Kazuhiro Saito MD, Abstract Co-Author: Nothing to Disclose

Joseph Ledsam MBChB, Presenter: Nothing to Disclose

Katsutoshi Sugimoto MD, PhD, Abstract Co-Author: Nothing to Disclose

Steven Sourbron PhD, Abstract Co-Author: Nothing to Disclose

Yoichi Araki RT, Abstract Co-Author: Nothing to Disclose

Fuminori Moriyasu MD, Abstract Co-Author: Nothing to Disclose

Soichi Akata MD, Abstract Co-Author: Nothing to Disclose

Koichi Tokuuye MD, PhD, Abstract Co-Author: Nothing to Disclose

To evaluate the efficacy of tracer kinetic modelling of DCE-MRI in early prediction of advanced hepatocellular carcinoma (HCC) response after treatment with transcatheter arterial chemoembolization (TACE) followed by sorafenib therapy.

This prospective study was institutional review board approved and informed consent was obtained. Sorafenib was administered 4 days after TACE of advanced HCC in eleven patients (21 lesions overall). DCE-MRI was performed pre-, 3 and 10 days after TACE using a 1.5T Siemens system and a 3D VIBE sequence. Gd-EOB-DTPA, used for a secondary objective to look at liver function, was injected at 2ml/s via the antecubital vein. DCE-MRI acquisitions of 5 images over 30 seconds in each phase were taken pre-contrast, at the hepatic arterial-dominant phase and at 60, 120, 180, 240, 330, 420 510 and 600 seconds post-contrast. Regions of interest were semi-automatically selected for lesions and abdominal aorta. Distribution volume of contrast agent (DV) and transfer constant Ktrans were calculated. The modified response evaluation criterion in solid tumors (mRECIST) one month after TACE was used to group patients into responders [complete response and partial response] and non-responders [stable disease and progressive disease]; recovery of parameter values after sorafenib was compared between the two groups. Angiogenesis factor angiopoeitin (ang2) was measured pre-, 3 and 10 days post-TACE.

DV pre-treatment was 30.8ml/100ml, and was decreased at 3 (20.6ml/100ml, p<0.001) and 10 days (20.0ml/100ml, p=0.002). Ktrans was not significantly changed. DV at 10 days was 8.6ml/100ml and 27.0ml/100ml for responders and non-responders respectively (p=0.02). Following sorafenib therapy DV fell by 5.6ml/100ml in responders, but increased by 2.5ml/100ml in non-responders (p=0.026). Ang2 decreased by 705ng/l in responders and 331ng/l in non-responders (p=0.037). A significant correlation (r=0.621, p=0.03) between DV and ang2 was observed.

DV 10 days post-TACE is useful in early prediction of therapeutic outcome in HCC. Changes in ang2 suggest this may be due to reduced vascular remodeling in non-responding lesions.

The DCE-MRI parameter DV may offer early prediction of patients unlikely to benefit from sorafenib. Early changes in therapy regime may increase survival in HCC and avoid unnecrssary side effects.

Saito, K, Ledsam, J, Sugimoto, K, Sourbron, S, Araki, Y, Moriyasu, F, Akata, S, Tokuuye, K, DCE-MRI for Early Prediction of Response in Advanced Hepatocellular Carcinoma after TACE and Sorafenib Therapy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003642.html