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Angiosomal radiopathologic analysis of transarterial radioembolization for the treatment of hepatocellular carcinoma
Purpose To assess the radiopathologic correlation following Yttrium-90 transarterial radioembolization (TARE) of hepatocellular carcinoma (HCC) using variable radiodosimetry to identify imaging surrogates of histologic response. Methods Twelve patients with HCC underwent ablative (≥ 190 Gy) and/or n...
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| Published in: | Abdominal imaging 2018-07, Vol.43 (7), p.1825-1836 |
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| container_title | Abdominal imaging |
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| creator | Ahmed, Altan F. Samreen, Naziya Grajo, Joseph R. Zendejas, Ivan Sistrom, Chris L. Collinsworth, Amy Esnakula, Ashwini Shah, Jehan L. Cabrera, Roniel Geller, Brian S. Toskich, Beau B. |
| description | Purpose
To assess the radiopathologic correlation following Yttrium-90 transarterial radioembolization (TARE) of hepatocellular carcinoma (HCC) using variable radiodosimetry to identify imaging surrogates of histologic response.
Methods
Twelve patients with HCC underwent ablative (≥ 190 Gy) and/or non-ablative ( |
| doi_str_mv | 10.1007/s00261-017-1354-6 |
| format | article |
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To assess the radiopathologic correlation following Yttrium-90 transarterial radioembolization (TARE) of hepatocellular carcinoma (HCC) using variable radiodosimetry to identify imaging surrogates of histologic response.
Methods
Twelve patients with HCC underwent ablative (≥ 190 Gy) and/or non-ablative (< 190 Gy) TARE delivered in a segmental, lobar, or combined fashion as a surgical neoadjuvant or bridge to transplantation. Both targeted tumor and treatment angiosome were analyzed before and after TARE utilizing hepatocyte-specific contrast-enhanced MRI or contrast-enhanced CT. Responses were graded using EASL and mRECIST criteria. Histologic findings including percent tumor necrosis and adjacent hepatic substrate effects were correlated with imaging features.
Results
Complete pathologic necrosis (CPN) was observed in 7/12 tumors post-TARE. Ablative and non-ablative dosing resulted in CPN in 5/6 and 2/6 tumors, respectively. Hyperintensity on T2-weighted imaging, the absence of hepatocyte-specific gadolinium contrast uptake, and plateau or persistent enhancement kinetics in the angiosome correlated with CPN and performed similarly to EASL and mRECIST criteria in predicting CPN.
Conclusions
The absence of hepatocyte-specific contrast uptake, increased signal on T2-weighted sequences, and plateau or persistent enhancement in the angiosome may represent MRI surrogates of CPN following TARE of HCC. These findings correlated with EASL and mRECIST response criteria. Further investigation is needed to determine the role of these findings as possible adjuncts to conventional imaging criteria.</description><identifier>ISSN: 2366-004X</identifier><identifier>EISSN: 2366-0058</identifier><identifier>DOI: 10.1007/s00261-017-1354-6</identifier><identifier>PMID: 29052747</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Ablation ; Computed tomography ; Correlation ; Criteria ; Gadolinium ; Gangrene ; Gastroenterology ; Hepatocellular carcinoma ; Hepatology ; Imaging ; Kinetics ; Liver cancer ; Magnetic resonance imaging ; Medical imaging ; Medicine ; Medicine & Public Health ; Necrosis ; Radiology ; Substrates ; Surgery ; Transplantation ; Tumors ; Yttrium ; Yttrium isotopes</subject><ispartof>Abdominal imaging, 2018-07, Vol.43 (7), p.1825-1836</ispartof><rights>Springer Science+Business Media, LLC 2017</rights><rights>Abdominal Radiology is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-50c3a0c96eeefd3e3178fa47787db8155e18b35afc50c5c98e1551b31353f7573</citedby><cites>FETCH-LOGICAL-c372t-50c3a0c96eeefd3e3178fa47787db8155e18b35afc50c5c98e1551b31353f7573</cites><orcidid>0000-0002-9704-2447 ; 0000-0002-3193-9737 ; 0000-0002-8452-2601 ; 0000-0002-7566-7913 ; 0000-0003-2762-0130</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29052747$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ahmed, Altan F.</creatorcontrib><creatorcontrib>Samreen, Naziya</creatorcontrib><creatorcontrib>Grajo, Joseph R.</creatorcontrib><creatorcontrib>Zendejas, Ivan</creatorcontrib><creatorcontrib>Sistrom, Chris L.</creatorcontrib><creatorcontrib>Collinsworth, Amy</creatorcontrib><creatorcontrib>Esnakula, Ashwini</creatorcontrib><creatorcontrib>Shah, Jehan L.</creatorcontrib><creatorcontrib>Cabrera, Roniel</creatorcontrib><creatorcontrib>Geller, Brian S.</creatorcontrib><creatorcontrib>Toskich, Beau B.</creatorcontrib><title>Angiosomal radiopathologic analysis of transarterial radioembolization for the treatment of hepatocellular carcinoma</title><title>Abdominal imaging</title><addtitle>Abdom Radiol</addtitle><addtitle>Abdom Radiol (NY)</addtitle><description>Purpose
To assess the radiopathologic correlation following Yttrium-90 transarterial radioembolization (TARE) of hepatocellular carcinoma (HCC) using variable radiodosimetry to identify imaging surrogates of histologic response.
