Dingxin Wang PhD, Presenter: Employee, Siemens AG

Ron Charles Gaba MD, Abstract Co-Author: Nothing to Disclose

Brian Jin BS, Abstract Co-Author: Nothing to Disclose

Robert J. Lewandowski MD, Abstract Co-Author: Scientific Advisory Board, Surefire Medical,Inc

Robert K. Ryu MD, Abstract Co-Author: Nothing to Disclose

Kent T. Sato MD, Abstract Co-Author: Nothing to Disclose

Laura Kulik MD, Abstract Co-Author: Speaker, Bayer AG Advisory Board, Bayer AG Speaker, Onyx Pharmaceuticals, Inc Advisory Board, Onyx Pharmaceuticals, Inc Speaker, Gilead Sciences, Inc

Mary F. Mulcahy MD, Abstract Co-Author: Nothing to Disclose

Andrew Christian Larson PhD, Abstract Co-Author: Nothing to Disclose

Riad Salem MD, MBA, Abstract Co-Author: Consultant, Bayer AG Consultant, Nordion, Inc Consultant, BioSphere Medical, Inc Advisory Board, Sirtex Medical Ltd Consultant, Merit Medical Systems, Inc

Reed A. Omary MD, Abstract Co-Author: Nothing to Disclose

Transcatheter arterial chemoembolization is widely accepted as the first-line therapy for intermediate-stage unresectable hepatocellular carcinoma (HCC). Transcatheter intraarterial perfusion magnetic resonance imaging (TRIP-MRI) provides a novel tool for functional monitoring of transarterial chemoembolization of HCC. In this study, we aimed to investigate the predictive value of TRIP-MRI measured perfusion changes during chemoembolization on overall survival (OS) in HCC patients treated with chemoembolization.

Patients with HCC who underwent chemoembolization within a Siemens Miyabi combined MR-DSA suite were studied. Each patient was catheterized under DSA guidance and transferred to a 1.5T MAGNETOM Espree MR imager for MRI scan. Intra-procedural tumor perfusion changes during chemoembolization were measured using TRIP-MRI with area under the time-signal enhancement curve (AUC) calculation. The endpoint of this study was OS. We studied the correlation between intra-procedural tumor percentage perfusion reduction and OS using the Kaplan-Meier method with the log-rank test and multivariate analyses with Cox proportional hazards model.

Forty six patients were eligible for the analysis. Patients with 35-85% intra-procedural tumor AUC reductions (n = 29) showed significantly improved OS compared to patients with AUC reductions outside this range (n = 17) (35.8 [95% CI, 27.4-44.2] versus 22.2 [95% CI, 11.8-32.6] months, P=0.048). The cumulative survival rates in the preferred and non-preferred perfusion reduction groups at 1 and 2 years after chemoembolization were 75.9% and 60.5% versus 52.9% and 25.2%. Multivariate analysis indicated the following factors were independent positive prognosticator of survival: American Joint Committee on Cancer stage less than 2 (hazard ratio = 0.30, 95% CI 0.11-0.80, P=0.017) and intra-procedural tumor perfusion reduction (hazard ratio = 0.39, 95% CI 0.17-0.89, P=0.026).

Our study shows the evidence of association between intra-procedural tumor perfusion reductions during chemoembolization and survival. TRIP-MRI performed within an integrated MR-DSA unit can potentially serve as an objective predictor of survival at the time of chemoembolization procedure.

TRIP-MRI offers a functional approach to monitor chemoembolization and can be used to predict overall survival in patients with unresectable HCC during chemoembolization.

Wang, D, Gaba, R, Jin, B, Lewandowski, R, Ryu, R, Sato, K, Kulik, L, Mulcahy, M, Larson, A, Salem, R, Omary, R, Transcatheter Intraarterial Perfusion Magnetic Resonance Imaging during Chemoembolization Predicts Overall Survival in Patients with Hepatocellular Carcinoma.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11015540.html