Aims and objectives
Hepatocellular carcinoma (HCC) is considered the mostcommon primary liver malignancy [1] with almost 60% of patients diagnosed when the tumor is nolonger eligible for potentially curative therapies [2].
One of themedical treatment approved for theadvanced stage is represented by Sorafenib,
an oralmultikinase inhibitor whose mechanism of action is based on the inhibition of proangiogenic signalingpathways.
Traditionalresponse criteriabased on viable tumor size,
such as modified RECIST,
are not longer sufficient.
Actuallytreatment with sorafenib can result in an irregular development of necrosis since the decreased tumorvascularization does...
Methods and materials
Ninety-eight p-CT examinations were performed among 29 cirrhoticpatients,
with advanced HCC before and every 2 months after Sorafenib administration.
Each patient performed a standard dynamic MDCT study and a p-CT study 45 minutes later,
on a 256-slice MDCT scanner.
pCT study tecnique
After selecting the appropriatetransverse level,
single location cine CT (40 CT acquisitions; 16 slices/8 cm width) was performedduring the intravenous bolus injection of additional 50 mL of non-ionic iodinated contrast agent
(Xenetix 350; Guerbet,
Aulnay,
France) at a rate of 5 mL/s and...
Results
The descriptive analysis of p-CT values at baseline for HCC lesions between the non-progressor (n=21)and progressor group (n=8) showed the following results: HP (ml/s/100 g) 54.3±15.9 vs 38.2±25.8;TTP (s) 16.6±2.5 vs 18.9±2.9; AP (ml/s) 52.0±15.8 vs 36.4±22.0; HPI (%) 84.0±24.4 vs 89.3±28.3(p=0.05).
p-CT values at follow-up for HCC lesions between the non-progressor (n=21) and progressorgroup (n=8) showed the following results: HP (ml/s/100 g) 28.7±21.5 vs 45.8±23.8; TTP (s) 22.4±8.4vs 17.2±2.7; AP (ml/s) 28.7±21.8 vs 44.0±24.2; HPI (%) 51.3±36.8 vs 87.0±22.5.
HP,
AP,
and HPI values...
Conclusion
In conclusion,
our data demonstrated that vascular changes measured by p-CT can help in theprediction of tumor response and in the assessment of the clinical outcome,
with a direct correlationwith patient’s survival.
Therefore,
we suggest using p-CT as a complementary strategy to selectpatients with advanced HCC receiving targeted anti-angiogenic therapy.
The identification of thesepredictors of response is an important milestone toward achieving a quantitative functional imagingmethod as a prognostic imaging biomarker,
helping in the classification of patients according toprognostic outcomes,
thus setting the stage for...
References
1.
Crissien AM,
Frenette C.
Current management of hepatocellular carcinoma.GastroenterolHepatol2014;10:153-161.
2.
EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma.
JHepatol2012;56:908–943.
