BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA.
Eur Radiol. 2021 Aug;31(8):5791-5801. doi: 10.1007/s00330-020-07636-5. Epub 2021 Jan 21.
To quantify hepatocellular carcinoma (HCC) and liver parenchyma stiffness using MR elastography (MRE) and serum alpha fetoprotein (AFP), before and 6 weeks (6w) after Y radioembolisation (RE), and to assess the value of baseline tumour and liver stiffness (TS/LS) and AFP in predicting response at 6w and 6 months (6 m).
Twenty-three patients (M/F 18/5, mean age 68.3 ± 9.3 years) scheduled to undergo RE were recruited into this prospective single-centre study. Patients underwent an MRI exam at baseline and 6w following RE (range 39-47 days) which included MRE using a prototype 2D EPI sequence. TS, peritumoural LS/LS remote from the tumour, tumour size, and AFP were measured at baseline and at 6w. Treatment response was determined using mRECIST at 6w and 6 m.
MRE was technically successful in 17 tumours which were classified at 6w as complete response (CR, n = 7), partial response (PR, n = 4), and stable disease (SD, n = 6). TS and peritumoural LS were significantly increased following RE (p = 0.016, p = 0.039, respectively), while LS remote from tumour was unchanged (p = 0.245). Baseline TS was significantly lower in patients who achieved CR at 6w (p = 0.014). Baseline TS, peritumoural LS (both AUC = 0.857), and AFP (AUC = 0.798) showed fair/excellent diagnostic performance in predicting CR at 6w, but were not significant predictors of OR or CR at 6 m.
Our initial results suggest that HCC TS and peritumoural LS increase early after RE. Baseline TS, peritumoural LS, and AFP were all significant predictors of CR to RE at 6w. These results should be confirmed in a larger study.
• Magnetic resonance elastography-derived tumour stiffness and peritumoural liver stiffness increase significantly at 6 weeks post radioembolisation whereas liver stiffness remote from the tumour is unchanged. • Baseline tumour stiffness and peritumoural liver stiffness are lower in patients who achieve complete response at 6 weeks post radioembolisation. • Baseline tumour size is significantly correlated with baseline tumour stiffness.
使用磁共振弹性成像（MRE）和血清甲胎蛋白（AFP）在 Y 放射栓塞（RE）前后 6 周（6w）量化肝癌（HCC）和肝实质硬度，并评估基线肿瘤和肝硬度（TS/LS）和 AFP 在预测 6w 和 6 个月（6m）时的反应中的价值。
本前瞻性单中心研究共招募了 23 名患者（男/女 18/5，平均年龄 68.3±9.3 岁），计划接受 RE。患者在 RE 后进行基线和 6w 的 MRI 检查（范围 39-47 天），其中包括使用原型 2D EPI 序列进行 MRE。在基线和 6w 时测量 TS、肿瘤周围 LS/远离肿瘤的 LS、肿瘤大小和 AFP。使用 mRECIST 在 6w 和 6m 时确定治疗反应。
17 个肿瘤的 MRE 技术成功，在 6w 时分类为完全缓解（CR，n=7）、部分缓解（PR，n=4）和稳定疾病（SD，n=6）。RE 后 TS 和肿瘤周围 LS 显著增加（p=0.016，p=0.039），而远离肿瘤的 LS 无变化（p=0.245）。在 6w 时达到 CR 的患者的基线 TS 显著较低（p=0.014）。基线 TS、肿瘤周围 LS（AUC=0.857）和 AFP（AUC=0.798）在预测 6w 时的 CR 方面具有良好/优秀的诊断性能，但不是 6m 时 OR 或 CR 的显著预测因子。
我们的初步结果表明，HCC 的 TS 和肿瘤周围 LS 在 RE 后早期增加。基线 TS、肿瘤周围 LS 和 AFP 都是 6w 时 RE 后 CR 的显著预测因子。这些结果应在更大的研究中得到证实。
·磁共振弹性成像衍生的肿瘤硬度和肿瘤周围肝硬度在放射栓塞后 6 周时显著增加，而远离肿瘤的肝硬度不变。
·RE 后 6 周达到完全缓解的患者的基线肿瘤硬度和肿瘤周围肝硬度较低。
·基线肿瘤大小与基线肿瘤硬度显著相关。
