title: Lobulated enhancement evaluation in the follow-up of liver metastases treated by stereotactic body radiation therapy.
abstract: OBJECTIVE
  The Response Evaluation Criteria in Solid Tumors (RECIST) can have limitations when used to evaluate local treatments for cancer, especially for liver malignancies treated by stereotactic body radiation therapy (SBRT). The aim of this study was to validate the relationship between the occurrence of lobulated enhancement (LE) and local relapse and to evaluate the utility of this relationship for predicting local progression.
  
  
  METHODS
  Imaging data of 59 lesions in 46 patients, including 281 computed tomographic (CT) scans, were retrospectively and blindly reviewed by 3 radiologists. One radiologist measured the lesion size, for each CT and overall, to classify responses using RECIST threshold criteria. The second studied LE occurrence. A third radiologist was later included and studied LE occurrence to evaluate the interobserver consistency for LE evaluation.
  
  
  RESULTS
  The mean duration of follow-up was 13.6 months. LE was observed in 16 of 18 progressive lesions, occurring before size-based progression in 50% of cases, and the median delay of LE detection was 3.2 months. The sensitivity of LE to predict progression was 89%, and its specificity was 100%. The positive predictive value was 100%, the negative predictive value was 95.3%, and the overall accuracy was 97%. The probability of local progression-free survival at 12 months was significantly higher for lesions without LE compared with all lesions: 0.80 (CI 95%: 0.65-0.89) versus 0.69 (CI 95%: 0.54-0.80), respectively. The overall concordance rate between the 2 readers of LE was 97.9%.
  
  
  CONCLUSIONS
  Response assessment of liver metastases treated by SBRT can be improved by including LE. This study demonstrates the diagnostic and predictive utility of LE for assessing local progression at a size still eligible for local salvage treatment.
authors.affiliation: Department of Radiology, Oscar Lambret Oncologic Center, Lille, France. Electronic address: h-jarraya@o-lambret.fr.
authors.forename: Hajer
authors.initials: H
authors.lastname: Jarraya
authors.affiliation: Department of Radiology, Oscar Lambret Oncologic Center, Lille, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Borde
authors.affiliation: Department of Radiotherapy, Oscar Lambret Oncologic Center, Lille, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Mirabel
authors.affiliation: Department of Body Imaging, Claude Huriez University Hospital, Lille, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Ernst
authors.affiliation: Department of Radiology, Oscar Lambret Oncologic Center, Lille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Boulanger
authors.affiliation: Department of Radiotherapy, Oscar Lambret Oncologic Center, Lille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Lartigau
authors.affiliation: Department of Radiology, Oscar Lambret Oncologic Center, Lille, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Ceugnart
authors.affiliation: Statistical Unit, Oscar Lambret Oncologic Center, Lille, France.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kramar
authors.affiliation: Department of Radiology, Oscar Lambret Oncologic Center, Lille, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Taieb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D015588:Observer Variation; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016879:Salvage Therapy; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D055815:Young Adult