Published in:
01-04-2016 | Pictorial essay
Hepatic imaging following intra-arterial embolotherapy
Published in: Abdominal Radiology | Issue 4/2016
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Purpose
To discuss guidelines and salient imaging findings of solid tumors treated with common intra-arterial procedures used in interventional oncology.
Methods
A meticulous literature search of PubMed-indexed articles was conducted. Key words included “imaging + embolization,” “imaging + TACE,” “imaging + radioembolization,” “imaging + Y90,” “mRECIST,” and “EASL.” Representative post-treatment cross-sectional images were obtained from past cases in this institution.
Results
Intra-arterial therapy (IAT) in interventional oncology includes bland embolization, chemoembolization, and radioembolization. Solid tumors of the liver are the primary focus of these procedures. Cross-sectional CT and/or MR are the main modalities used to image tumors after treatment. Traditional size-based response criteria (WHO and RECIST) alone are of limited utility in determining response to IAT; tumoral necrosis and enhancement must be considered. Specifically for HCC, the EASL and mRECIST guidelines are becoming widely adopted response criteria to assess these factors. DWI, FDG-PET, and CEUS are modalities that play an adjunctive but controversial role.
Conclusions
Radiologists must be aware that the different forms of intra-arterial therapy yield characteristic findings on cross-sectional imaging. Knowledge of these findings is integral to accurate assessment of tumor response and progression.