Methods
Twelve patients with HCC underwent ablative (≥ 190 Gy) and/or non-ablative (< 190 Gy) TARE delivered in a segmental, lobar, or combined fashion as a surgical neoadjuvant or bridge to transplantation. Both targeted tumor and treatment angiosome were analyzed before and after TARE utilizing hepatocyte-specific contrast-enhanced MRI or contrast-enhanced CT. Responses were graded using EASL and mRECIST criteria. Histologic findings including percent tumor necrosis and adjacent hepatic substrate effects were correlated with imaging features.
Results
Complete pathologic necrosis (CPN) was observed in 7/12 tumors post-TARE. Ablative and non-ablative dosing resulted in CPN in 5/6 and 2/6 tumors, respectively. Hyperintensity on T2-weighted imaging, the absence of hepatocyte-specific gadolinium contrast uptake, and plateau or persistent enhancement kinetics in the angiosome correlated with CPN and performed similarly to EASL and mRECIST criteria in predicting CPN.
Conclusions
The absence of hepatocyte-specific contrast uptake, increased signal on T2-weighted sequences, and plateau or persistent enhancement in the angiosome may represent MRI surrogates of CPN following TARE of HCC. These findings correlated with EASL and mRECIST response criteria. Further investigation is needed to determine the role of these findings as possible adjuncts to conventional imaging criteria.</description><subject>Ablation</subject><subject>Computed tomography</subject><subject>Correlation</subject><subject>Criteria</subject><subject>Gadolinium</subject><subject>Gangrene</subject><subject>Gastroenterology</subject><subject>Hepatocellular carcinoma</subject><subject>Hepatology</subject><subject>Imaging</subject><subject>Kinetics</subject><subject>Liver cancer</subject><subject>Magnetic resonance imaging</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Necrosis</subject><subject>Radiology</subject><subject>Substrates</subject><subject>Surgery</subject><subject>Transplantation</subject><subject>Tumors</subject><subject>Yttrium</subject><subject>Yttrium isotopes</subject><issn>2366-004X</issn><issn>2366-0058</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kcFq3DAURUVpSIYkH5BNMXTTjZsny5Ls5RDaJBDoJoHsxLPmeUbBtqaSvJh-Tb-lXxYNk0yh0JWEdO59j3sZu-LwlQPo6whQKV4C1yUXsi7VB7aohFIlgGw-Hu_18xm7jPEFALiSnFfylJ1VLchK13rB5uW0dj76EYci4Mr5LaaNH_za2QInHHbRxcL3RQo4RQyJgnsnaez84H5hcn7687v3oUgbyiBhGmlKe9WGsp23NAzzgKGwGKyb8qwLdtLjEOny7TxnT9-_Pd7clQ8_bu9vlg-lFbpKpQQrEGyriKhfCRJcNz3WWjd61TVcSuJNJyT2NpPStg3lN96JnIfotdTinH05-G6D_zlTTGZ0cb8OTuTnaHgra9AASmb08z_oi59DTiCaCpSWbU6vyRQ_UDb4GAP1ZhvciGFnOJh9LeZQi8m1mH0tRmXNpzfnuRtpdVS8l5CB6gDE_DWtKfwd_X_XV78xmqI</recordid><startdate>20180701</startdate><enddate>20180701</enddate><creator>Ahmed, Altan F.</creator><creator>Samreen, Naziya</creator><creator>Grajo, Joseph R.</creator><creator>Zendejas, Ivan</creator><creator>Sistrom, Chris L.</creator><creator>Collinsworth, Amy</creator><creator>Esnakula, Ashwini</creator><creator>Shah, Jehan L.</creator><creator>Cabrera, Roniel</creator><creator>Geller, Brian S.</creator><creator>Toskich, Beau B.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>JQ2</scope><scope>K7-</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9704-2447</orcidid><orcidid>https://orcid.org/0000-0002-3193-9737</orcidid><orcidid>https://orcid.org/0000-0002-8452-2601</orcidid><orcidid>https://orcid.org/0000-0002-7566-7913</orcidid><orcidid>https://orcid.org/0000-0003-2762-0130</orcidid></search><sort><creationdate>20180701</creationdate><title>Angiosomal radiopathologic analysis of transarterial radioembolization for the treatment of hepatocellular carcinoma</title><author>Ahmed, Altan F. ; Samreen, Naziya ; Grajo, Joseph R. ; Zendejas, Ivan ; Sistrom, Chris L. ; Collinsworth, Amy ; Esnakula, Ashwini ; Shah, Jehan L. ; Cabrera, Roniel ; Geller, Brian S. ; Toskich, Beau B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-50c3a0c96eeefd3e3178fa47787db8155e18b35afc50c5c98e1551b31353f7573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Ablation</topic><topic>Computed tomography</topic><topic>Correlation</topic><topic>Criteria</topic><topic>Gadolinium</topic><topic>Gangrene</topic><topic>Gastroenterology</topic><topic>Hepatocellular carcinoma</topic><topic>Hepatology</topic><topic>Imaging</topic><topic>Kinetics</topic><topic>Liver cancer</topic><topic>Magnetic resonance imaging</topic><topic>Medical imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Necrosis</topic><topic>Radiology</topic><topic>Substrates</topic><topic>Surgery</topic><topic>Transplantation</topic><topic>Tumors</topic><topic>Yttrium</topic><topic>Yttrium isotopes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ahmed, Altan F.