Gadoxetic Acid Uptake Rate as a Measure of Global and Regional Liver Function as Compared With Indocyanine Green Retention, Albumin-Bilirubin Score, and Portal Venous Perfusion

Simeth, Josiah; Aryal, Madhava; Owen, Dawn; Cuneo, Kyle C.; Lawrence, Theodore S.; Cao, Yue

doi:10.1016/j.adro.2022.100942

Cited by 5 publications

(5 citation statements)

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“…There have been studies showing quantification of hepatobiliary agent uptake rate can be used as a direct measure of regional liver function. 17,29,[39][40][41][42] because hepatobiliary agents, such as the one used in this study, are taken up by the hepatocytes compared to other vascular contrast agents which are not taken up by the hepatocytes and thus not a direct analog to liver function. Binning of the input was performed.…”

Section: Ntcp Modeling and Calculationmentioning

confidence: 99%

“…Compared with SPECT images, MRI images in general have better resolution. Recent studies showed that DGAE MRI is significantly correlated with global liver function (ICGR, ALBI) 17–20 . There are also studies showing the significant correlation of patient outcome (change of global liver function) using DGAE MRI data 21–23 .…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies showed that DGAE MRI is significantly correlated with global liver function (ICGR, ALBI). [17][18][19][20] There are also studies showing the significant correlation of patient outcome (change of global liver function) using DGAE MRI data. [21][22][23] In addition, we developed a deep learning method to predict the voxel-by-voxel post-RT liver function (i.e., a conditional generative adversarial network [cGAN] with Wasserstein loss [cWGAN]), which could be useful in treatment planning for adaptive radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Deep learning prediction of post‐SBRT liver function changes and NTCP modeling in hepatocellular carcinoma based on DGAE‐MRI

et al. 2023

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BackgroundStereotactic body radiation therapy (SBRT) produces excellent local control for patients with hepatocellular carcinoma (HCC). However, the risk of toxicity for normal liver tissue is still a limiting factor. Normal tissue complication probability (NTCP) models have been proposed to estimate the toxicity with the assumption of uniform liver function distribution, which is not optimal. With more accurate regional liver functional imaging available for individual patient, we can improve the estimation and be more patient‐specific.PurposeTo develop normal tissue complication probability (NTCP) models using pre‐/during‐treatment (RT) dynamic Gadoxetic Acid‐enhanced (DGAE) MRI for adaptation of RT in a patient‐specific manner in hepatocellular cancer (HCC) patients who receive SBRT.Methods24 of 146 HCC patients who received SBRT underwent DGAE MRI. Physical doses were converted into EQD2 for analysis. Voxel‐by‐voxel quantification of the contrast uptake rate (k1) from DGAE‐MRI was used to quantify liver function. A logistic dose‐response model was used to estimate the fraction of liver functional loss, and NTCP was estimated using the cumulative functional reserve model for changes in Child‐Pugh (C‐P) scores. Model parameters were calculated using maximum‐likelihood estimations. During‐RT liver functional maps were predicted from dose distributions and pre‐RT k1 maps with a conditional Wasserstein generative adversarial network (cWGAN). Imaging prediction quality was assessed using root‐mean‐square error (RMSE) and structural similarity (SSIM) metrics. The dose‐response and NTCP were fit on both original and cWGAN predicted images and compared using a Wilcoxon signed‐rank test.ResultsLogistic dose response models for changes in k1 yielded D50 of 35.2 (95% CI: 26.7–47.5) Gy and k of 0.62 (0.49–0.75) for the whole population. The high baseline ALBI (poor liver function) subgroup showed a significantly smaller D50 of 11.7 (CI: 9.06–15.4) Gy and larger k of 0.96 (CI: 0.74–1.22) compared to a low baseline ALBI (good liver function) subgroup of 54.8 (CI: 38.3–79.1) Gy and 0.59 (CI: 0.48–0.74), with p‐values of < 0.001 and = 0.008, respectively, which indicates higher radiosensitivity for the worse baseline liver function cohort. Subset analyses were also performed for high/low baseline CP subgroups. The corresponding NTCP models showed good agreement for the fit parameters between cWGAN predicted and the ground‐truth during‐RT images with no statistical differences for low ALBI subgroup.ConclusionsNTCP models which incorporate voxel‐wise functional information from DGAE‐MRI k1 maps were successfully developed and feasibility was demonstrated in a small patient cohort. cWGAN predicted functional maps show promise for estimating localized patient‐specific response to RT and warrant further validation in a larger patient cohort.

