Prognostic value of baseline volumetric multiparametric MR imaging in neuroendocrine liver metastases treated with transarterial chemoembolization
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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.
• 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.
KeywordsChemoembolization Liver neoplasms Magnetic resonance imaging Neuroendocrine tumors Prognosis
Apparent diffusion coefficient
European Association for the Study of the Liver
Hepatic progression-free survival
Modified Response Evaluation Criteria in Solid Tumors
Neuroendocrine liver metastases
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.
Written informed consent was waived by the Institutional Review Board.
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.
• diagnostic or prognostic study
• performed at one institution
- 12.Pandey A, Pandey P, Ghasabeh MA et al (2018) Baseline volumetric multiparametric MRI: can it be used to predict survival in patients with unresectable intrahepatic cholangiocarcinoma undergoing transcatheter arterial chemoembolization? Radiology 289:843–853Google Scholar
- 16.Pandey A, Pandey P, Ghasabeh MA et al (2018) Baseline volumetric multiparametric MRI: can it be used to predict survival in patients with unresectable intrahepatic cholangiocarcinoma undergoing transcatheter arterial chemoembolization? Radiology 180450Google Scholar
- 17.Taniai N, Onda M, Tajiri T et al (2002) Good embolization response for colorectal liver metastases with hypervascularity. Hepatogastroenterology 49:1531–1534Google Scholar
- 22.Blazic IM, Lilic GB, Gajic MM (2017) Quantitative assessment of rectal cancer response to neoadjuvant combined chemotherapy and radiation therapy: comparison of three methods of positioning region of interest for ADC measurements at diffusion-weighted MR imaging. Radiology 282:418–428CrossRefGoogle Scholar
- 38.Gupta S, Johnson MM, Murthy R et al (2005) Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors: variables affecting response rates and survival. Cancer Am Cancer Soc 104:1590–1602Google Scholar