Prognostic Significance of Arterial Phase CT for Prediction of Response to Transcatheter Arterial Chemoembolization in Unresectable Hepatocellular Carcinoma
A Retrospective Analysis
Sanjeev Katyal1,
James H. Oliver1,
Mark S. Peterson1,
Paul J. Chang1,
Richard L. Baron1 and
Brian I. Carr2
1
Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop
St., Pittsburgh, PA 15213.
2
Department of Transplantation Medicine, University of Pittsburgh Medical
Center, Pittsburgh, PA 15213.
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Fig. 1. —62-year-old man with type 1 hypervascular pattern of
enhancement. Hepatic arterial phase CT scan shows well-circumscribed
hypervascular mass in medial segment of left hepatic lobe. Mass enhances more
than adjacent liver parenchyma (arrowheads). Note brightly enhancing
aorta (black arrow) and faintly opacified inferior vena cava
(white arrow).
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Fig. 2. —58-year-old woman with type 2 hypovascular pattern of
enhancement. Hepatic arterial phase CT scan shows large low-attenuation
(hypovascular) mass involving both right and left hepatic lobes
(arrowheads). Multiple low-attenuation satellite nodules
(arrows) are also visible.
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Fig. 3. —67-year-old man with type 3 enhancement pattern. Hepatic
arterial phase CT scan shows large hypervascular mass (arrows) in
left hepatic lobe and predominantly hypovascular mass in anterior segment of
right hepatic lobe (arrowheads).
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Fig. 4A. —53-year-old man with type 1 predominantly hypervascular
pattern of enhancement who was classified as responder after transcatheter
arterial chemoembolization. Hepatic arterial phase CT image shows two
hypervascular lesions (arrowheads) and one smaller hypovascular
lesion (arrows) in hepatic dome.
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Fig. 4B. —53-year-old man with type 1 predominantly hypervascular
pattern of enhancement who was classified as responder after transcatheter
arterial chemoembolization. Hepatic arterial phase CT image obtained at same
level as A after three treatments of transcatheter arterial
chemoembolization shows that two hypervascular lesions (arrowheads)
shown in A are smaller and less vascular. Hypovascular lesion
(arrows) shown in A has also decreased in attenuation,
consistent with loss of vascularity.
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Fig. 5A. —56-year-old woman with type 2 pattern of enhancement who was
classified as nonresponder with progressive disease despite transcatheter
arterial chemoembolization. Hepatic arterial phase CT scan shows discrete
low-attenuation lesion (arrowheads) in left hepatic lobe and mild
enlargement of gastrohepatic (white arrow) and cardiophrenic
(black arrow) lymph nodes.
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Fig. 5B. —56-year-old woman with type 2 pattern of enhancement who was
classified as nonresponder with progressive disease despite transcatheter
arterial chemoembolization. Hepatic arterial phase CT scan obtained after
three treatments of transcatheter arterial chemoembolization shows increase in
size and vascularity of tumor with bilobar involvement (arrowheads).
Gastrohepatic (small arrow) and cardiophrenic (large arrow)
lymph nodes have also markedly increased in size.
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Fig. 6. —Graph shows Kaplan-Meier survival analysis for both
responders (solid line) and nonresponders (dotted line) to
transcatheter arterial chemoembolization. Patients who responded to
transcatheter arterial chemoembolization survived significantly longer than
those who did not respond (p < 0.01).
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Fig. 7. —Graph shows Kaplan-Meier survival analysis for patients with
pattern of only hypervascular (type 1A) lesions (solid line) and
patients with pattern of predominant number of hypervascular (type 1B) lesions
(dotted line) during hepatic arterial phase CT. Patients with only
hypervascular lesions lived significantly longer than did patients with
predominant number of hypervascular lesions (p < 0.03).
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Fig. 8. —Graph shows Kaplan-Meier survival analysis for nonresponders
to transcatheter arterial chemoembolization with predominant pattern of
hypervascular (type 1) lesions (solid line) and nonresponders with
predominant pattern of hypovascular (type 2) lesions (dotted line)
during hepatic arterial phase CT. Nonresponders with hypervascular pattern
survived significantly longer than did nonresponders with hypovascular pattern
(p = 0.05).
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Fig. 9. —Graph shows Kaplan-Meier survival analysis for nonresponders
to transcatheter arterial chemoembolization comparing nonresponders with
stable disease (solid line) with nonresponders with progressive
disease (dotted line). Nonresponders with stable disease survived
significantly longer than did nonresponders with progressive disease
(p = 0.05).
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