title: Intraprocedural transcatheter intra-arterial perfusion MRI as a predictor of tumor response to chemoembolization for hepatocellular carcinoma.
abstract: OBJECTIVE
  To prospectively test the hypothesis that transcatheter intraarterial perfusion magnetic resonance imaging (TRIP-MRI) measured semiquantitative perfusion reductions during transcatheter arterial chemoembolization of hepatocellular carcinoma (HCC) are associated with tumor response.
  
  
  METHODS
  Twenty-eight patients (mean age 63 years; range 47-87 years) with 29 tumors underwent chemoembolization in a combined magnetic resonance interventional radiology suite. Intraprocedural tumor perfusion reductions during chemoembolization were monitored using TRIP-MRI. Pre- and postchemoembolization semiquantitative area under the time-signal enhancement curve (AUC) tumor perfusion was measured. Mean tumor perfusion pre- and postchemoembolization were compared using a paired t-test. Imaging follow-up was performed 1-3 months after chemoembolization. We studied the relationship between short-term tumor imaging response and intraprocedural perfusion reductions using univariate and multivariate analysis.
  
  
  RESULTS
  Intraprocedural AUC perfusion value decreased significantly after chemoembolization (342.1 vs. 158.6 arbitrary unit, P < .001). Twenty-six patients with 27 HCCs (n = 27) had follow-up imaging at mean 39 days postchemoembolization. Favorable response was present in 67% of these treated tumors according to necrosis criteria. Fifteen of 16 (94%) tumors with 25%-75% perfusion reductions showed necrosis treatment response compared to only 3 of 11 (27%) tumors with perfusion reductions outside the above range (P = .001). Multivariate logistic regression indicated that intraprocedural tumor perfusion reduction and Child-Pugh class were independent factors associated significantly with tumor response (P = .012 and .047, respectively).
  
  
  CONCLUSIONS
  TRIP-MRI can successfully measure semiquantitative changes in HCC perfusion during chemoembolization. Intraprocedural tumor perfusion reductions are associated with future tumor response.
authors.affiliation: Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
authors.forename: Dingxin
authors.initials: D
authors.lastname: Wang
authors.forename: Ron C
authors.initials: RC
authors.lastname: Gaba
authors.forename: Brian
authors.initials: B
authors.lastname: Jin
authors.forename: Ahsun
authors.initials: A
authors.lastname: Riaz
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Kent T
authors.initials: KT
authors.lastname: Sato
authors.forename: Ann B
authors.initials: AB
authors.lastname: Ragin
authors.forename: Laura M
authors.initials: LM
authors.lastname: Kulik
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Larson
authors.forename: Reed A
authors.initials: RA
authors.lastname: Omary
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy*; D002404:Catheterization / Q000379:methods; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome