基线容积多参数磁共振成像对经动脉化疗栓塞治疗的神经内分泌肝脏转移瘤的预后价值。
Prognostic value of baseline volumetric multiparametric MR imaging in neuroendocrine liver metastases treated with transarterial chemoembolization.
机构信息
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Nelson 143, Central Radiology, MRI, 600 North Wolfe Street, Room 143, Baltimore, MD, 21287, USA.
出版信息
Eur Radiol. 2019 Oct;29(10):5160-5171. doi: 10.1007/s00330-019-06100-3. Epub 2019 Mar 15.
OBJECTIVES
To determine whether baseline multiparametric MR imaging can predict overall survival (OS) and hepatic progression-free survival (HPFS) in patients with neuroendocrine liver metastases (NELMs) treated with transarterial chemoembolization (TACE).
METHODS
This retrospective study included 84 NELMs patients treated with TACE. Tumor volume and volumetric measurements of arterial enhancement (AE), venous enhancement (VE), and apparent diffusion coefficient (ADC) were performed on baseline MR imaging. A maximum of one, two, and five index lesions were selected in each patient. OS was the primary endpoint and HPFS was the secondary endpoint. Prognostic values of volumetric multiparametric MR parameters for predicting OS and HPFS considering a maximum of one, two, and five index lesions were assessed.
RESULTS
Prognostic values of volumetric multiparametric MR parameters for predicting OS and HPFS were similar regardless of the maximum number of index lesions. Multivariate survival analysis showed that baseline dominant tumor volume ≥ 73 cm, volumetric mean AE ≥ 45%, and mean VE ≥ 73% were independent prognostic factors for OS (HR 2.73; 95% CI 1.45, 5.15; HR 0.32; 95% CI 0.17, 0.63; HR 0.35; 95% CI 0.17, 0.72, respectively) and HPFS (HR 2.30, 95% CI 1.38, 3.84; HR 0.46, 95% CI 0.25, 0.84; HR 0.36, 95% CI 0.19, 0.57, respectively). OS and HPFS were similar in patients with low and high volumetric mean ADC.
CONCLUSION
Volumetric enhancement values and tumor volume of the dominant lesion on baseline MR imaging may act as prognostic factors for OS and HPFS in NELMs patients treated with TACE.
KEY POINTS
• High volumetric mean AE and VE, and low tumor volume of the dominant lesion on baseline MR imaging were associated with favorable OS and HPFS in NELMs patients treated with TACE. • Evaluation of multiple lesions does not provide additional information as compared to single lesion evaluation.
目的
确定基线多参数磁共振成像（MR）能否预测接受经动脉化疗栓塞术（TACE）治疗的神经内分泌肝脏转移瘤（NELM）患者的总生存期（OS）和肝无进展生存期（HPFS）。
方法
本回顾性研究纳入了 84 例接受 TACE 治疗的 NELM 患者。在基线 MR 成像上对肿瘤体积和动脉增强（AE）、静脉增强（VE）和表观扩散系数（ADC）的容积测量值进行评估。每位患者最多选择一个、两个或五个指标性病变。OS 为主要终点，HPFS 为次要终点。评估考虑最多一个、两个和五个指标性病变时，容积多参数 MR 参数对预测 OS 和 HPFS 的预后价值。
结果
无论最大病变数量如何，容积多参数 MR 参数对预测 OS 和 HPFS 的预后价值均相似。多变量生存分析显示，基线时最大肿瘤体积≥73cm、容积平均 AE≥45%和平均 VE≥73%是 OS（HR 2.73；95%CI 1.45，5.15；HR 0.32；95%CI 0.17，0.63；HR 0.35；95%CI 0.17，0.72）和 HPFS（HR 2.30，95%CI 1.38，3.84；HR 0.46，95%CI 0.25，0.84；HR 0.36，95%CI 0.19，0.57）的独立预后因素。在低和高容积平均 ADC 的患者中，OS 和 HPFS 相似。
结论
基线 MR 成像上的肿瘤增强值和优势病变的肿瘤体积可能是接受 TACE 治疗的 NELM 患者 OS 和 HPFS 的预后因素。
重点
• 在接受 TACE 治疗的 NELM 患者中，基线 MR 成像上的高容积平均 AE 和 VE 值、低优势病变肿瘤体积与良好的 OS 和 HPFS 相关。• 与单个病变评估相比，多个病变的评估并不能提供更多信息。
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