Unresectable hepatocellular carcinoma: MR imaging after intraarterial therapy. part i. identification and validation of volumetric functional response criteria

Susanne Bonekamp, Zhen Li, Jean François H Geschwind, Vivek Gowdra Halappa, Celia Corona Villalobos, Diane Reyes, Timothy M. Pawlik, David Bonekamp, John Eng, Ihab R Kamel

Research output: Contribution to journalArticle

Abstract

Purpose: To identify and validate the optimal thresholds for volumetric functional MR imaging response criteria to predict overall survival after intraarterial treatment (IAT) in patients with unresectable hepatocellular carcinoma (HCC). Materials and Methods: Institutional review board approval and waiver of informed consent were obtained. A total of 143 patients who had undergone MR imaging before and 3-4 weeks after the first cycle of IAT were included. MR imaging analysis of one representative HCC index lesion was performed with proprietary software after initial treatment. Subjects were randomly divided into training (n = 114 [79.7%]) and validation (n = 29 [20.3%]) data sets. Uni- and multivariate Cox models were used to determine the best cutoffs, as well as survival differences, between response groups in the validation data set. Results: Optimal cutoffs in the training data set were 23% increase in apparent diffusion coefficient (ADC) and 65% decrease in volumetric enhancement in the portal venous phase (VE). Subsequently, 25% increase in ADC and 65% decrease in VE were used to stratify patients in the validation data set. Comparison of ADC responders (n = 12 [58.6%]) with nonresponders (n = 17 [34.5%]) showed significant differences in survival (25th percentile survival, 11.2 vs 4.9 months, respectively; P = .008), as did VE responders (n = 9 [31.0%]) compared with nonresponders (n = 20 [69.0%]; 25th percentile survival, 11.5 vs 5.1 months, respectively; P = .01). Stratification of patients with a combination of the criteria resulted in significant differences in survival between patients with lesions that fulfilled both criteria (n = ±[20.7%]; too few cases to determine 25th percentile), one criterion (n = 9 [31.0%]; 25th percentile survival, 6.0 months), and neither criterion (n = 14 [48.3%]; 25th percentile survival, 5.1 months; P = .01). The association between the two criteria and overall survival remained significant in a multiv.

Original languageEnglish (US)
Pages (from-to)420-430
Number of pages11
JournalRadiology
Volume268
Issue number2
DOIs
StatePublished - Aug 2013
Externally publishedYes

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Hepatocellular Carcinoma
Survival
Therapeutics
Research Ethics Committees
Informed Consent
Proportional Hazards Models
Software
Datasets

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Unresectable hepatocellular carcinoma : MR imaging after intraarterial therapy. part i. identification and validation of volumetric functional response criteria. / Bonekamp, Susanne; Li, Zhen; Geschwind, Jean François H; Halappa, Vivek Gowdra; Corona Villalobos, Celia; Reyes, Diane; Pawlik, Timothy M.; Bonekamp, David; Eng, John; Kamel, Ihab R.

In: Radiology, Vol. 268, No. 2, 08.2013, p. 420-430.

