Progression of Treated versus Untreated Liver Imaging Reporting and Data System Category 4 Masses after Transcatheter Arterial Embolization Therapy |
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Authors: | James Ronald Rajan T. Gupta Daniele Marin Qi Wang Nicholas S. Durocher Paul V. Suhocki Charles Y. Kim |
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Affiliation: | 1. Division of Vascular & Interventional Radiology, Department of Radiology, Duke University Medical Center, Box 3808, 2301 Erwin Road, Durham, NC 27710;2. Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, Box 3808, 2301 Erwin Road, Durham, NC 27710;3. Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China |
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Abstract: | PurposeTo compare outcomes of treated vs untreated Liver Imaging Reporting and Data System category 4 (LR-4) masses after transcatheter arterial embolization.Materials and MethodsIn 167 patients undergoing embolization for HCC from January 2005 to December 2012, LR-4 masses were retrospectively identified on CT and MR imaging examinations performed before embolization. In 149 patients undergoing embolization from January 2013 to December 2016, masses prospectively classified as LR-4 were identified. In total, there were 81 LR-4 masses in 62 patients (16 women; mean age 62 y; range 29-83 y). Procedures were reviewed to determine whether LR-4 masses were within or outside the liver volume that received embolization during treatment of dominant masses. Time to progression to LR-5 and by modified Response Evaluation Criteria in Solid Tumors (mRECIST) was estimated for treated vs untreated LR-4 masses using the Kaplan-Meier method and compared using the log rank test.ResultsLR-4 masses averaged 1.8 cm; 88%, 60%, 14%, and 14% demonstrated arterial phase hyperenhancement, washout, a capsule, and growth. Of LR-4 masses, 62 were within the liver volume that received embolization and considered treated, and 19 were outside and considered untreated. Response rates according to mRECIST were 37% vs 21% for treated vs untreated masses (P = .27). The 6- and 12-month rates of progression to LR-5 were 7% and 26% for treated masses vs 27% and 75% for untreated masses (P = .001). According to mRECIST, 7% and 27% of treated masses progressed vs 30% and 65% of untreated masses (P = .001).ConclusionsLR-4 masses that receive embolization in the setting of dominant masses elsewhere show lower rates of progression compared with untreated masses. |
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Keywords: | APHE arterial phase hyperenhancing CI confidence interval HCC hepatocellular carcinoma LI-RADS Liver Imaging Reporting and Data System LR LI-RADS category mRECIST modified Response Evaluation Criteria in Solid Tumors |
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