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Section: Ntcp Modeling and Calculationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Deep learning prediction of post‐SBRT liver function changes and NTCP modeling in hepatocellular carcinoma based on DGAE‐MRI

et al. 2023

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“…1 and 2). 58,59 This is because, unlike patients with liver metastases, patients with HCC are unlikely to have uniform liver function, and this heterogeneity can be directly visualized with DGAE-MRI. In a study assessing 24 patients with HCC undergoing adaptive liver SBRT, it was reported that regional hepatic function loss after SBRT was associated with local radiation dose that was quantified with DGAE-MRI 60 .…”

Section: Toxicitymentioning

confidence: 99%

Evolution of Response-Based Radiotherapy for Hepatocellular Cancer

Elaimy,

Cao,

Lawrence

2023

Cancer J

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Stereotactic body radiation therapy has emerged as a safe and effective treatment modality for properly selected hepatocellular cancer (HCC) patients with normal liver function. However, many HCC patients have reduced baseline liver function due to underlying cirrhosis or prior liver-directed therapies. Therefore, because of the increased risk of hepatotoxicity, the use of stereotactic body radiation therapy for patients with reduced liver function has been approached with caution. Individualized, response-based radiotherapy incorporates models, imaging tools, and biomarkers that determine the dose-response relationship of the liver before, during, and after treatment and has been useful in reducing the likelihood of liver damage without sacrificing tumor control. This review discusses the evolution of response-based radiotherapy for HCC and highlights areas for further investigation.

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“…The hepatocyte uptake rate is the main descriptor of liver function and has been correlated with CP score in patients with cirrhosis as well as ICG-R15 measurements and GSA uptake in SPECT images [ 64 , 66 ]. However, for patients with poor liver function, the product of uptake rate and liver volume was found to be better correlated with ICG-R15 and ALBI scores than uptake rate alone [ 67 ].…”

Section: Functional Mri Of the Livermentioning

confidence: 99%

Role of Functional MRI in Liver SBRT: Current Use and Future Directions

Tadimalla

Wang

Haworth

2022

Cancers

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Stereotactic body radiation therapy (SBRT) is an emerging treatment for liver cancers whereby large doses of radiation can be delivered precisely to target lesions in 3–5 fractions. The target dose is limited by the dose that can be safely delivered to the non-tumour liver, which depends on the baseline liver functional reserve. Current liver SBRT guidelines assume uniform liver function in the non-tumour liver. However, the assumption of uniform liver function is false in liver disease due to the presence of cirrhosis, damage due to previous chemo- or ablative therapies or irradiation, and fatty liver disease. Anatomical information from magnetic resonance imaging (MRI) is increasingly being used for SBRT planning. While its current use is limited to the identification of target location and size, functional MRI techniques also offer the ability to quantify and spatially map liver tissue microstructure and function. This review summarises and discusses the advantages offered by functional MRI methods for SBRT treatment planning and the potential for adaptive SBRT workflows.

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Gadoxetic Acid Uptake Rate as a Measure of Global and Regional Liver Function as Compared With Indocyanine Green Retention, Albumin-Bilirubin Score, and Portal Venous Perfusion

Cited by 5 publications

References 39 publications

Deep learning prediction of post‐SBRT liver function changes and NTCP modeling in hepatocellular carcinoma based on DGAE‐MRI

Deep learning prediction of post‐SBRT liver function changes and NTCP modeling in hepatocellular carcinoma based on DGAE‐MRI

Evolution of Response-Based Radiotherapy for Hepatocellular Cancer

Role of Functional MRI in Liver SBRT: Current Use and Future Directions

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