Imaging predictors of the response to transarterial chemoembolization in patients with hepatocellular carcinoma: A radiological-pathological correlation
Imaging predictors of the response to transarterial chemoembolization in patients with hepatocellular carcinoma: A radiological-pathological correlation
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DOI：
10.1002/lt.23413
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发表时间：
2012-06-01
影响因子：
4.6
通讯作者：
Yao, Francis Y.
中科院分区：
文献类型：
--
作者：
Kwan, Sharon W.;Fidelman, Nicholas;Yao, Francis Y.
经动脉化疗栓塞术（TACE）是桥接肝细胞癌（HCC）患者与肝移植的标准治疗方法之一。本研究旨在确定TACE前后成像的哪些特征与病理标本中的肿瘤坏死相关。回顾性分析了105例患者的132个HCC病灶，这些患者在TACE后接受了肝移植。在70%的结节中，实现了>90%的坏死。病理学分析显示>90%病变坏死的发生与病变强烈增强（P = 0.03）和TACE前内脏血管造影显示直径大于0.9 mm的供血血管相关（P = 0.01）。几乎完全的病变坏死也与TACE给药期间病变内乙碘油的广泛蓄积相关（P = 0.04）。在TACE后计算机断层扫描成像中，缺乏残留对比增强（P < 0.0001），病变大小减小（P = 0.04），由于乙碘油蓄积导致的高病变密度（P = 0.03），以及乙碘油在整个病变中的弥散分布（P = 0.0001）也与病理分析中的几乎完全病变坏死相关。总之，本研究发现了HCC的多种TACE前后影像学特征，这些特征与TACE后组织病理学分析的接近完全肿瘤坏死相关。这些发现可能有助于指导选择最佳治疗策略，将HCC患者与肝移植联系起来。肝移植18：727736，2012。(C)2012年AASLD。
Transarterial chemoembolization (TACE) is one of the standard therapies for bridging patients with hepatocellular carcinoma (HCC) to transplantation. This study was designed to determine which features on pre- and post-TACE imaging are associated with tumor necrosis in pathological specimens. Records of 105 patients with 132 HCC lesions who underwent liver transplantation after TACE were retrospectively reviewed. In 70% of the nodules, >90% necrosis was achieved. The development of >90% lesion necrosis upon pathological analysis was associated with avid lesion enhancement (P = 0.03) and the presence of a feeding vessel larger than 0.9 mm in diameter on the pre-TACE visceral angiogram (P = 0.01). Near-complete lesion necrosis was also associated with an extensive accumulation of ethiodized oil within a lesion during TACE administration (P = 0.04). On post-TACE computed tomography imaging, a lack of residual contrast enhancement (P < 0.0001), a decrease in the lesion size (P = 0.04), a high lesion density due to an accumulation of ethiodized oil (P = 0.03), and a diffuse distribution of ethiodized oil throughout the lesion (P = 0.0001) were also correlated with near-complete lesion necrosis upon pathological analysis. In conclusion, this study found multiple pre- and post-TACE imaging characteristics of HCC that were associated with near-complete tumor necrosis upon histopathological analysis after TACE. These findings may help to guide the selection of an optimal treatment strategy for bridging patients with HCC to liver transplantation. Liver Transpl 18:727736, 2012. (C) 2012 AASLD.