Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, Tuebingen 72076, Germany.
Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, Tuebingen 72076, Germany.
Acad Radiol. 2017 Nov;24(11):1352-1363. doi: 10.1016/j.acra.2017.05.006. Epub 2017 Jun 23.
This study aimed to evaluate the potential role of computed tomography texture analysis (CTTA) of arterial and portal-venous enhancement phase image data for prediction and accurate assessment of response of hepatocellular carcinoma undergoing drug-eluting bead transarterial chemoembolization (TACE) by comparison to liver perfusion CT (PCT).
Twenty-eight patients (27 male; mean age 67.2 ± 10.4) with 56 hepatocellular carcinoma-typical liver lesions were included. Arterial and portal-venous phase CT data obtained before and after TACE with a mean time of 39.93 ± 62.21 days between examinations were analyzed. TACE was performed within 48 hours after first contrast-enhanced CT. CTTA software was a prototype. CTTA analysis was performed blinded (for results) by two observers separately. Combined results of modified Response Evaluation Criteria In Solid Tumors (mRECIST) and PCT of the liver were used as the standard of reference. Time to progression was additionally assessed for all patients. CTTA parameters included heterogeneity, intensity, average, deviation, skewness, and entropy of co-occurrence. Each parameter was compared to those of PCT (blood flow [BF], blood volume, arterial liver perfusion [ALP], portal-venous perfusion, and hepatic perfusion index) measured before and after TACE.
mRECIST + PCT yielded 28.6% complete response (CR), 42.8% partial response, and 28.6% stable disease. Significant correlations were registered in the arterial phase in CR between changes in mean heterogeneity and BF (P = .004, r = -0.815), blood volume (P = .002, r = -0.851), and ALP (P = .002, r = -0.851), respectively. In the partial response group, changes in mean heterogeneity correlated with changes in ALP (P = .003) and to a lesser degree with hepatic perfusion index (P = .027) in the arterial phase. In the stable disease group, BF correlated with entropy of nonuniformity (P = .010). In the portal-venous phase, no statistically significant correlations were registered in all groups. Receiver operating characteristic analysis of CTTA parameters yielded predictive cutoff values for CR in the arterial contrast-enhanced CT phase for uniformity of skewness (sensitivity: 90.0%; specificity: 45.8%), and in the portal-venous phase for uniformity of heterogeneity (sensitivity: 92.3%; specificity: 81.8%).
Significant correlations exist between CTTA parameters and those derived from PCT both in the pre- and the post-TACE settings, and some of them have predictive value for TACE midterm outcome.
本研究旨在通过与肝脏灌注 CT（PCT）比较，评估动脉期和门静脉期增强图像数据的 CT 纹理分析（CTTA）在预测和准确评估经载药微球动脉化疗栓塞（TACE）治疗的肝细胞癌患者反应中的潜在作用。
共纳入 28 例（27 例男性；平均年龄 67.2±10.4）56 个典型肝癌病灶的患者。TACE 前后的动脉期和门静脉期 CT 数据在两次检查之间平均间隔 39.93±62.21 天获得。TACE 在首次对比增强 CT 后 48 小时内进行。CTTA 分析软件为原型。两名观察者分别对结果进行盲法（结果）分析。改良的实体瘤反应评估标准（mRECIST）和肝脏 PCT 的综合结果被用作参考标准。对所有患者进行无进展时间评估。CTTA 参数包括异质性、强度、平均值、偏差、偏度和共生熵。将每个参数与 TACE 前后测量的 PCT（血流[BF]、血容量、动脉肝脏灌注[ALP]、门静脉灌注和肝灌注指数）进行比较。
mRECIST+PCT 得到 28.6%的完全缓解（CR）、42.8%的部分缓解和 28.6%的稳定疾病。在 CR 患者中，动脉期的平均异质性与 BF（P=0.004，r=-0.815）、血容量（P=0.002，r=-0.851）和 ALP（P=0.002，r=-0.851）之间存在显著相关性。在部分缓解组中，动脉期平均异质性与 ALP（P=0.003）变化相关，与肝灌注指数变化相关程度较低（P=0.027）。在稳定疾病组中，BF 与非均匀性的熵相关（P=0.010）。在门静脉期，所有组均未检测到统计学显著相关性。CTTA 参数的受试者工作特征分析为动脉期增强 CT 阶段的 CR 获得了偏度均匀性的预测截断值（敏感性：90.0%；特异性：45.8%），在门静脉期获得了异质性均匀性的预测截断值（敏感性：92.3%；特异性：81.8%）。
在 TACE 前后，CTTA 参数与 PCT 衍生参数之间存在显著相关性，其中一些参数对 TACE 中期结果具有预测价值。
