Response assessment of hepatocellular carcinoma treated with yttrium-90 radioembolization: inter-reader variability, comparison with 3D quantitative approach, and role in the prediction of clinical outcomes

King, Michael; Tong, Angela; Dane, Bari; Huang, Chenchan; Zhan, Chenyang; Shanbhogue, Krishna

doi:10.1016/j.ejrad.2020.109351

Cited by 10 publications

(24 citation statements)

References 43 publications

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“…King et al reported lower inter-reader agreement for LR-TR categories and a higher frequency of TR-Equivocal categorization on early (4–6 weeks) versus late (6–9 months) post-treatment imaging in patients undergoing radioembolization with Y-90. 36 It is not uncommon for observations treated with these modalities to manifest a transient increase in size and/or in enhancement on imaging performed in the first 3–6 months, which may be misinterpreted as viable residual tumor. 37 Although the LR-TRA may be applied to observations treated with radiation-based therapies, this should be done with caution.…”

Section: The Role and Value Of Ct/mri Li-radsmentioning

confidence: 99%

Up-to-Date Role of CT/MRI LI-RADS in Hepatocellular Carcinoma

Cunha¹,

Chernyak²,

Fowler³

et al. 2021

JHC

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Hepatocellular carcinoma (HCC) is a leading cause of mortality worldwide and a major healthcare burden in most societies. Computed tomography (CT) and magnetic resonance imaging (MRI) play a pivotal role in the medical care of patients with or at risk for hepatocellular carcinoma (HCC). When stringent imaging criteria are fulfilled, CT and MRI allow for diagnosis, staging, and assessment of response to treatment, without the need for invasive workup, and can inform clinical decision making. Owing to the central role of these imaging modalities in HCC management, standardization is essential to facilitate proper imaging technique, accurate interpretation, and clear communication among all stakeholders in both the clinical practice and research settings. The Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system that provides standardization across the continuum of HCC imaging, including ordinal probabilistic approach for reporting that directs individualized management. This review discusses the up-to-date role of CT and MRI in HCC imaging from the LI-RADS perspective. It also provides a glimpse into the future by discussing how advances in knowledge and technology are likely to enrich the LI-RADS approach.

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Section: The Role and Value Of Ct/mri Li-radsmentioning

confidence: 99%

Up-to-Date Role of CT/MRI LI-RADS in Hepatocellular Carcinoma

Cunha¹,

Chernyak²,

Fowler³

et al. 2021

JHC

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“…Previous studies have emphasized the challenge of assessing HCC response post TARE [8,24], with poor to moderate inter-reader agreement using mRECIST or LI-RADS-TR in one study [19]. King et al showed a correlation between mRECIST, qEASL (3D measurement of the lesion), and LI-RADS-TR criteria and percentage of necrosis at pathology [19]. Additional imaging features including rim enhancement, lack of hepatocytespecific contrast uptake, T2-hyperintensity, and plateau or persistent enhancement were described as having potential added value to classic criteria of response assessment [8,24].…”

Section: Introductionmentioning

confidence: 96%

“…The assessment of the degree of necrosis is of particular interest as it determines tumor viability. Published data on pathologic correlation in patients with HCC treated with TARE is limited (9-35 patients) [8,19,[24][25][26]. Previous studies have emphasized the challenge of assessing HCC response post TARE [8,24], with poor to moderate inter-reader agreement using mRECIST or LI-RADS-TR in one study [19].…”

Section: Introductionmentioning

confidence: 99%

“…Traditional criteria for response to therapy assessment such as the Response Evaluation Criteria in Solid Tumor (RECIST) have been adapted in order to achieve a more accurate evaluation of lesions after LRT. As such, the European Association for the Study of Liver (EASL) criteria and the modified RECIST criteria (mRECIST) that only assess the viable tumor portion instead of the whole lesion have been adapted to LRT assessment [17][18][19][20]. In addition, the use of post-contrast image subtraction with MRI has been shown to be useful for tumor necrosis assessment [21][22][23].…”

Section: Introductionmentioning

confidence: 99%

“…Published data on pathologic correlation in patients with HCC treated with TARE is limited (9-35 patients) [8,19,[24][25][26]. Previous studies have emphasized the challenge of assessing HCC response post TARE [8,24], with poor to moderate inter-reader agreement using mRECIST or LI-RADS-TR in one study [19]. King et al showed a correlation between mRECIST, qEASL (3D measurement of the lesion), and LI-RADS-TR criteria and percentage of necrosis at pathology [19].…”

