change in Hounsfield units (HUs) of the index tumors between the preprocedure and immediate postprocedure scans; vascular contrast retention (VCR) was rated; and defects in contrast retention (DCR) were also documented. The morphology of residual enhancing tumor on follow-up CT was described as partial, circumferential, or total. Association between TCR variables and tumor response were assessed using multivariate logistic regression.Of 104 hepatic tumors, 51 (49%) tumors had complete response (CR) by mRECIST criteria; 23 (22.1%) had partial response (PR); 21 (20.2%) had stable disease (SD); and 9 (8.7%) had progressive disease (PD). By multivariate analysis, TCR, VCR, and tumor size are independent predictors of CR (p = 0.02, 0.05, and 0.005 respectively). In 75 tumors, DCR was found to be an independent predictor of failure to achieve complete response (p0.0001) by imaging criteria.TCR, VCR, and DCR on immediate posttreatment CT are independent predictors of CR by mRECIST criteria.

Purpose To determine the factors that are independent predictors of subsequent radiologic necrosis following embolotherapy of HCC. Materials and Methods From Dec 2007 and Mar 2012, 101 pts with Okuda stage I or II HCC not amenable to resection, with adequate liver function were randomized to HAE with Bead Block (BB, n=51) or TACE with LC Bead (n=50) loaded with 150 mg of doxorubicin. 72 patients (BB, n=35; LC, n=37) underwent pre-procedure triphasic CT, immediate post-procedure non-contrast CT 15 min after embolization, and followup triphasic CT 3 weeks post treatment. 135 index tumors were assessed. TCR was determined based on change in Hounsfield units (HU) of the index tumors between pre-procedure and immediate post-procedure scans (Grade 0, 120 HU change). Radiologic tumor necrosis was measured on the 3 week followup CT by calculating the ratio of necrotic and overall tumor volumes using semi-automated volumetric analysis software developed at our institution. Univariate and multivariate regression was performed to determine whether demographic factors, tumor characteristics, embolic agent, and TCR were predictors of the degree of necrosis. Results Demographics and initial tumor characteristics between the BB and LC groups were comparable: median age 68 vs 55 (p Conclusion Tumor contrast retention, but not embolic agent, is an independent predictor of radiologic necrosis following embolotherapy for HCC.