Abstract
Many hepatocellular carcinoma (HCC) patients do not qualify for curative surgical intervention and are instead treated with locoregional therapies (LRTs) including ablative and endovascular therapies. Assessment of imaging response is essential in the management of HCC for determining efficacy of therapy and as a surrogate marker for improved survival. The established morphological image biomarkers for tumor burden measurement continue to be applied, as size measurement can easily be used in clinical practice. However, in the setting of liver-directed LRTs for HCC, simple tumor morphological changes can be less informative and usually appear later than biologic changes. Functional imaging (such as perfusion and diffusion imaging, PET-CT/MR and MR spectroscopy) has the potential to be a promising technique for assessment of HCC response to LRTs. Although promising, none of these functional imaging biomarkers have gone through all the required steps of standardization and validation and established accepted criteria for clinical practice.
Highlights
Ye et al: Radiological biomarkers for hepatocellular carcinoma (HCC) biomarkers, assess their accuracy for determining tumor response after locoregional therapies (LRTs) and discuss their challenges in clinical practice
The studies of 31P-MR spectroscopy (MRS) assessing the effectiveness of chemoembolization treatment for HCC have shown that a significant decrease in nucleoside triphosphates (NTP) and an increase in Pi had been observed in the early phase of chemotherapy or chemoembolization in liver tumors, followed by changes in phosphodiesters (PDE) and phosphomonoester (PME) levels [92,93]
Functional imaging has an important position in assessing tumor response in locoregional therapy for HCCs, which induce biologic changes that may be detected by functional imaging much earlier than morphological imaging
Summary
In 2000, The European Association for the Study of the Liver (EASL) proposed determination of therapeutic success of HCC to LRTs should measure the size of residual viable tumor rather than the overall size of the tumor [14] (Table I and Fig. 3). The EASL and the AASLD-JNCI and mRESIST criteria suggested assessing response criteria for HCC response to LRTs based on the size of viable enhancing tumor rather than overall tumor size including area of necrosis. These criteria have been shown to correlate well with histopathologic response than WHO and RECIST criteria. Enhancement-based systems of response to LRTs assessing change in size of viable enhancing tumor rather than overall tumor size have been shown to correlate well with histopathologic response and are more accurate at predicting survival after therapy than WHO and RECIST size-based models. The three-dimensional volumetric tumor measurements could be more accurately identify the result of HCC response to LRTs, and it is a priority in future clinical trial research [16]
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