title: A comparison of chemoembolization endpoints using angiographic versus transcatheter intraarterial perfusion/MR imaging monitoring.
abstract: OBJECTIVE
  Transcatheter arterial chemoembolization (TACE) is an established treatment for unresectable liver cancer. This study was conducted to test the hypothesis that angiographic endpoints during TACE are measurable and reproducible by comparing subjective angiographic versus objective magnetic resonance (MR) endpoints of TACE.
  
  
  METHODS
  The study included 12 consecutive patients who presented for TACE for surgically unresectable HCC or progressive hepatic metastases despite chemotherapy. All procedures were performed with a dedicated imaging system. Angiographic series before and after TACE were reviewed independently by three board-certified interventional radiologists. A subjective angiographic chemoembolization endpoint (SACE) classification scheme, modified from an established angiographic grading system in the cardiology literature, was designed to assist in reproducibly classifying angiographic endpoints. Reproducibility in SACE classification level was compared among operators, and MR imaging perfusion reduction was compared with SACE levels for each observer.
  
  
  RESULTS
  Twelve patients successfully underwent 15 separate TACE sessions. SACE levels ranged from I through IV. There was moderate agreement in SACE classification (kappa = 0.46 +/- 0.12). There was no correlation between SACE level and MR perfusion reduction (r = 0.16 for one operator and 0.02 for the other two).
  
  
  CONCLUSIONS
  Angiographic endpoints during TACE vary widely, have moderate reproducibility among operators, and do not correlate with functional MR imaging perfusion endpoints. Future research should aim to determine ideal angiographic and functional MR imaging endpoints for TACE according to outcome measures such as imaging response, pathologic response, and survival.
authors.affiliation: Department of Radiology, Northwestern University, 676 North St. Clair Street, Suite 800, Chicago, Illinois 60611, USA. r-lewandowski@northwestern.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Dingxin
authors.initials: D
authors.lastname: Wang
authors.forename: James
authors.initials: J
authors.lastname: Gehl
authors.forename: Bassel
authors.initials: B
authors.lastname: Atassi
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Kent
authors.initials: K
authors.lastname: Sato
authors.forename: Albert A
authors.initials: AA
authors.lastname: Nemcek
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Laura
authors.initials: L
authors.lastname: Kulik
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Larson
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.forename: Reed A
authors.initials: RA
authors.lastname: Omary
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D016896:Treatment Outcome