Automated feature quantification of Lipiodol as imaging biomarker to predict therapeutic efficacy of conventional transarterial chemoembolization of liver cancer

Abstract

Conventional transarterial chemoembolization (cTACE) is a guideline-approved image-guided therapy option for liver cancer using the radiopaque drug-carrier and micro-embolic agent Lipiodol, which has been previously established as an imaging biomarker for tumor response. To establish automated quantitative and pattern-based image analysis techniques of Lipiodol deposition on 24 h post-cTACE CT as biomarker for treatment response. The density of Lipiodol deposits in 65 liver lesions was automatically quantified using Hounsfield Unit thresholds. Lipiodol deposition within the tumor was automatically assessed for patterns including homogeneity, sparsity, rim, and peripheral deposition. Lipiodol deposition was correlated with enhancing tumor volume (ETV) on baseline and follow-up MRI. ETV on baseline MRI strongly correlated with Lipiodol deposition on 24 h CT (p < 0.0001), with 8.22% ± 14.59 more Lipiodol in viable than necrotic tumor areas. On follow-up, tumor regions with Lipiodol showed higher rates of ETV reduction than areas without Lipiodol (p = 0.0475) and increasing densities of Lipiodol enhanced this effect. Also, homogeneous (p = 0.0006), non-sparse (p < 0.0001), rim deposition within sparse tumors (p = 0.045), and peripheral deposition (p < 0.0001) of Lipiodol showed improved response. This technical innovation study showed that an automated threshold-based volumetric feature characterization of Lipiodol deposits is feasible and enables practical use of Lipiodol as imaging biomarker for therapeutic efficacy after cTACE.

Parthenolide induces rapid thiol oxidation that leads to ferroptosis in hepatocellular carcinoma cells

“…This unique characteristic of PTL may benefit patients with HCC, as the majority of patients are not eligible for curative systematic treatment and require unique options such as trans-arterial chemoembolization (TACE). TACE allows for the delivery of therapeutic treatment directly to the tumor with minimal side effects by avoiding systemic metabolism ( de Baere et al, 2016 ; Stark et al, 2020 ). TACE can result in a 60 percent response rate sustained for 6 months or longer ( Llovet and Bruix, 2003 ; Zhang et al, 2018 ).…”

Study on the changes of CT texture parameters before and after HCC treatment in the efficacy evaluation and survival predication of patients with HCC

“…In this study, we performed some experimental explorations for processing lipiodol deposition in CT images after c-TACE and finally chose to eliminate the effect of lipiodol deposition. Although the morphology of lipiodol deposition and its proportion to the volume of the lesion can provide valuable diagnostic information ( 34 ), as the CT value of lipiodol is much higher than that of the lesion, high-density lipiodol affects many of the grayscale histogram parameters when the lipiodol and the lesion are subjected to texture analysis at the same time. The deposition of lipiodol may be flakes or scattered spots, and it is difficult to distinguish lipiodol deposition from lesion enhancement and blood vessels with the naked eye, making it difficult to manually remove lipiodol deposition when delineating the ROIs.…”

“…Although the deposition of lipiodol is not directly related to its efficacy, it is of great value in clinical diagnosis and development of follow-up treatment plans. CT is more commonly used in the whole process of TACE treatment of HCC, and has many advantages, such as: measuring lesion volume and liver volume, displaying tumor blood supply artery morphology and variation, three-dimensional reconstruction to find ectopic blood supply, discovering hepatic artery-portal vein or hepatic vein fistula, evaluation of tumor bone and lung metastasis, and observation of lipiodol deposition (34)(35)(36)(37)(38). The short appointment time and few restrictions on examination also give CT examination unique advantages in the follow-up review of lipiodol TACE.…”

Cerebral lipiodol embolisation

“…There is an increased lipiodol density in liver tumours that have a higher proportion of necrosis; those with a CT density of >241 Hounsfield units (HU) have necrosis in 84% of voxels, compared with 71% for those with CT density of 84–154 HU 5. Case reports of cerebral embolisation have not quantified a specific density on CT scanning, although the changes are high density and disseminated, mainly involving the grey matter of the cerebral hemispheres, cerebellum, brainstem and thalamus 2 6.…”