title: Imaging predictors of the response to transarterial chemoembolization in patients with hepatocellular carcinoma: a radiological-pathological correlation.
abstract: Transarterial chemoembolization (TACE) is one of the standard therapies for bridging patients with hepatocellular carcinoma (HCC) to transplantation. This study was designed to determine which features on pre- and post-TACE imaging are associated with tumor necrosis in pathological specimens. Records of 105 patients with 132 HCC lesions who underwent liver transplantation after TACE were retrospectively reviewed. In 70% of the nodules, >90% necrosis was achieved. The development of >90% lesion necrosis upon pathological analysis was associated with avid lesion enhancement (P = 0.03) and the presence of a feeding vessel larger than 0.9 mm in diameter on the pre-TACE visceral angiogram (P = 0.01). Near-complete lesion necrosis was also associated with an extensive accumulation of ethiodized oil within a lesion during TACE administration (P = 0.04). On post-TACE computed tomography imaging, a lack of residual contrast enhancement (P < 0.0001), a decrease in the lesion size (P = 0.04), a high lesion density due to an accumulation of ethiodized oil (P = 0.03), and a diffuse distribution of ethiodized oil throughout the lesion (P = 0.0001) were also correlated with near-complete lesion necrosis upon pathological analysis. In conclusion, this study found multiple pre- and post-TACE imaging characteristics of HCC that were associated with near-complete tumor necrosis upon histopathological analysis after TACE. These findings may help to guide the selection of an optimal treatment strategy for bridging patients with HCC to liver transplantation.
authors.affiliation: Department of Radiology, University of Washington, Seattle, WA, USA.
authors.forename: Sharon W
authors.initials: SW
authors.lastname: Kwan
authors.forename: Nicholas
authors.initials: N
authors.lastname: Fidelman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ma
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kerlan
authors.forename: Francis Y
authors.initials: FY
authors.lastname: Yao
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D001706:Biopsy / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media