title: Perfusion reduction at transcatheter intraarterial perfusion MR imaging: a promising intraprocedural biomarker to predict transplant-free survival during chemoembolization of hepatocellular carcinoma.
abstract: OBJECTIVE
  To investigate the predictive value of transcatheter intraarterial perfusion (TRIP) magnetic resonance (MR) imaging-measured tumor perfusion changes during transarterial chemoembolization on transplant-free survival (TFS) in patients with unresectable hepatocellular carcinoma (HCC).
  
  
  METHODS
  This HIPAA-compliant prospective study was approved by the institutional review board. Written informed consent was obtained from all patients. Fifty-one consecutive adult patients with surgically unresectable single or multifocal measurable HCC and adequate laboratory parameters who underwent chemoembolization in a combined MR imaging-interventional radiology suite between February 2006 and June 2010 were studied. Tumor perfusion changes during chemoembolization were measured by using TRIP MR imaging with area under the time-signal intensity curve calculation. The end point of the study was TFS. The authors assessed the correlation between the percentage perfusion reduction in the tumor during chemoembolization and TFS by using univariate and multivariate analyses.
  
  
  RESULTS
  Fifty patients (mean age, 61 years; 39 men aged 42-87 years [mean age, 61 years] and 11 women aged 49-83 years [mean age, 62 years]) were eligible for the analysis. Patients with 35%-85% intraprocedural tumor area under the time-signal intensity curve reduction (n = 32) showed significantly improved median TFS compared with patients with an area under the time-signal intensity curve reduction outside this range (n = 18) (16.6 months [95% confidence interval: 11.2, 22.0 months] vs 9.3 months [95% confidence interval: 6.6, 12.0 months], respectively; P = .046; hazard ratio: 0.46; 95% confidence interval: 0.21, 1.00). The cumulative TFS rates in the 35%-85% and less than 35% or more than 85% perfusion reduction groups at 1, 2, and 5 years after chemoembolization were 66.4%, 42.2%, and 28.2% versus 33.8%, 16.9%, and 0%, respectively.
  
  
  CONCLUSIONS
  The study shows evidence of an association between intraprocedural tumor perfusion reduction during chemoembolization and TFS and suggests the utility of TRIP MR imaging- measured tumor perfusion reduction as an intraprocedural imaging biomarker during chemoembolization.
authors.affiliation: From the Departments of Radiology (D.W., B.J., R.J.L., A.R., K.M., R.K.R., K.T.S., A.C.L., R.S., R.A.O.), Hepatology (L.M.K.), and Medicine (M.F.M., R.S.), Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center (R.J.L., L.M.K., M.F.M., A.C.L., R.S., R.A.O.), and Biomedical Engineering Department, McCormick School of Engineering (A.C.L., R.A.O.), Northwestern University, Chicago, Ill; Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn (D.W.); and Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Ill (R.C.G.).
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: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Ahsun
authors.initials: A
authors.lastname: Riaz
authors.forename: Khairuddin
authors.initials: K
authors.lastname: Memon
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Kent T
authors.initials: KT
authors.lastname: Sato
authors.forename: Laura M
authors.initials: LM
authors.lastname: Kulik
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
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: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D000970:Antineoplastic Agents / Q000008:administration & dosage; D015415:Biomarkers; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000628:therapy*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D003287:Contrast Media; D019786:Gadolinium DTPA