title: mRECIST criteria and contrast-enhanced US for the assessment of the response of hepatocellular carcinoma to transarterial chemoembolization.
abstract: OBJECTIVE
  We aimed to evaluate the combination of the modified Response Evaluation Criteria In Solid Tumors (mRECIST) and contrast-enhanced ultrasonography (CEUS) as a tool for the assessment of hepatocellular carcinoma treated with transarterial chemoembolization.
  
  
  METHODS
  Forty-seven hepatocellular carcinoma patients (80 target tumors suitable for mRECIST measurements) were studied. They were treated with scheduled transarterial chemoembolization with doxorubicin-eluting microspheres every 5-7 weeks. Imaging follow-up (performed one month after each transarterial chemoembolization) included a standard, contrast-enhanced modality (computed tomography [CT] in 12 patients or magnetic resonance imaging [MRI] in 35 patients) and CEUS. The study focused on response evaluation after the third transarterial chemoembolization. CEUS required a bolus injection of an echo-enhancer and imaging with a dedicated, low mechanical index technique. The longest diameters of the enhancing target tumors were measured on the CEUS or CT/MRI, and mRECIST criteria were applied. Radiologic responses were correlated with overall survival and time to progression.
  
  
  RESULTS
  The measurements of longest diameters of the enhancing target tumors were easily performed in all patients. According to mRECIST-CEUS and mRECIST-CT/MRI, complete response was recorded in five and six patients, partial response in 22 and 21 patients, stable disease in 16 and 14 patients, and progressive disease in four and six patients, respectively. There was a high degree of concordance between CEUS and CT/MRI (kappa coefficient=0.84, P < 0.001). Responders (complete+partial response) according to mRECIST-CEUS had a significantly longer mean overall survival and time to progression compared to nonresponders (37.1 vs. 11.0 months, P < 0.001 and 24.6 vs. 10.9 months, P = 0.007, respectively).
  
  
  CONCLUSIONS
  The mRECIST-CEUS combination is feasible and has prognostic value in the assessment of hepatocellular carcinoma following transarterial chemoembolization.
authors: Departments of Radiology (H.M. e-mail: hipmosch@gmail.com, M.G.P., I.K.) and Urology (K.S.), General Hospital Tzanio, Piraeus, Greece; the 2nd Department of Radiology (K.M., K.C., N.K.), University of Athens, Attikon Hospital, Athens, Greece; the Department of Gynecology (A.A.), Liverpool Women's Hospital Crown Street, Liverpool, UK.
authors: Hippocrates
authors: H
authors: Moschouris
authors: Katerina
authors: K
authors: Malagari
authors: Marina G
authors: MG
authors: Papadaki
authors: Ioannis
authors: I
authors: Kornezos
authors: Konstantinos
authors: K
authors: Stamatiou
authors: Antonios
authors: A
authors: Anagnostopoulos
authors: Katerina
authors: K
authors: Chatzimichael
authors: Nikolaos
authors: N
authors: Kelekis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods; D003287:Contrast Media; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D066066:Response Evaluation Criteria in Solid Tumors; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods
chemical_list: D003287:Contrast Media