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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 3/2016

01-03-2016 | Clinical Investigation

Histogram Analysis of CT Perfusion of Hepatocellular Carcinoma for Predicting Response to Transarterial Radioembolization: Value of Tumor Heterogeneity Assessment

Authors: Caecilia S. Reiner, Sonja Gordic, Gilbert Puippe, Fabian Morsbach, Moritz Wurnig, Niklaus Schaefer, Patrick Veit-Haibach, Thomas Pfammatter, Hatem Alkadhi

Published in: CardioVascular and Interventional Radiology | Issue 3/2016

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Abstract

Purpose

To evaluate in patients with hepatocellular carcinoma (HCC), whether assessment of tumor heterogeneity by histogram analysis of computed tomography (CT) perfusion helps predicting response to transarterial radioembolization (TARE).

Materials and Methods

Sixteen patients (15 male; mean age 65 years; age range 47–80 years) with HCC underwent CT liver perfusion for treatment planning prior to TARE with Yttrium-90 microspheres. Arterial perfusion (AP) derived from CT perfusion was measured in the entire tumor volume, and heterogeneity was analyzed voxel-wise by histogram analysis. Response to TARE was evaluated on follow-up imaging (median follow-up, 129 days) based on modified Response Evaluation Criteria in Solid Tumors (mRECIST). Results of histogram analysis and mean AP values of the tumor were compared between responders and non-responders. Receiver operating characteristics were calculated to determine the parameters’ ability to discriminate responders from non-responders.

Results

According to mRECIST, 8 patients (50 %) were responders and 8 (50 %) non-responders. Comparing responders and non-responders, the 50th and 75th percentile of AP derived from histogram analysis was significantly different [AP 43.8/54.3 vs. 27.6/34.3 mL min−1 100 mL−1); p < 0.05], while the mean AP of HCCs (43.5 vs. 27.9 mL min−1 100 mL−1; p > 0.05) was not. Further heterogeneity parameters from histogram analysis (skewness, coefficient of variation, and 25th percentile) did not differ between responders and non-responders (p > 0.05). If the cut-off for the 75th percentile was set to an AP of 37.5 mL min−1 100 mL−1, therapy response could be predicted with a sensitivity of 88 % (7/8) and specificity of 75 % (6/8).

Conclusion

Voxel-wise histogram analysis of pretreatment CT perfusion indicating tumor heterogeneity of HCC improves the pretreatment prediction of response to TARE.
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Metadata
Title
Histogram Analysis of CT Perfusion of Hepatocellular Carcinoma for Predicting Response to Transarterial Radioembolization: Value of Tumor Heterogeneity Assessment
Authors
Caecilia S. Reiner
Sonja Gordic
Gilbert Puippe
Fabian Morsbach
Moritz Wurnig
Niklaus Schaefer
Patrick Veit-Haibach
Thomas Pfammatter
Hatem Alkadhi
Publication date
01-03-2016
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 3/2016
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-015-1185-1

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