Prognostic value of baseline volumetric multiparametric MR imaging in neuroendocrine liver metastases treated with transarterial chemoembolization

  • Yan Luo
  • Ankur Pandey
  • Mounes Aliyari Ghasabeh
  • Pallavi Pandey
  • Farnaz Najmi Varzaneh
  • Manijeh Zarghampour
  • Pegah Khoshpouri
  • Sanaz Ameli
  • Zhen Li
  • Daoyu Hu
  • Ihab R. KamelEmail author
Magnetic Resonance



To determine whether baseline multiparametric MR imaging can predict overall survival (OS) and hepatic progression-free survival (HPFS) in patients with neuroendocrine liver metastases (NELMs) treated with transarterial chemoembolization (TACE).


This retrospective study included 84 NELMs patients treated with TACE. Tumor volume and volumetric measurements of arterial enhancement (AE), venous enhancement (VE), and apparent diffusion coefficient (ADC) were performed on baseline MR imaging. A maximum of one, two, and five index lesions were selected in each patient. OS was the primary endpoint and HPFS was the secondary endpoint. Prognostic values of volumetric multiparametric MR parameters for predicting OS and HPFS considering a maximum of one, two, and five index lesions were assessed.


Prognostic values of volumetric multiparametric MR parameters for predicting OS and HPFS were similar regardless of the maximum number of index lesions. Multivariate survival analysis showed that baseline dominant tumor volume ≥ 73 cm3, volumetric mean AE ≥ 45%, and mean VE ≥ 73% were independent prognostic factors for OS (HR 2.73; 95% CI 1.45, 5.15; HR 0.32; 95% CI 0.17, 0.63; HR 0.35; 95% CI 0.17, 0.72, respectively) and HPFS (HR 2.30, 95% CI 1.38, 3.84; HR 0.46, 95% CI 0.25, 0.84; HR 0.36, 95% CI 0.19, 0.57, respectively). OS and HPFS were similar in patients with low and high volumetric mean ADC.


Volumetric enhancement values and tumor volume of the dominant lesion on baseline MR imaging may act as prognostic factors for OS and HPFS in NELMs patients treated with TACE.

Key Points

High volumetric mean AE and VE, and low tumor volume of the dominant lesion on baseline MR imaging were associated with favorable OS and HPFS in NELMs patients treated with TACE.

Evaluation of multiple lesions does not provide additional information as compared to single lesion evaluation.


Chemoembolization Liver neoplasms Magnetic resonance imaging Neuroendocrine tumors Prognosis 



Apparent diffusion coefficient


Arterial enhancement


Diffusion-weighted imaging


European Association for the Study of the Liver


Hepatic progression-free survival


Modified Response Evaluation Criteria in Solid Tumors


Neuroendocrine liver metastases


Overall survival


Progression-free survival


Transarterial chemoembolization


Venous enhancement



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Ihab R Kamel.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in a previously published paper (Gowdra HV et al Neuroendocrine liver metastasis treated by using intra-arterial therapy: volumetric functional imaging biomarkers of early tumor response and survival. Radiology 2013; 266:502–513). We have reported on 55 out of 84 patients included in the current study. However, the prior report focused on the prognostic value of pre- and post-TACE changes in volumetric multiparametric MR imaging of the dominant lesion for predicting overall survival. The current study included a larger sample size and evaluated whether baseline volumetric MR imaging only can predict overall survival and hepatic progression-free survival. Also, the prognostic values of baseline volumetric MR metrics using three different numbers of index lesions (one, two, and five) were compared in the current study.


• retrospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2019_6100_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 15 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Yan Luo
    • 1
    • 2
  • Ankur Pandey
    • 2
  • Mounes Aliyari Ghasabeh
    • 2
  • Pallavi Pandey
    • 2
  • Farnaz Najmi Varzaneh
    • 2
  • Manijeh Zarghampour
    • 2
  • Pegah Khoshpouri
    • 2
  • Sanaz Ameli
    • 2
  • Zhen Li
    • 1
  • Daoyu Hu
    • 1
  • Ihab R. Kamel
    • 2
    Email author
  1. 1.Department of Radiology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
  2. 2.Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins University School of MedicineBaltimoreUSA

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