Imaging of hepatocellular carcinoma after treatment with yttrium-90 microspheres
Imaging of hepatocellular carcinoma after treatment with yttrium-90 microspheres
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DOI：
10.2214/ajr.06.0706
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发表时间：
2007-03-01
影响因子：
5
通讯作者：
Miller, Frank H.
中科院分区：
文献类型：
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作者：
Keppke, Ana L.;Salem, Riad;Miller, Frank H.
OBJECTIVE.钇-90放射性栓塞是治疗不能切除的肝细胞癌（HCC）的一种新兴疗法。尽管在许多研究中已经评价了基于大小的治疗反应，但仅在少数研究中使用坏死作为反应标准。我们研究的目的是描述Y-90治疗后HCC的影像学特征，并比较尺寸标准（世界卫生组织[ WHO]和实体瘤反应评价标准[RECIST]）与坏死标准和联合标准（RECIST和坏死）评估反应。分析了42例患者的76个Y-90治疗的HCC病灶的CT图像。我们使用了四个反应标准：WHO大小，RECIST大小，坏死和联合标准（RECIST和坏死）。影像学表现为结节状和边缘强化。采用Kaplan-Meier方法评估生存率。根据RECIST标准，缓解率为23%，根据WHO标准为26%，根据坏死标准为57%，根据联合标准为59%。根据坏死和联合标准的反应比单独根据尺寸标准的反应更早检测到。10个响应病灶最初尺寸增大。治疗后，10个病灶周围强化结节增大，2个病灶缩小，2个病灶消失。Y-90给药后，25个病灶中有21个边缘薄增强，对治疗有反应。Okuda I期和Okuda II期患者的中位生存时间分别为660天和236天。联合使用大小和坏死标准可能比单独使用大小标准更准确地评估对Y-90治疗的反应。Y-90治疗后的影像学特征，包括大小，坏死，周边增强结节，和薄边缘增强，进行了描述。
OBJECTIVE. Yttrium-90 radioembolization is an emerging therapy for unresectable hepatocellular carcinoma (HCC). Although therapeutic response based on size has been evaluated in numerous studies, necrosis has been used as a criterion of response in only a few studies. The purpose of our study was to describe the imaging features of HCC after Y-90 treatment and to compare size criteria (World Health Organization [ WHO] and Response Evaluation Criteria in Solid Tumors [RECIST]) with necrosis criteria and combined criteria (RECIST and necrosis) for assessment of response.MATERIALS AND METHODS. CT images of 42 patients with 76 Y-90-treated HCC lesions were analyzed. We used four response criteria: WHO size, RECIST size, necrosis, and combined criteria (RECIST and necrosis). Imaging features of treated lesions included both nodular and peripheral rim enhancement. Survival was assessed with the Kaplan-Meier method.RESULTS. The response rate was 23% according to RECIST criteria, 26% according to WHO criteria, 57% according to necrosis criteria, and 59% according to combined criteria. Response according to necrosis and combined criteria was detected earlier than response according to size criteria alone. Ten responding lesions initially increased in size. After therapy, enhancing peripheral nodules increased in size in 10 lesions, decreased in size in two lesions, and disappeared in two lesions. Twenty-one of 25 lesions with thin rim enhancement after Y-90 administration responded to treatment. The median survival times were 660 and 236 days for Okuda stage I and Okuda stage II disease, respectively.CONCLUSION. Use of combined size and necrosis criteria may lead to more accurate assessment of response to Y-90 therapy than use of size criteria alone. Imaging features after Y-90 treatment, including size, necrosis, peripheral enhancing nodules, and thin rim enhancement, are described.