Maxime Ronot MD, Presenter: Nothing to Disclose

Marco Dioguardi Burgio MD, Abstract Co-Author: Nothing to Disclose

Onorina Bruno MD, Abstract Co-Author: Nothing to Disclose

Claire Francoz, Abstract Co-Author: Nothing to Disclose

Valerie Paradis MD, Abstract Co-Author: Nothing to Disclose

Francois Durand, Abstract Co-Author: Nothing to Disclose

Laurent Castera, Abstract Co-Author: Nothing to Disclose

Valerie Vilgrain MD, Abstract Co-Author: Nothing to Disclose

To compare the diagnostic performance of RECIST1.1, mRECIST, and EASL criteria for assessing tumor necrosis in a consecutive series of patients treated with transarterial chemoembolisation (TACE) before liver transplantation (LT) for hepatocellular carcinoma (HCC).

Between 2006 and 2012, all patients treated with at least one session of TACE before LT for HCC were included. Response to treatment was evaluated by two independent readers on the last MDCT before LT according to RECIST1.1, mRECIST, and EASL criteria. Tumor response on imaging was compared to the tumor necrosis assessed on pathologic examination of the liver explant. Major necrosis was defined as the presence of more than 90% of necrosis. Necrosis between 50-90% and < 50% were defined as intermediate and minor necrosis, respectively. Inter-reader agreement for the tumor response was evaluated by the kappa statistic. Factors associated with a major (>90%) necrosis were tested by multivariate analysis.

58 patients with 88 HCC treated with 94 TACE sessions (53 male (91%) were included. Before TACE, patients had a mean 1.6 (range 1-4)of HCC with a mean 25mm diameter (range 10-80 mm). HCC was unique in 30 patients (52%). All HCCs were hypervascular on arterial phase MDCT acquisition. 51 nodules (58%) showed major necrosis. Among them, lesions were classified as complete response according to RECIST1.1, mRECIST and EASL in 2 (4%), 47 (92%) and 47(92%) for reader 1, respectively, and 1 (2%), 45 (88%) and 45 (88%) for reader 2, respectively. Despite similar performances with mRECIST and EASL, only mRECIST was correlated with major necrosis on multivariate analysis for both readers (p<0.0001). Inter-observer agreement was substantial for RECIST1.1 (k=0.65 +/- 0.08), mRECIST (k=0.78+/-0.07), and EASL (k=0.75+/-0.07).

mRECIST and EASL criteria showed better correlation with major tumor necrosis than RECIST1.1. mRECIST showed better correlation with tumoral major necrosis and should be used to evaluate response to TACE.

Patients with HCC treated by TACE should be evaluated with mRECIST criteria. 

Ronot, M, Dioguardi Burgio, M, Bruno, O, Francoz, C, Paradis, V, Durand, F, Castera, L, Vilgrain, V, Radio-pathological Correlation in HCC Treated by Transarterial Chemoembolisation: Comparison between RECIST, mRECIST and EASL Criteria.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045442.html