</creatorcontrib><creatorcontrib>Samreen, Naziya</creatorcontrib><creatorcontrib>Grajo, Joseph R.</creatorcontrib><creatorcontrib>Zendejas, Ivan</creatorcontrib><creatorcontrib>Sistrom, Chris L.</creatorcontrib><creatorcontrib>Collinsworth, Amy</creatorcontrib><creatorcontrib>Esnakula, Ashwini</creatorcontrib><creatorcontrib>Shah, Jehan L.</creatorcontrib><creatorcontrib>Cabrera, Roniel</creatorcontrib><creatorcontrib>Geller, Brian S.</creatorcontrib><creatorcontrib>Toskich, Beau B.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central 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Library)</collection><collection>Biological Science Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Abdominal imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ahmed, Altan F.</au><au>Samreen, Naziya</au><au>Grajo, Joseph R.</au><au>Zendejas, Ivan</au><au>Sistrom, Chris L.</au><au>Collinsworth, Amy</au><au>Esnakula, Ashwini</au><au>Shah, Jehan L.</au><au>Cabrera, Roniel</au><au>Geller, Brian S.</au><au>Toskich, Beau B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Angiosomal radiopathologic analysis of transarterial radioembolization for the treatment of hepatocellular carcinoma</atitle><jtitle>Abdominal imaging</jtitle><stitle>Abdom Radiol</stitle><addtitle>Abdom Radiol (NY)</addtitle><date>2018-07-01</date><risdate>2018</risdate><volume>43</volume><issue>7</issue><spage>1825</spage><epage>1836</epage><pages>1825-1836</pages><issn>2366-004X</issn><eissn>2366-0058</eissn><abstract>Purpose
To assess the radiopathologic correlation following Yttrium-90 transarterial radioembolization (TARE) of hepatocellular carcinoma (HCC) using variable radiodosimetry to identify imaging surrogates of histologic response.
Methods
Twelve patients with HCC underwent ablative (≥ 190 Gy) and/or non-ablative (< 190 Gy) TARE delivered in a segmental, lobar, or combined fashion as a surgical neoadjuvant or bridge to transplantation. Both targeted tumor and treatment angiosome were analyzed before and after TARE utilizing hepatocyte-specific contrast-enhanced MRI or contrast-enhanced CT. Responses were graded using EASL and mRECIST criteria. Histologic findings including percent tumor necrosis and adjacent hepatic substrate effects were correlated with imaging features.
Results
Complete pathologic necrosis (CPN) was observed in 7/12 tumors post-TARE. Ablative and non-ablative dosing resulted in CPN in 5/6 and 2/6 tumors, respectively. Hyperintensity on T2-weighted imaging, the absence of hepatocyte-specific gadolinium contrast uptake, and plateau or persistent enhancement kinetics in the angiosome correlated with CPN and performed similarly to EASL and mRECIST criteria in predicting CPN.
Conclusions
The absence of hepatocyte-specific contrast uptake, increased signal on T2-weighted sequences, and plateau or persistent enhancement in the angiosome may represent MRI surrogates of CPN following TARE of HCC. These findings correlated with EASL and mRECIST response criteria. Further investigation is needed to determine the role of these findings as possible adjuncts to conventional imaging criteria.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>29052747</pmid><doi>10.1007/s00261-017-1354-6</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-9704-2447</orcidid><orcidid>https://orcid.org/0000-0002-3193-9737</orcidid><orcidid>https://orcid.org/0000-0002-8452-2601</orcidid><orcidid>https://orcid.org/0000-0002-7566-7913</orcidid><orcidid>https://orcid.org/0000-0003-2762-0130</orcidid></addata></record> |
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| subjects | Ablation Computed tomography Correlation Criteria Gadolinium Gangrene Gastroenterology Hepatocellular carcinoma Hepatology Imaging Kinetics Liver cancer Magnetic resonance imaging Medical imaging Medicine Medicine & Public Health Necrosis Radiology Substrates Surgery Transplantation Tumors Yttrium Yttrium isotopes |
| title | Angiosomal radiopathologic analysis of transarterial radioembolization for the treatment of hepatocellular carcinoma |
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