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CT and MRI imaging findings following recent hepatic radioembolization: avoiding confusion interpreting benign findings versus pathologic findings
S192
Posters and Exhibits
Purpose: To determine the safety and efficacy of transarterial yttrium-90 (90Y) radioembolization in patients with unresectable intrahepatic cholangiocarcinoma. Materials and Methods: This is a single institution retrospective cohort study of patients with intrahepatic cholangiocarcinoma who were treated with transarterial 90Y radioembolization between October 2009 and April 2014. 68 patients (30 males, 38 females, median age of 71) identified. 48 patients (70.5%) received systemic chemotherapy prior to radioembolization. Primary endpoints included biochemical and clinical toxicities, and overall survival from time of radioembolization. Results: A total of 114 radioembolization treatments were performed in 68 patients. The average radiation dose delivered was 176.9⫾86.7 Gy (mean⫾SD). At 1 month follow-up there was no major complications. Forty-nine patients (72%) reported grade 1 or 2 toxicities (mostly fatigue, nausea, anorexia, abdominal pain, fever) at 1 month follow-up. Radioembolization treatment had no significant effect on liver functions at 1 month. Patients’ pre-radioembolization MELD scores slightly increased from 7.1⫾1.69 (mean⫾SD) to 7.7⫾2.97 (mean⫾SD). Thirty-six patients were alive at 6-month post-treatment and 3 patients had jaundice, 2 patients had ascites and 1 had portal vein thrombosis and 58% of patients had grade 1 or 2 toxicities. The MELD score was 8.6⫾4.9 (mean⫾SD) at 6 months. The median overall survival from time of the first radioembolization treatment was 11.7 months (95% CI of 7.1-18.8). Conclusion: Transarterial 90Y radioembolization is safe treatment option and provides survival benefit in patients with intrahepatic cholangiocarcinoma.
Educational Exhibit
Abstract No. 439
CT and MRI imaging findings following recent hepatic radioembolization: avoiding confusion interpreting benign findings versus pathologic findings
Posters and Exhibits
M. Stanley1, P. Villas2, J. Brown2, S. Atluri2; 1Radiology, Bryn Mawr Hospital, Phoenixville, PA; 2Lankenau Medical Center, Wynnewood, PA Learning Objectives: Explain pertinent therapeutic response related MRI and CT radiologic findings following recent hepatic radioemobolization Communicate differences between pathologic findings versus expected post-radioembolization findings to the reading diagnostic radiologist Background: Radioembolization of hepatic primary and metastatic malignancies with Y90 microspheres has been rapidly adopted in recent years. Since radioembolization is a relatively new method of hepatic tumor treatment, many diagnostic radiogists may be unfamiliar with the posttreatment CT or MRI appearance. As the mechanism of therapy differs from chemoembolization and other traditional treatment, the imaging features of radioembolization likewise demonstrate changes that may not be recognized as typical response to treatment. Traditional evaluation of tumor response to treatment has been primarily based on size measurements. Early post-radioembolization imaging may
’
JVIR
show a variable response with either decrease, increase, or stability in tumor size. A treated tumor demonstrating either stability or increase in size may be misinterpereted by the reading radiology as progression of disease. Misinterpretation of these findings can have significant sequela regarding clinical decision making. Clinical Findings/Procedure Details: Tumor size reduction is the most common imaging finding to assess effective treatment in not only radioembolization but all therapies. Consideration of additional findings such as extent of tumor necrosis and decrease or elimination of vascularity should also be taken into account. DW-MRI can also be particularly helpful in assessing treatment response, particularly in poorly defined tumors. Post treatment images will typically demonstrate less restricted diffusion. A pictoral review of examples of each of these imaging findings will be displayed. Conclusion and/or Teaching Points: The imaging findings after a recent radioembolization of hepatic tumors can be variable and may be misinterpreted. Other than tumor size, other factors such as necrosis and avascularity should be accounted for to properly assess treatment response. Education of these CT and MRI findings by the interventionalist is important to avoid potential pitfalls and optimize patient care.
