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Early effect of 90Y radioembolisation on hepatocellular carcinoma and liver parenchyma stiffness measured with MR elastography: initial experience

  • Hepatobiliary-Pancreas
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Abstract

Objectives

To quantify hepatocellular carcinoma (HCC) and liver parenchyma stiffness using MR elastography (MRE) and serum alpha fetoprotein (AFP), before and 6 weeks (6w) after 90Y radioembolisation (RE), and to assess the value of baseline tumour and liver stiffness (TS/LS) and AFP in predicting response at 6w and 6 months (6 m).

Methods

Twenty-three patients (M/F 18/5, mean age 68.3 ± 9.3 years) scheduled to undergo RE were recruited into this prospective single-centre study. Patients underwent an MRI exam at baseline and 6w following RE (range 39–47 days) which included MRE using a prototype 2D EPI sequence. TS, peritumoural LS/LS remote from the tumour, tumour size, and AFP were measured at baseline and at 6w. Treatment response was determined using mRECIST at 6w and 6 m.

Results

MRE was technically successful in 17 tumours which were classified at 6w as complete response (CR, n = 7), partial response (PR, n = 4), and stable disease (SD, n = 6). TS and peritumoural LS were significantly increased following RE (p = 0.016, p = 0.039, respectively), while LS remote from tumour was unchanged (p = 0.245). Baseline TS was significantly lower in patients who achieved CR at 6w (p = 0.014). Baseline TS, peritumoural LS (both AUC = 0.857), and AFP (AUC = 0.798) showed fair/excellent diagnostic performance in predicting CR at 6w, but were not significant predictors of OR or CR at 6 m.

Conclusion

Our initial results suggest that HCC TS and peritumoural LS increase early after RE. Baseline TS, peritumoural LS, and AFP were all significant predictors of CR to RE at 6w. These results should be confirmed in a larger study.

Key Points

• Magnetic resonance elastography–derived tumour stiffness and peritumoural liver stiffness increase significantly at 6 weeks post radioembolisation whereas liver stiffness remote from the tumour is unchanged.

• Baseline tumour stiffness and peritumoural liver stiffness are lower in patients who achieve complete response at 6 weeks post radioembolisation.

• Baseline tumour size is significantly correlated with baseline tumour stiffness.

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Abbreviations

AFP:

Alpha fetoprotein

LS:

Liver stiffness

MRE:

Magnetic resonance elastography

RE:

90Y radioembolisation

TS:

Tumour stiffness

VOI:

Volume of interest

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Acknowledgements

The authors thank the participants for their time and are grateful to the MR technologists for assistance with imaging.

Funding

This study was funded through NCI U01 CA172320.

Author information

Authors and Affiliations

  1. BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Paul Kennedy, Sara Lewis, Octavia Bane, Stefanie J Hectors & Bachir Taouli

  2. Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA

    Sara Lewis, Edward Kim & Bachir Taouli

  3. Department of Radiology, Weill Cornell Medicine, New York, NY, USA

    Stefanie J Hectors

  4. Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Myron Schwartz

Authors
  1. Paul Kennedy
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  2. Sara Lewis
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Correspondence to Bachir Taouli.

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Guarantor

The scientific guarantor of this publication is Bachir Taouli.

Conflict of interest

The other 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 obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

The patients reported in this study have been reported previously. There is no overlap in MR data between the studies. MR elastography data reported here has not been previously reported.

Methodology

• prospective

• Observational - longitudinal study

• performed at one institution

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Kennedy, P., Lewis, S., Bane, O. et al. Early effect of 90Y radioembolisation on hepatocellular carcinoma and liver parenchyma stiffness measured with MR elastography: initial experience. Eur Radiol 31, 5791–5801 (2021). https://doi.org/10.1007/s00330-020-07636-5

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  • DOI: https://doi.org/10.1007/s00330-020-07636-5

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