From the Departments of Radiology (D.W., B.J., R.J.L., A.R., K.M., R.K.R., K.T.S., A.C.L., R.S., R.A.O.), Hepatology (L.M.K.), and Medicine (M.F.M., R.S.), Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center (R.J.L., L.M.K., M.F.M., A.C.L., R.S., R.A.O.), and Biomedical Engineering Department, McCormick School of Engineering (A.C.L., R.A.O.), Northwestern University, Chicago, Ill; Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn (D.W.); and Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Ill (R.C.G.).
Radiology. 2014 Aug;272(2):587-97. doi: 10.1148/radiol.14131311. Epub 2014 Mar 28.
To investigate the predictive value of transcatheter intraarterial perfusion (TRIP) magnetic resonance (MR) imaging-measured tumor perfusion changes during transarterial chemoembolization on transplant-free survival (TFS) in patients with unresectable hepatocellular carcinoma (HCC).
This HIPAA-compliant prospective study was approved by the institutional review board. Written informed consent was obtained from all patients. Fifty-one consecutive adult patients with surgically unresectable single or multifocal measurable HCC and adequate laboratory parameters who underwent chemoembolization in a combined MR imaging-interventional radiology suite between February 2006 and June 2010 were studied. Tumor perfusion changes during chemoembolization were measured by using TRIP MR imaging with area under the time-signal intensity curve calculation. The end point of the study was TFS. The authors assessed the correlation between the percentage perfusion reduction in the tumor during chemoembolization and TFS by using univariate and multivariate analyses.
Fifty patients (mean age, 61 years; 39 men aged 42-87 years [mean age, 61 years] and 11 women aged 49-83 years [mean age, 62 years]) were eligible for the analysis. Patients with 35%-85% intraprocedural tumor area under the time-signal intensity curve reduction (n = 32) showed significantly improved median TFS compared with patients with an area under the time-signal intensity curve reduction outside this range (n = 18) (16.6 months [95% confidence interval: 11.2, 22.0 months] vs 9.3 months [95% confidence interval: 6.6, 12.0 months], respectively; P = .046; hazard ratio: 0.46; 95% confidence interval: 0.21, 1.00). The cumulative TFS rates in the 35%-85% and less than 35% or more than 85% perfusion reduction groups at 1, 2, and 5 years after chemoembolization were 66.4%, 42.2%, and 28.2% versus 33.8%, 16.9%, and 0%, respectively.
The study shows evidence of an association between intraprocedural tumor perfusion reduction during chemoembolization and TFS and suggests the utility of TRIP MR imaging- measured tumor perfusion reduction as an intraprocedural imaging biomarker during chemoembolization.
探讨经导管肝动脉内灌注（TRIP）磁共振（MR）成像测量的肿瘤灌注变化在不可切除肝细胞癌（HCC）患者经动脉化疗栓塞（TACE）后无移植生存（TFS）中的预测价值。
本 HIPAA 合规性前瞻性研究获得了机构审查委员会的批准。所有患者均获得书面知情同意。研究纳入 2006 年 2 月至 2010 年 6 月在 MR 成像-介入放射学联合诊室接受 TACE 的 51 例连续成年单发或多发可测量 HCC 且实验室参数足够的手术不可切除 HCC 患者。采用 TRIP MR 成像计算曲线下面积来测量 TACE 期间肿瘤灌注变化。研究终点为 TFS。作者采用单因素和多因素分析评估 TACE 期间肿瘤灌注减少百分比与 TFS 之间的相关性。
50 例患者（平均年龄 61 岁；39 例男性，年龄 42-87 岁[平均年龄 61 岁]；11 例女性，年龄 49-83 岁[平均年龄 62 岁]）符合分析条件。35%-85%的肿瘤术中曲线下面积减少患者（n=32）的中位 TFS 明显长于曲线下面积减少范围之外的患者（n=18）（16.6 个月[95%置信区间：11.2，22.0 个月]与 9.3 个月[95%置信区间：6.6，12.0 个月]；P=.046；风险比：0.46；95%置信区间：0.21，1.00）。TACE 后 1、2 和 5 年时，35%-85%和灌注减少<35%或>85%的累积 TFS 率分别为 66.4%、42.2%和 28.2%，以及 33.8%、16.9%和 0%。
本研究表明 TACE 期间肿瘤灌注减少与 TFS 之间存在关联的证据，并提示在 TACE 期间使用 TRIP MR 成像测量的肿瘤灌注减少作为术中成像生物标志物的效用。