Abstract No. 440 Hepatic yttrium-90 radioembolization treatment of patients with liver dominant metastatic renal cell cancer - the Moffitt experience J. Shah1,2, J. Choi1, G.E. El-Haddad1, J. Sweeney1, B. Biebel1, P.E. Spiess3, S. Gupta4, M.N. Fishman4, S. E. Hoffe5, R. Shridhar5, B. Kis1; 1Interventional Radiology, Moffitt Cancer Center, Tampa, FL; 2Surgery, University of Texas Health Science Center, San Antonio, TX; 3Urology, Moffitt Cancer Center, Tampa, FL; 4GU Oncology, Moffitt Cancer Center, Tampa, FL; 5Radiation Oncology, Moffitt Cancer Center, Tampa, FL Purpose: To determine safety and efficacy of transarterial yttrium-90 (90Y) glass microsphere radioembolization in patients with liver dominant metastatic renal cell carcinoma (RCC). Materials and Methods: This is a single institution retrospective study of patients with liver dominant metastasic RCC treated with radioembolization from May 2010 to April 2014. All patients included in this study underwent radical nephrectomy and received systemic chemotherapy prior to radioembolization. Retrospective review of electronic medical records and imaging studies was performed to evaluate clinical and biochemical toxicities and overall survival. Radiologic response of liver metastasis was evaluated in cross sectional imaging (CT or MRI) and was categorized according to modified Response Evaluation Criteria In Solid Tumors (mRECIST). Results: A total of 15 patients were identified (11 males, 4 females) with a median age of 67 years. Bilobar disease was present in 9 patients, while 6 patients had unilobar or segmental disease. One patient developed recurrent disease and received a second lobar treatment. The average dose delivered was 144.3þ36.1 Gy (meanþSD). There was no major complication only grade 1 and 2 toxicities were recorded in all patients, mostly fatigue and anorexia. The median overall survival was 46.1 months (95% CI 9.2-not reached). The median progression free
Posters and Exhibits
Purpose: To determine the safety and efficacy of transarterial yttrium-90 (90Y) radioembolization in patients with unresectable intrahepatic cholangiocarcinoma. Materials and Methods: This is a single institution retrospective cohort study of patients with intrahepatic cholangiocarcinoma who were treated with transarterial 90Y radioembolization between October 2009 and April 2014. 68 patients (30 males, 38 females, median age of 71) identified. 48 patients (70.5%) received systemic chemotherapy prior to radioembolization. Primary endpoints included biochemical and clinical toxicities, and overall survival from time of radioembolization. Results: A total of 114 radioembolization treatments were performed in 68 patients. The average radiation dose delivered was 176.9⫾86.7 Gy (mean⫾SD). At 1 month follow-up there was no major complications. Forty-nine patients (72%) reported grade 1 or 2 toxicities (mostly fatigue, nausea, anorexia, abdominal pain, fever) at 1 month follow-up. Radioembolization treatment had no significant effect on liver functions at 1 month. Patients’ pre-radioembolization MELD scores slightly increased from 7.1⫾1.69 (mean⫾SD) to 7.7⫾2.97 (mean⫾SD). Thirty-six patients were alive at 6-month post-treatment and 3 patients had jaundice, 2 patients had ascites and 1 had portal vein thrombosis and 58% of patients had grade 1 or 2 toxicities. The MELD score was 8.6⫾4.9 (mean⫾SD) at 6 months. The median overall survival from time of the first radioembolization treatment was 11.7 months (95% CI of 7.1-18.8). Conclusion: Transarterial 90Y radioembolization is safe treatment option and provides survival benefit in patients with intrahepatic cholangiocarcinoma.
