title: Uveal Melanoma Metastatic to the Liver: The Role of Quantitative Volumetric Contrast-Enhanced MR Imaging in the Assessment of Early Tumor Response after Transarterial Chemoembolization.
abstract: OBJECTIVE
  To determine whether volumetric changes of enhancement as seen on contrast-enhanced magnetic resonance (MR) imaging can help assess early tumor response and predict survival in patients with metastatic uveal melanoma after one session of transarterial chemoembolization (TACE).
  
  
  METHODS
  Fifteen patients with 59 lesions who underwent MR imaging before and 3 to 4 weeks after the first TACE were retrospectively included. MR analysis evaluated signal intensities, World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), European Association for the Study of the Liver (EASL), modified RECIST (mRECIST), tumor volume [volumetric RECIST (vRECIST)], and volumetric tumor enhancement [quantitative EASL (qEASL)]. qEASL was expressed in cubic centimeters [qEASL (cm(3))] and as a percentage of the tumor volume [qEASL (%)]. Paired t test with its exact permutation distribution was used to compare measurements before and after TACE. The Kaplan-Meier method with the log-rank test was used to calculate overall survival for responders and non-responders.
  
  
  RESULTS
  In target lesions, mean qEASL (%) decreased from 63.9% to 42.6% (P = .016). No significant changes were observed using the other response criteria. In non-target lesions, mean WHO, RECIST, EASL, mRECIST, vRECIST, and qEASL (cm(3)) were significantly increased compared to baseline. qEASL (%) remained stable (P = .214). Median overall survival was 5.6 months. qEASL (cm(3)) was the only parameter that could predict survival based on target lesions (3.6 vs 40.5 months, P < .001) or overall (target and non-target lesions) response (4.4 vs 40.9 months, P = .001).
  
  
  CONCLUSIONS
  Volumetric tumor enhancement may be used as a surrogate biomarker for survival prediction in patients with uveal melanoma after the first TACE.
authors: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: jfg@jhmi.edu.
authors: Rafael
authors: R
authors: Duran
authors: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: j.chapiro@googlemail.com.
authors: Julius
authors: J
authors: Chapiro
authors: Ultrasound and Interventions, Philips Research North America, Briarcliff Manor, NY, USA. Electronic address: cfranga1@jhu.edu.
authors: Constantine
authors: C
authors: Frangakis
authors: Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: ming.lin@philips.com.
authors: MingDe
authors: M
authors: Lin
authors: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: tschlac1@jhmi.edu.
authors: Todd R
authors: TR
authors: Schlachter
authors: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: rschern1@jhmi.edu.
authors: Rüdiger E
authors: RE
authors: Schernthaner
authors: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: zwang58@jhmi.edu.
authors: Zhijun
authors: Z
authors: Wang
authors: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: lsavic1@jhmi.edu.
authors: Lynn J
authors: LJ
authors: Savic
authors: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: vaniatacher@gmail.com.
authors: Vania
authors: V
authors: Tacher
authors: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: ikamel@jhmi.edu.
authors: Ihab R
authors: IR
authors: Kamel
authors: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: jfg@jhmi.edu.
authors: Jean-François
authors: JF
authors: Geschwind