Wen Tao Li

Utility of diffusion-weighted imaging to assess hepatocellular carcinoma viability following transarterial chemoembolization

The purpose of the present study was to evaluate whether diffusion-weighted imaging (DWI) can be used to assess hepatocellular carcinoma (HCC) viability following transarterial chemoembolization (TACE). A total of 41 consecutive patients were treated according to chemoembolization protocols. The follow-up was performed between six and eight weeks post-chemoembolization by multidetector computed tomography [or enhanced magnetic resonance imaging (MRI)] and DW-MRI on the same day. The presence of any residual tumor and the extent of tumor necrosis were evaluated according to the European Association for the Study of the Liver. The apparent diffusion coefficient (ADC) values of the entire area of the treated mass and the vital and necrotic tumor tissues were recorded. Correlation coefficients were also calculated to compare the percentage of necrosis with ADC values. The mean ADC values of the necrotic and vital tumor tissues were 2.22±0.31×10−3 mm2/sec and 1.42±0.25×10−3 mm2/sec, respectively (Mann-Whitney U test, P<0.001). The results from the receiver operating characteristic analysis showed that the threshold ADC value was 1.84×10−3 mm2/sec with 92.3% sensitivity and 100% specificity for identifying the necrotic tumor tissues. A significant linear regression correlation was identified between the ADC value of the entire area of the treated mass and the extent of tumor necrosis (r=0.58; P<0.001). In conclusion, DWI can be used to assess HCC viability following TACE.

Diffusion-Weighted MR Imaging of Hepatocellular Carcinoma: Current Value in Clinical Evaluation of Tumor Response to Locoregional Treatment

The established size-based image biomarkers for tumor burden measurement continue to be applied to solid tumors, as size measurement can easily be used in clinical practice. However, in the setting of novel targeted therapies and liver-directed locoregional treatments for hepatocellular carcinoma (HCC), simple tumor anatomic changes can be less informative and usually appear later than biologic changes. Functional magnetic resonance (MR) imaging has the potential to be a promising technique for assessment of HCC response to therapy. Diffusion-weighted MR imaging is now widely used as a standard imaging modality to evaluate the liver. This review discusses the current clinical value of diffusion-weighted MR imaging in the evaluation of tumor response after nonsurgical locoregional treatment of HCC.

Pre-treatment apparent diffusion coefficient is imaging biomarker for prediction of response to chemoembolization in hepatocellular carcinoma

We read with great interest the article by Dr Mannelli nd colleagues [1], “Serial diffusion-weighted MRI in patients ith hepatocellular carcinoma: Prediction and assessment of esponse to transarterial chemoembolization. Preliminary experince”, which appeared in the April 2013 issue of European Journal f Radiology. This study reported that HCCs with poor and incomplete esponse to TACE (<50% necrosis on post-TACE MRI) had sigificantly lower pre-treatment ADC and lower post TACE ADC ompared to HCCs with good/complete response (≥50% necrosis): DC pre-TACE 1.35 ± 0.42 vs. 1.64 ± 0.39 × 10−3 mm2/s (p = 0.042); ost-TACE ADC 1.34 ± 0.36 vs. 1.92 ± 0.47 (p = 0.0008). There was o difference in ADC values. The authors stated that this is the rst report of use baseline tumor ADC values to predict response of CC to TACE. With the introduction of novel targeted agents, there has een a growing interest to monitor the therapeutic response t an early phase of treatment using functional magnetic resnance imaging (MRI). The National Cancer Institute (NCI) has ecognized the potential of this technique and has proposed conensus guidelines for MR-diffusion weighted imaging to meet inimum standards for its use as an effective image biomarker 2]. Previous studies had shown diffusion-weighted MR imagng was significantly altered after TACE with increases in ADC alues [3–6]. Our previous study is consistent with the above entioned studies [7]. Our results have also shown that nonesponding lesions had significantly higher pretreatment mean DC than responding lesions (1.726 ± 0.323 × 10−3 mm2/s vs. .294 ± 0.185 × 10−3 mm2/s) (Mann–Whitney U-test, p < 0.001). igh pretreatment mean ADC value of hepatocellular carcinoma as predictive of poor response to chemoembolization. Prognotic value for response to chemoembolization was expressed as -index of 0.867, which was a natural extension of area under he receiver operating characteristic curve (AUC). Another study lso showed there were significant linear regression relation etween the survival time and pre-chemoembolization lesion DC values (r = −0.698, p < 0.001) or the changes in ADC value ost-chemoembolization (r = 0.702, p < 0.001) [8]. Recently, our reliminary results, in 46 HCC patients cohort, showed that C-index f overall EASL responses, target EASL responses and pre-treatment DCs responses for response to chemoembolization were 0.786, .746 and 0.781, respectively. The results from Dr Mannelli and colleagues’ study [1] are disordant with ours. This discordance may be related to the nature of umors with or without necrotic tissue pre-treatment. In Dr Manelli and colleagues’ study [1] and Kubota et al. study [6], there is

