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05.04.2022 | Magnetic Resonance

Assessment of HCC response to Yttrium-90 radioembolization with gadoxetate disodium MRI: correlation with histopathology

verfasst von: Naik Vietti Violi, Jeffrey Gnerre, Amy Law, Stefanie Hectors, Octavia Bane, John Doucette, Ghadi Abboud, Edward Kim, Myron Schwartz, M Isabel Fiel, Bachir Taouli

Erschienen in: European Radiology | Ausgabe 9/2022

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Abstract

Background and aims

Transarterial ⁹⁰Y radioembolization (TARE) is increasingly being used for hepatocellular carcinoma (HCC) treatment. However, tumor response assessment after TARE may be challenging. We aimed to assess the diagnostic performance of gadoxetate disodium MRI for predicting complete pathologic necrosis (CPN) of HCC treated with TARE, using histopathology as the reference standard.

Methods

This retrospective study included 48 patients (M/F: 36/12, mean age: 62 years) with HCC treated by TARE followed by surgery with gadoxetate disodium MRI within 90 days of surgery. Two radiologists evaluated tumor response using RECIST1.1, mRECIST, EASL, and LI-RADS-TR criteria and evaluated the percentage of necrosis on subtraction during late arterial, portal venous, and hepatobiliary phases (AP/PVP/HBP). Statistical analysis included inter-reader agreement, correlation between radiologic and pathologic percentage of necrosis, and prediction of CPN using logistic regression and ROC analyses.

Results

Histopathology demonstrated 71 HCCs (2.8 ± 1.7 cm, range: 0.5–7.5 cm) including 42 with CPN, 22 with partial necrosis, and 7 without necrosis. EASL and percentage of tumor necrosis on subtraction at the AP/PVP were independent predictors of CPN (p = 0.02–0.03). Percentage of necrosis, mRECIST, EASL, and LI-RADS-TR had fair to good performance for diagnosing CPN (AUCs: 0.78 – 0.83), with a significant difference between subtraction and LI-RADS-TR for reader 2, and in specificity between subtraction and other criteria for both readers (p-range: 0.01–0.04). Radiologic percentage of necrosis was significantly correlated to histopathologic degree of tumor necrosis (r = 0.66 – 0.8, p < 0.001).

Conclusions

Percentage of tumor necrosis on subtraction and EASL criteria were significant independent predictors of CPN in HCC treated with TARE. Image subtraction should be considered for assessing HCC response to TARE when using MRI.

Key Points

• Percentage of tumor necrosis on image subtraction and EASL criteria are significant independent predictors of complete pathologic necrosis in hepatocellular carcinoma treated with ⁹⁰ Y radioembolization.

• Subtraction, mRECIST, EASL, and LI-RADS-TR have fair to good performance for diagnosing complete pathologic necrosis in hepatocellular carcinoma treated with ⁹⁰ Y radioembolization.

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Titel: Assessment of HCC response to Yttrium-90 radioembolization with gadoxetate disodium MRI: correlation with histopathology
verfasst von: Naik Vietti Violi
Jeffrey Gnerre
Amy Law
Stefanie Hectors
Octavia Bane
John Doucette
Ghadi Abboud
Edward Kim
Myron Schwartz
M Isabel Fiel
Bachir Taouli
Publikationsdatum: 05.04.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 9/2022
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-022-08732-4

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Assessment of HCC response to Yttrium-90 radioembolization with gadoxetate disodium MRI: correlation with histopathology