Computed tomographic perfusion imaging for the prediction of response transarterial radioembolization with Yttrium-90 glass microspheres of hepatocellular carcinoma

Abstract

OBJECTIVE: The present study aimed to estimate the clinical value of quantitative computed tomography perfusion imaging (CTPI) parameters in predicting early treatment response, as determined by the modified response evaluation criteria in solid tumours (mRECIST), in patients with HCC who underwent transarterial radioembolization (TARE).

PATIENTS AND METHODS: This retrospective cohort study included 54 patients with HCC who had TARE treatment between July 2018 and August 2019. Each patient was evaluated using CTPI before the procedure and in the first and third months after the procedure. In the third month, treatment response was determined based on mRECIST and used as a reference. ROC analysis was performed to determine the relationship between the CTPI parameters before treatment and one month after treatment and the treatment response.

RESULTS: Significant cut-off values for three of the CTPI parameters - hepatic blood flow (BF). time to start (TTS) and hepatic perfusion index (HPI) - which were among the pre-treatment CTPI parameters, were found to predict progressive disease (PD). The TTS cut-off value was 1.29 (sensitivity: 86.7%; specificity: 6.7%), the BF cut-off value was 81.58 (sensitivity: 53.3%; specificity: 90%) and the HPI cut-off value was 88.26 (sensitivity: 33%; specificity: 96.7%).

CONCLUSIONS: BV, TTS and HPI may be predictive for PD in HCC lesions in the third month after TARE treatment. In contrast, the CTPI parameters in the first month after TARE played no significant role in predicting the treatment response and determining the effects of TARE on the microvascular level.