BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Eur Radiol. 2024 Jan;34(1):475-484. doi: 10.1007/s00330-023-10045-z. Epub 2023 Aug 4.
Radiation segmentectomy using yttrium-90 plays an emerging role in the management of early-stage HCC. However, the value of early post-treatment MRI for response assessment is uncertain. We assessed the value of response criteria obtained early after radiation segmentectomy in predicting long-term response in patients with HCC.
Patients with HCC who underwent contrast-enhanced MRI before, early, and 12 months after radiation segmentectomy were included in this retrospective single-center study. Three independent radiologists reviewed images at baseline and 1 follow-up after radiation segmentectomy and assessed lesion-based response according to mRECIST, LI-RADS treatment response algorithm (TRA), and image subtraction. The endpoint was response at 12 months based on consensus readout of two separate radiologists. Diagnostic accuracy for predicting complete response (CR) at 12 months based on the 1 post-treatment MRI was calculated.
Eighty patients (M/F 60/20, mean age 67.7 years) with 80 HCCs were assessed (median size baseline, 1.8 cm [IQR, 1.4-2.9 cm]). At 12 months, 74 patients were classified as CR (92.5%), 5 as partial response (6.3%), and 1 as progressive disease (1.2%). Diagnostic accuracy for predicting CR was fair to good for all readers with excellent positive predictive value (PPV): mRECIST (range between 3 readers, accuracy: 0.763-0.825, PPV: 0.966-1), LI-RADS TRA (accuracy: 0.700-0.825, PPV: 0.983-1), and subtraction (accuracy: 0.775-0.825, PPV: 0.967-1), with no difference in accuracy between criteria (p range 0.053 to > 0.9).
mRECIST, LI-RADS TRA, and subtraction obtained on early post-treatment MRI show similar performance for predicting long-term response in patients with HCC treated with radiation segmentectomy.
Response assessment extracted from early post-treatment MRI after radiation segmentectomy predicts complete response in patients with HCC with high PPV (≥ 0.96).
• Early post-treatment response assessment on MRI predicts response in patients with HCC treated with radiation segmentectomy with fair to good accuracy and excellent positive predictive value. • There was no difference in diagnostic accuracy between mRECIST, LI-RADS, and subtraction for predicting HCC response to radiation segmentectomy.
钇-90 放射性肝段切除术在治疗早期 HCC 中发挥着新兴作用。然而，早期治疗后 MRI 对反应评估的价值尚不确定。我们评估了 HCC 患者放射性肝段切除术后早期获得的反应标准预测长期反应的价值。
本回顾性单中心研究纳入了接受钇-90 放射性肝段切除术前、术后早期和术后 12 个月行增强 MRI 检查的 HCC 患者。3 名独立的放射科医生在基线和术后 1 次随访时评估图像，并根据 mRECIST、LI-RADS 治疗反应算法（TRA）和图像减影评估基于病变的反应。终点是由两位独立放射科医生共识阅读得出的 12 个月时的反应。根据术后 1 次 MRI 计算预测 12 个月时完全缓解（CR）的诊断准确性。
共评估了 80 例 HCC 患者（M/F 为 60/20，平均年龄 67.7 岁）（基线时肿瘤中位数大小为 1.8cm [IQR，1.4-2.9cm]）。12 个月时，74 例患者被归类为 CR（92.5%），5 例为部分缓解（6.3%），1 例为进展性疾病（1.2%）。所有读者的预测 CR 诊断准确性均为中等至良好，具有极好的阳性预测值（PPV）：mRECIST（3 位读者之间的范围，准确性：0.763-0.825，PPV：0.966-1）、LI-RADS TRA（准确性：0.700-0.825，PPV：0.983-1）和减影（准确性：0.775-0.825，PPV：0.967-1），各标准间的准确性无差异（p 值范围为 0.053 至＞0.9）。
放射性肝段切除术后早期获得的 mRECIST、LI-RADS TRA 和减影显示出相似的性能，可预测 HCC 患者接受放射性肝段切除术治疗后的长期反应。
放射性肝段切除术后早期 MRI 上的反应评估对预测 HCC 患者的完全缓解具有高阳性预测值（≥0.96）。
早期治疗后 MRI 上的反应评估可预测接受钇-90 放射性肝段切除术治疗的 HCC 患者的反应，其准确性为中等至良好，阳性预测值极高（≥0.96）。
mRECIST、LI-RADS 和减影预测 HCC 对放射性肝段切除术反应的诊断准确性无差异。
