Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA; Institute of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, 10117 Berlin, Germany.
Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA; Institute of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, 10117 Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) (Digital) Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany.
Clin Imaging. 2022 Sep;89:112-119. doi: 10.1016/j.clinimag.2022.06.013. Epub 2022 Jun 26.
This study assessed the response to conventional transarterial chemoembolization (cTACE) in patients with liver metastases from rare tumor primaries using one-dimensional (1D) and three-dimensional (3D) quantitative response assessment methods, and investigate the relationship of lipiodol deposition in predicting response.
This retrospective bicentric study included 16 patients with hepatic metastases from rare tumors treated with cTACE between 2002 and 2017. Multi-phasic MR imaging obtained before and after cTACE was used for assessment of response. Response evaluation criteria in solid tumors (RECIST) and modified-RECIST (mRECIST) were utilized for 1D response assessment, and volumetric RECIST (vRECIST) and enhancement-based quantitative European Association for Study of the Liver EASL (qEASL) were used for 3D response assessment. The same day post-cTACE CT scan was analyzed to quantify intratumoral lipiodol deposition (%).
The mean and standard deviation (SD) of diameter of treated lesions per targeted area was 7.5 ± 5.4 cm, and the mean and SD of number of metastases in each targeted area was 4.2 ± 4.6. cTACE was technically successful in all patients, without major complications. While RECIST and vRECIST methods did not allocate patients with partial response, mRECIST and qEASL identified patients with partial response. Intratumoral lipiodol deposition significantly predicted treatment response according qEASL (R = 0.470, p < 0.01), while no association was shown between lipiodol deposition within treated tumor area and RECIST or mRECIST (p > 0.212).
3D quantitative volumetric response analysis can be used for stratification of response to cTACE in patients with hepatic metastases originating from rare primary tumors. Lipiodol deposition could potentially be used as an early surrogate to predict response to cTACE.
本研究采用一维（1D）和三维（3D）定量反应评估方法，评估来源于罕见肿瘤的肝转移患者对常规经动脉化疗栓塞（cTACE）的反应，并探讨碘油沉积在预测反应中的关系。
本回顾性双中心研究纳入 2002 年至 2017 年间接受 cTACE 治疗的 16 例肝转移瘤患者。治疗前后的多期 MR 成像用于评估反应。采用实体瘤反应评估标准（RECIST）和改良 RECIST（mRECIST）进行 1D 反应评估，采用容积 RECIST（vRECIST）和基于增强的欧洲肝脏研究协会 EASL 定量（qEASL）进行 3D 反应评估。分析同一天的 cTACE 后 CT 扫描，以定量分析肿瘤内碘油沉积（%）。
靶向区域内治疗病变的平均直径为 7.5±5.4cm，每个靶向区域内转移灶的平均数量为 4.2±4.6。所有患者的 cTACE 均获得技术成功，无重大并发症。虽然 RECIST 和 vRECIST 方法未将部分缓解的患者分配，但 mRECIST 和 qEASL 方法识别出部分缓解的患者。根据 qEASL，肿瘤内碘油沉积与治疗反应显著相关（R=0.470，p<0.01），而治疗肿瘤区域内的碘油沉积与 RECIST 或 mRECIST 之间无关联（p>0.212）。
3D 定量容积反应分析可用于分层来源于罕见原发性肿瘤的肝转移患者对 cTACE 的反应。碘油沉积可能可作为预测 cTACE 反应的早期替代指标。
