title: Quantitative therapy response assessment by volumetric iodine-uptake measurement: initial experience in patients with advanced hepatocellular carcinoma treated with sorafenib.
abstract: OBJECTIVE
  To investigate the volumetric iodine-uptake (VIU) changes by dual-energy CT (DECT) in assessing the response to sorafenib treated hepatocellular carcinoma (HCC) patients, compared with AASLD (American Association for the Study of Liver Diseases) and Choi criteria.
  
  
  METHODS
  Fifteen patients with HCC receiving sorafenib, monitored with contrast-enhanced DECT scans at baseline and a minimum of one follow-up (8-12 weeks) were retrospectively evaluated. 30 target lesions in total were analyzed for tumor response according to VIU and adapted Choi criteria and compared with the standard AASLD.
  
  
  RESULTS
  According to AASLD criteria, 67% target lesions showed disease control: partial response (PR) in 3% and stable disease (SD) in 63%. 33% lesions progressed (PD). Disease control rate presented by VIU (60%) was similar to AASLD (67%) and Choi (63%) (P>0.05). For disease control group, change in mean VIU was from 149.5 ± 338.3mg to 108.5 ± 284.1mg (decreased 19.1 ± 42.9%); and for progressive disease group, change in mean VIU was from 163.7 ± 346.7 mg to 263.9 ± 537.2 mg (increased 230.5 ± 253.1%). Compared to AASLD (PR, 3%), VIU and Choi presented more PR (33% and 30%, respectively) in disease control group (P<0.05). VIU has moderate consistency with both AASLD (kappa=0.714; P<0.005) and Choi (kappa=0.648; P<0.005), while VIU showed a better consistency and correlation with AASLD (kappa=0.714; P<0.005; r=0.666, P<0.005) than Choi with AASLD (kappa=0.634, P<0.005; r=0.102, P=0.296).
  
  
  CONCLUSIONS
  VIU measurements by DECT can evaluate the disease control consistent with the current standard AASLD. Measurements are semi-automatic and therefore easy and robust to apply. As VIU reflects vital tumor burden in HCC, it is likely to be an optimal tumor response biomarker in HCC.
authors.affiliation: Department of Radiology, The First Affiliated Hospital of China Medical University, 155 Nanjingbei Street, Shenyang, 110001, China. daixudex@vip.sina.com
authors.forename: Xu
authors.initials: X
authors.lastname: Dai
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schlemmer
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schmidt
authors.forename: Karolin
authors.initials: K
authors.lastname: Höh
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.forename: Tom M
authors.initials: TM
authors.lastname: Ganten
authors.forename: Maria-Katharina
authors.initials: MK
authors.lastname: Ganten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000378:metabolism; D003287:Contrast Media / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007479:Iopamidol / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care / Q000379:methods; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D010865:Pilot Projects; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D000077157:Sorafenib; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D003287:Contrast Media; D010671:Phenylurea Compounds; C057937:iomeprol; D009536:Niacinamide; D000077157:Sorafenib; D007479:Iopamidol