Educational Exhibit
Abstract No. 439
CT and MRI imaging findings following recent hepatic radioembolization: avoiding confusion interpreting benign findings versus pathologic findings
Posters and Exhibits
M. Stanley1, P. Villas2, J. Brown2, S. Atluri2; 1Radiology, Bryn Mawr Hospital, Phoenixville, PA; 2Lankenau Medical Center, Wynnewood, PA Learning Objectives: Explain pertinent therapeutic response related MRI and CT radiologic findings following recent hepatic radioemobolization Communicate differences between pathologic findings versus expected post-radioembolization findings to the reading diagnostic radiologist Background: Radioembolization of hepatic primary and metastatic malignancies with Y90 microspheres has been rapidly adopted in recent years. Since radioembolization is a relatively new method of hepatic tumor treatment, many diagnostic radiogists may be unfamiliar with the posttreatment CT or MRI appearance. As the mechanism of therapy differs from chemoembolization and other traditional treatment, the imaging features of radioembolization likewise demonstrate changes that may not be recognized as typical response to treatment. Traditional evaluation of tumor response to treatment has been primarily based on size measurements. Early post-radioembolization imaging may
’
JVIR
show a variable response with either decrease, increase, or stability in tumor size. A treated tumor demonstrating either stability or increase in size may be misinterpereted by the reading radiology as progression of disease. Misinterpretation of these findings can have significant sequela regarding clinical decision making. Clinical Findings/Procedure Details: Tumor size reduction is the most common imaging finding to assess effective treatment in not only radioembolization but all therapies. Consideration of additional findings such as extent of tumor necrosis and decrease or elimination of vascularity should also be taken into account. DW-MRI can also be particularly helpful in assessing treatment response, particularly in poorly defined tumors. Post treatment images will typically demonstrate less restricted diffusion. A pictoral review of examples of each of these imaging findings will be displayed. Conclusion and/or Teaching Points: The imaging findings after a recent radioembolization of hepatic tumors can be variable and may be misinterpreted. Other than tumor size, other factors such as necrosis and avascularity should be accounted for to properly assess treatment response. Education of these CT and MRI findings by the interventionalist is important to avoid potential pitfalls and optimize patient care.
Abstract No. 440 Hepatic yttrium-90 radioembolization treatment of patients with liver dominant metastatic renal cell cancer - the Moffitt experience J. Shah1,2, J. Choi1, G.E. El-Haddad1, J. Sweeney1, B. Biebel1, P.E. Spiess3, S. Gupta4, M.N. Fishman4, S. E. Hoffe5, R. Shridhar5, B. Kis1; 1Interventional Radiology, Moffitt Cancer Center, Tampa, FL; 2Surgery, University of Texas Health Science Center, San Antonio, TX; 3Urology, Moffitt Cancer Center, Tampa, FL; 4GU Oncology, Moffitt Cancer Center, Tampa, FL; 5Radiation Oncology, Moffitt Cancer Center, Tampa, FL Purpose: To determine safety and efficacy of transarterial yttrium-90 (90Y) glass microsphere radioembolization in patients with liver dominant metastatic renal cell carcinoma (RCC). Materials and Methods: This is a single institution retrospective study of patients with liver dominant metastasic RCC treated with radioembolization from May 2010 to April 2014. All patients included in this study underwent radical nephrectomy and received systemic chemotherapy prior to radioembolization. Retrospective review of electronic medical records and imaging studies was performed to evaluate clinical and biochemical toxicities and overall survival. Radiologic response of liver metastasis was evaluated in cross sectional imaging (CT or MRI) and was categorized according to modified Response Evaluation Criteria In Solid Tumors (mRECIST). Results: A total of 15 patients were identified (11 males, 4 females) with a median age of 67 years. Bilobar disease was present in 9 patients, while 6 patients had unilobar or segmental disease. One patient developed recurrent disease and received a second lobar treatment. The average dose delivered was 144.3þ36.1 Gy (meanþSD). There was no major complication only grade 1 and 2 toxicities were recorded in all patients, mostly fatigue and anorexia. The median overall survival was 46.1 months (95% CI 9.2-not reached). The median progression free