Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Saturday, 10 / 24 / 2020

Articles

ORIGINAL ARTICLE

Predicting Infiltrative Hepatocellular Carcinoma Patient Outcome Post-TACE: MR Bias Field Correction Effect on 3D-quantitative Image Analysis

Cuihong Liu1,2 , Susanne Smolka2,3Xenophon Papademetris4, Duc Do Minh2,3, Geliang Gan5Yanhong Deng5, MingDe Lin2, Julius Chapiro2,*, Ximing Wang*,6,7, Christos Georgiades8and Kelvin Hong8

1  Department of Ultrasound Diagnosis and Treatment, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
2  Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
3  Department of Diagnostic and Interventional Radiology, Charité University Hospital, Berlin, Germany
4  Department of Biomedical Engineering, Yale University, New Haven, CT, USA
5  School of Public Health, Yale University, New Haven, CT, USA
6  Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
7  Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
8  Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA
*Correspondence to: Julius Chapiro, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA. Tel: +1-203-343-7457, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ; Ximing Wang, Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, Shandong 250021, China. Tel: +86-151-6888-7762, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2020;8(3):292-298 DOI: 10.14218/JCTH.2020.00054
Received:June 13, 2020 Accepted: July 20, 2020 Published online: August 18, 2020

Abstract

Background and Aims: To investigate the impact of MR bias field correction on response determination and survival prediction using volumetric tumor enhancement analysis in patients with infiltrative hepatocellular carcinoma, after transcatheter arterial chemoembolization (TACE).

Methods: This study included 101 patients treated with conventional or drug-eluting beads TACE between the years of 2001 and 2013. Semi-automated 3D quantification software was used to segment and calculate the enhancing tumor volume (ETV) of the liver with and without bias-field correction on multi-phasic contrast-enhanced MRI before and 1-month after initial TACE. ETV (expressed as cm3) at baseline imaging and the relative change in ETV (as % change, ETV%) before and after TACE were used to predict response and survival, respectively. Statistical survival analyses included Kaplan-Meier curve generation and Cox proportional hazards modeling. Q statistics were calculated and used to identify the best cut-off value for ETV to separate responders and non-responders (ETV cm3). The difference in survival was evaluated between responders and non-responders using Kaplan-Meier and Cox models.

Results: MR bias field correction correlated with improved response calculation from baseline MR as well as survival after TACE; using a 415 cm3 cut-off for ETV at baseline (hazard ratio: 2.00, 95% confidence interval: 1.23-3.26, p=0.01) resulted in significantly improved response prediction (median survival in patients with baseline ETV <415 cm3: 19.66 months vs. ≥415 cm3: 9.21 months, p<0.001, log-rank test). A ≥41% relative decrease in ETV (hazard ratio: 0.58, 95%confidence interval: 0.37-0.93, p=0.02) was significant in predicting survival (ETV ≥41%: 19.20 months vs. ETV <41%: 8.71 months, p=0.008, log-rank test). Without MR bias field correction, response from baseline ETV could be predicted but survival after TACE could not.

Conclusions: MR bias field correction improves both response assessment and accuracy of survival prediction using whole liver tumor enhancement analysis from baseline MR after initial TACE in patients with infiltrative hepatocellular carcinoma.

Keywords

3D volume measurement, Infiltrative HCC, TACE, Segmentation, Bias field correction

Journal of Clinical and Translational Hepatology 2020 vol. 8, 292-298  [ Html  ] [ PDF Full-text ]

© The Authors 2020. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

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