基于 MRI 容积增强和 CT 容积油沉积与病理相关性预测肝癌 TACE 后坏死。
Prediction of post-TACE necrosis of hepatocellular carcinoma usingvolumetric enhancement on MRI and volumetric oil deposition on CT, with pathological correlation.
机构信息
The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA.
Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
出版信息
Eur Radiol. 2018 Jul;28(7):3032-3040. doi: 10.1007/s00330-017-5198-9. Epub 2018 Jan 30.
OBJECTIVE
To investigate whether volumetric enhancement on baseline MRI and volumetric oil deposition on unenhanced CT would predict HCC necrosis and response post-TACE.
METHOD
Of 115 retrospective HCC patients (173 lesions) who underwent cTACE, a subset of 53 HCC patients underwent liver transplant (LT). Semiautomatic volumetric segmentation of target lesions was performed on dual imaging to assess the accuracy of predicting tumour necrosis after TACE in the whole cohort and at pathology in the LT group. Predicted percentage tumour necrosis is defined as 100 % - (%baseline MRI enhancement - %CT oil deposition).
RESULTS
Mean predicted tumour necrosis by dual imaging modalities was 61.5 % ± 31.6%; mean percentage tumour necrosis on follow-up MRI was 63.8 % ± 31.5 %. In the LT group, mean predicted tumour necrosis by dual imaging modalities was 77.6 % ± 27.2 %; mean percentage necrosis at pathology was 78.7 % ± 31.5 %. There was a strong significant correlation between predicted tumour necrosis and volumetric necrosis on MRI follow-up (r = 0.889, p<0.001) and between predicted tumour necrosis and pathological necrosis (r = 0.871, p<0.001).
CONCLUSION
Volumetric pre-TACE enhancement on MRI and post-TACE oil deposition in CT may accurately predict necrosis in treated HCC lesions.
KEY POINTS
• Imaging-based tumour response can assist in therapeutic decisions. • Lipiodol retention as carrier agent in cTACE is a tumour necrosis biomarker. • Predicting tumour necrosis with dual imaging potentially obviates immediate post-treatment MRI. • Predicting tumour necrosis would facilitate further therapeutic decisions in HCC post-cTACE. • Pre-TACE MRI and post-TACE CT predict necrosis in treated HCC.
目的
研究基线 MRI 容积增强和未增强 CT 容积油沉积是否可预测 TACE 后 HCC 坏死和反应。
方法
回顾性分析 115 例接受 cTACE 的 HCC 患者（173 个病灶），其中 53 例 HCC 患者接受了肝移植（LT）。在双成像上对目标病灶进行半自动容积分割，以评估整个队列中 TACE 后肿瘤坏死的预测准确性，并在 LT 组中评估病理学的预测准确性。预测肿瘤坏死百分比定义为 100% - (%基线 MRI 增强-%CT 油沉积)。
结果
双成像模式预测的平均肿瘤坏死百分比为 61.5% ± 31.6%；随访 MRI 上的平均肿瘤坏死百分比为 63.8% ± 31.5%。在 LT 组中，双成像模式预测的平均肿瘤坏死百分比为 77.6% ± 27.2%；病理学上的平均坏死百分比为 78.7% ± 31.5%。MRI 随访时双成像模式预测的肿瘤坏死与体积坏死之间存在很强的显著相关性(r=0.889，p<0.001)，与病理坏死之间也存在很强的显著相关性(r=0.871，p<0.001)。
结论
TACE 前 MRI 容积增强和 TACE 后 CT 油沉积可准确预测治疗 HCC 病变的坏死。
关键点
· 基于影像的肿瘤反应有助于治疗决策。
· cTACE 中作为载体的碘化油是肿瘤坏死的生物标志物。
· 双成像预测肿瘤坏死可能避免 TACE 后即刻行 MRI 检查。
· TACE 后预测肿瘤坏死有助于进一步治疗 HCC。
· TACE 前 MRI 和 TACE 后 CT 可预测治疗后的 HCC 坏死。
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