Section: Introductionmentioning

confidence: 99%

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Assessment of HCC response to Yttrium-90 radioembolization with gadoxetate disodium MRI: correlation with histopathology

et al. 2022

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Background and aims Transarterial 90 Y radioembolization (TARE) is increasingly being used for hepatocellular carcinoma (HCC) treatment. However, tumor response assessment after TARE may be challenging. We aimed to assess the diagnostic performance of gadoxetate disodium MRI for predicting complete pathologic necrosis (CPN) of HCC treated with TARE, using histopathology as the reference standard. Methods This retrospective study included 48 patients (M/F: 36/12, mean age: 62 years) with HCC treated by TARE followed by surgery with gadoxetate disodium MRI within 90 days of surgery. Two radiologists evaluated tumor response using RECIST1.1, mRECIST, EASL, and LI-RADS-TR criteria and evaluated the percentage of necrosis on subtraction during late arterial, portal venous, and hepatobiliary phases (AP/PVP/HBP). Statistical analysis included inter-reader agreement, correlation between radiologic and pathologic percentage of necrosis, and prediction of CPN using logistic regression and ROC analyses. Results Histopathology demonstrated 71 HCCs (2.8 ± 1.7 cm, range: 0.5-7.5 cm) including 42 with CPN, 22 with partial necrosis, and 7 without necrosis. EASL and percentage of tumor necrosis on subtraction at the AP/PVP were independent predictors of CPN (p = 0.02-0.03). Percentage of necrosis, mRECIST, EASL, and LI-RADS-TR had fair to good performance for diagnosing CPN (AUCs: 0.78 -0.83), with a significant difference between subtraction and LI-RADS-TR for reader 2, and in specificity between subtraction and other criteria for both readers (p-range: 0.01-0.04). Radiologic percentage of necrosis was significantly correlated to histopathologic degree of tumor necrosis (r = 0.66 -0.8, p < 0.001). Conclusions Percentage of tumor necrosis on subtraction and EASL criteria were significant independent predictors of CPN in HCC treated with TARE. Image subtraction should be considered for assessing HCC response to TARE when using MRI. Key Points• Percentage of tumor necrosis on image subtraction and EASL criteria are significant independent predictors of complete pathologic necrosis in hepatocellular carcinoma treated with 90 Y radioembolization. • Subtraction, mRECIST, EASL, and LI-RADS-TR have fair to good performance for diagnosing complete pathologic necrosis in hepatocellular carcinoma treated with 90 Y radioembolization.

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Updates on LI‐RADS Treatment Response Criteria for Hepatocellular Carcinoma: Focusing on MRI

Patel

Aslam

Parikh

et al. 2023

Magnetic Resonance Imaging

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As the incidence of hepatocellular carcinoma (HCC) and subsequent treatments with liver‐directed therapies rise, the complexity of assessing lesion response has also increased. The Liver Imaging Reporting and Data Systems (LI‐RADS) treatment response algorithm (LI‐RADS TRA) was created to standardize the assessment of response after locoregional therapy (LRT) on contrast‐enhanced CT or MRI. Originally created based on expert opinion, these guidelines are currently undergoing revision based on emerging evidence. While many studies support the use of LR‐TRA for evaluation of HCC response after thermal ablation and intra‐arterial embolic therapy, data suggest a need for refinements to improve assessment after radiation therapy. In this manuscript, we review expected MR imaging findings after different forms of LRT, clarify how to apply the current LI‐RADS TRA by type of LRT, explore emerging literature on LI‐RADS TRA, and highlight future updates to the algorithm. Evidence Level 3. Technical Efficacy Stage 2.

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Response assessment of hepatocellular carcinoma treated with yttrium-90 radioembolization: inter-reader variability, comparison with 3D quantitative approach, and role in the prediction of clinical outcomes

Cited by 10 publications

References 43 publications

Up-to-Date Role of CT/MRI LI-RADS in Hepatocellular Carcinoma

Up-to-Date Role of CT/MRI LI-RADS in Hepatocellular Carcinoma

Assessment of HCC response to Yttrium-90 radioembolization with gadoxetate disodium MRI: correlation with histopathology

Updates on LI‐RADS Treatment Response Criteria for Hepatocellular Carcinoma: Focusing on MRI

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