Abstract
Conventional transarterial chemoembolization (cTACE) is a guideline-approved image-guided therapy option for liver cancer using the radiopaque drug-carrier and micro-embolic agent Lipiodol, which has been previously established as an imaging biomarker for tumor response. To establish automated quantitative and pattern-based image analysis techniques of Lipiodol deposition on 24 h post-cTACE CT as biomarker for treatment response. The density of Lipiodol deposits in 65 liver lesions was automatically quantified using Hounsfield Unit thresholds. Lipiodol deposition within the tumor was automatically assessed for patterns including homogeneity, sparsity, rim, and peripheral deposition. Lipiodol deposition was correlated with enhancing tumor volume (ETV) on baseline and follow-up MRI. ETV on baseline MRI strongly correlated with Lipiodol deposition on 24 h CT (p < 0.0001), with 8.22% ± 14.59 more Lipiodol in viable than necrotic tumor areas. On follow-up, tumor regions with Lipiodol showed higher rates of ETV reduction than areas without Lipiodol (p = 0.0475) and increasing densities of Lipiodol enhanced this effect. Also, homogeneous (p = 0.0006), non-sparse (p < 0.0001), rim deposition within sparse tumors (p = 0.045), and peripheral deposition (p < 0.0001) of Lipiodol showed improved response. This technical innovation study showed that an automated threshold-based volumetric feature characterization of Lipiodol deposits is feasible and enables practical use of Lipiodol as imaging biomarker for therapeutic efficacy after cTACE.
Highlights
Conventional transarterial chemoembolization is a guideline-approved image-guided therapy option for liver cancer using the radiopaque drug-carrier and micro-embolic agent Lipiodol, which has been previously established as an imaging biomarker for tumor response
Inclusion criteria were the presence of radiologically confirmed hepatocellular carcinoma (HCC) or other solid liver tumors (intrahepatic cholangiocarcinoma (ICC) or liver-predominant metastatic disease), age ≥ 18, Eastern Cooperative Oncology Group (ECOG) performance status 0–2, Child Pugh class A or B
We found that tumors with sparse Lipiodol deposition on 24 h CT tended to have a smaller reduction in viable tumor tissue after Conventional transarterial chemoembolization (cTACE) than tumors with non-sparse heterogeneous deposition of Lipiodol (− 25.8% ± 66.6 vs. − 72.7% ± 27.2, p < 0.0001)
Summary
Conventional transarterial chemoembolization (cTACE) is a guideline-approved image-guided therapy option for liver cancer using the radiopaque drug-carrier and micro-embolic agent Lipiodol, which has been previously established as an imaging biomarker for tumor response. Homogeneous (p = 0.0006), non-sparse (p < 0.0001), rim deposition within sparse tumors (p = 0.045), and peripheral deposition (p < 0.0001) of Lipiodol showed improved response This technical innovation study showed that an automated thresholdbased volumetric feature characterization of Lipiodol deposits is feasible and enables practical use of Lipiodol as imaging biomarker for therapeutic efficacy after cTACE. Abbreviations BCLC Barcelona clinic liver cancer CT Computed tomography cTACE Conventional transarterial chemoembolization ETV Enhancing tumor volume HCC Hepatocellular carcinoma IAT Intraarterial therapy ICC Intrahepatic cholangiocarcinoma KW Kruskal–Wallis test LiRADS Liver imaging reporting and data system MRI Magnetic resonance imaging MWU Mann–Whitney U test. In light of the unmet clinical need and given the aforementioned multifunctional properties of Lipiodol, the purpose of this study was to establish automated quantification instruments to allow practical deployment of Lipiodol as a predictive imaging biomarker for therapeutic efficacy on 24 h postprocedural CT that is commonly used to verify Lipidol deposition after c TACE19–21
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