Research output: Contribution to journalArticle

Bonekamp, Susanne ; Li, Zhen ; Geschwind, Jean François H ; Halappa, Vivek Gowdra ; Corona Villalobos, Celia ; Reyes, Diane ; Pawlik, Timothy M. ; Bonekamp, David ; Eng, John ; Kamel, Ihab R. / Unresectable hepatocellular carcinoma : MR imaging after intraarterial therapy. part i. identification and validation of volumetric functional response criteria. In: Radiology. 2013 ; Vol. 268, No. 2. pp. 420-430.
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abstract = "Purpose: To identify and validate the optimal thresholds for volumetric functional MR imaging response criteria to predict overall survival after intraarterial treatment (IAT) in patients with unresectable hepatocellular carcinoma (HCC). Materials and Methods: Institutional review board approval and waiver of informed consent were obtained. A total of 143 patients who had undergone MR imaging before and 3-4 weeks after the first cycle of IAT were included. MR imaging analysis of one representative HCC index lesion was performed with proprietary software after initial treatment. Subjects were randomly divided into training (n = 114 [79.7{\%}]) and validation (n = 29 [20.3{\%}]) data sets. Uni- and multivariate Cox models were used to determine the best cutoffs, as well as survival differences, between response groups in the validation data set. Results: Optimal cutoffs in the training data set were 23{\%} increase in apparent diffusion coefficient (ADC) and 65{\%} decrease in volumetric enhancement in the portal venous phase (VE). Subsequently, 25{\%} increase in ADC and 65{\%} decrease in VE were used to stratify patients in the validation data set. Comparison of ADC responders (n = 12 [58.6{\%}]) with nonresponders (n = 17 [34.5{\%}]) showed significant differences in survival (25th percentile survival, 11.2 vs 4.9 months, respectively; P = .008), as did VE responders (n = 9 [31.0{\%}]) compared with nonresponders (n = 20 [69.0{\%}]; 25th percentile survival, 11.5 vs 5.1 months, respectively; P = .01). Stratification of patients with a combination of the criteria resulted in significant differences in survival between patients with lesions that fulfilled both criteria (n = ±[20.7{\%}]; too few cases to determine 25th percentile), one criterion (n = 9 [31.0{\%}]; 25th percentile survival, 6.0 months), and neither criterion (n = 14 [48.3{\%}]; 25th percentile survival, 5.1 months; P = .01). The association between the two criteria and overall survival remained significant in a multiv.",
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T2 - MR imaging after intraarterial therapy. part i. identification and validation of volumetric functional response criteria

AU - Bonekamp, Susanne

AU - Li, Zhen

AU - Geschwind, Jean François H

AU - Halappa, Vivek Gowdra

AU - Corona Villalobos, Celia

AU - Reyes, Diane

AU - Pawlik, Timothy M.

AU - Bonekamp, David

AU - Eng, John

AU - Kamel, Ihab R

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N2 - Purpose: To identify and validate the optimal thresholds for volumetric functional MR imaging response criteria to predict overall survival after intraarterial treatment (IAT) in patients with unresectable hepatocellular carcinoma (HCC). Materials and Methods: Institutional review board approval and waiver of informed consent were obtained. A total of 143 patients who had undergone MR imaging before and 3-4 weeks after the first cycle of IAT were included. MR imaging analysis of one representative HCC index lesion was performed with proprietary software after initial treatment. Subjects were randomly divided into training (n = 114 [79.7%]) and validation (n = 29 [20.3%]) data sets. Uni- and multivariate Cox models were used to determine the best cutoffs, as well as survival differences, between response groups in the validation data set. Results: Optimal cutoffs in the training data set were 23% increase in apparent diffusion coefficient (ADC) and 65% decrease in volumetric enhancement in the portal venous phase (VE). Subsequently, 25% increase in ADC and 65% decrease in VE were used to stratify patients in the validation data set. Comparison of ADC responders (n = 12 [58.6%]) with nonresponders (n = 17 [34.5%]) showed significant differences in survival (25th percentile survival, 11.2 vs 4.9 months, respectively; P = .008), as did VE responders (n = 9 [31.0%]) compared with nonresponders (n = 20 [69.0%]; 25th percentile survival, 11.5 vs 5.1 months, respectively; P = .01). Stratification of patients with a combination of the criteria resulted in significant differences in survival between patients with lesions that fulfilled both criteria (n = ±[20.7%]; too few cases to determine 25th percentile), one criterion (n = 9 [31.0%]; 25th percentile survival, 6.0 months), and neither criterion (n = 14 [48.3%]; 25th percentile survival, 5.1 months; P = .01). The association between the two criteria and overall survival remained significant in a multiv.

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