Intra-arterial Infusion Chemotherapy for Advanced Non–Small-Cell Lung Cancer: Preliminary Experience on the Safety, Efficacy, and Clinical Outcomes

PURPOSE To investigate the effectiveness and toxicity of intra-arterial infusion chemotherapy as a therapeutic modality for advanced non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS In a retrospective study, 40 patients with stage III NSCLC received intra-arterial infusion chemotherapy with gemcitabine and cisplatin. Tumor staining was graded based on angiography, and the number of NSCLC feeding arteries detected was recorded. Toxicity was assessed according to National Cancer Institute Common Toxicity Criteria for Adverse Events. The response to treatment was evaluated per Response Evaluation Criteria In Solid Tumors (RECIST). Efficacy was assessed based on time to tumor progression (TTP), and survival was estimated by Kaplan-Meier analysis. Prognostic factors influencing TTP and overall survival rate were evaluated by Cox regression analysis. RESULTS The most frequent drug-related adverse events were cough (n = 17; 42.5%), anorexia (n = 14; 35%), and pain (n = 9; 22.5%). Evaluated per RECIST, a total of 47.5% of patients (n = 19) exhibited response to therapy after completion of the first three cycles of intra-arterial infusion chemotherapy. The median TTP was 5 months. Patients had a median life expectancy of 9 months. By Cox regression analysis, tumor staining was shown to be an independent prognostic factor for TTP (relative risk, 0.405; 95% confidence interval, 0.216-0.760) and overall survival (relative risk, 0.348; 95% confidence interval, 0.185-0.656). CONCLUSIONS Intra-arterial infusion chemotherapy for advanced lung cancer has the potential to reduce the size of tumors and has no severe adverse effects.

Apparent Diffusion Coefficients at Diffusion-weighted MR Imaging: Potential Predictors of Survival in Patients with Hepatocellular Carcinoma Treated with Chemoembolization

920 radiology.rsna.org Radiology: Volume 272: Number 3—September 2014 Methods section, that we used a double-consent Zelen design in the random assignment of patients (1). The double-consent version of the Zelen design differs because participants allocated to the control group are asked for their consent to the standard treatment, and those who decline may receive the experimental (or some other) treatment. Participants allocated to the experimental group are asked whether they consent to the new treatment. If they decline, they receive the standard treatment as in a single-consent version (2,3). We also agree that, in the standard Zelen design, results from patients in each treatment group who refuse consent to the allocated treatment and undergo the alternative therapy should be included in the analysis (2–4). However, in practice, these patients may be unwilling to undergo regular follow-up. In our study, although all patients allocated to the experimental group received the new treatment and the subsequent follow-up, four patients in the control group declined the assigned treatment and failed to participate in the follow-up regularly; thus, their results had to be excluded from the data analysis, as described in our Materials and Methods section. For this reason, we think the further analysis in our study is also in accord with the Zelen design.

Uremia-associated cardiovascular and lung injury

A 23-year-old woman presented to the emergency department with severe dyspnea. She reported progressively worsening dyspnea during the previous 2 weeks. She had a history of end-stage renal disease (ESRD) due to chronic glomerulonephritis. The patient had been maintained on peritoneal dialysis (PD) for 3 years. The PD prescription consisted of three 2 L exchanges per day, 1.5% dextrose solutions. Chemistries were significant for a parathyroid hormone of 146.7 pmol/L (normal, 1.3–9.3 pmol/L), phosphorous of 3.52 mmol/L (normal, 0.8–1.65 mmol/L) and serum calcium of 2.54 mmol/L (normal, 2.1–2.6 mmol/L). The chest radiograph showed a typical picture of congestive heart failure with cardiomegaly and ground glass opacity changes in both lung fields. Transthoracic echocardiography revealed a dilated left ventricle and left atrium with cardiac muscle and left ventricular papillary muscle echo enhancement (Figure 1). Chest computed tomography (CT) images showed left atrium and ventricle dilatation. CT images also showed myocardium, lung and coronary artery calcification (Figure 2). The results of single-photon emission CT technetium-99m methoxyisobutylisonitrile (SPECT 99mTc-MIBI) showed that the mild reductions of 99mTc-MIBI uptake were found in anterior, posterior and posterolateral segments of the left ventricular due to myocardial damage.