Prediction of post-TACE necrosis of hepatocellular carcinoma using
volumetric enhancement on MRI and volumetric oil deposition
on CT, with pathological correlation
Farnaz Najmi Varzaneh
Mounes Aliyari Ghasabeh
Robert Albert Anders
Ihab R. Kamel
Received: 6 July 2017 / Revised: 10 November 2017 / Accepted: 16 November 2017 / Published online: 30 January 2018
European Society of Radiology 2018
Objective To investigate whether volumetric enhancement on baseline MRI and volumetric oil deposition on unenhanced CT
would predict HCC necrosis and response post-TACE.
Method Of 115 retrospective HCC patients (173 lesions) who underwent cTACE, a subset of 53 HCC patients underwent liver
transplant (LT). Semiautomatic volumetric segmentation of target lesions was performed on dual imaging to assess the accuracy
of predicting tumour necrosis after TACE in the whole cohort and at pathology in the LT group. Predicted percentage tumour
necrosis is defined as 100 % - (%baseline MRI enhancement - %CT oil deposition).
Results Mean predicted tumour necrosis by dual imaging modalities was 61.5 % ± 31.6%; mean percentage tumour necrosis on
follow-up MRI was 63.8 % ± 31.5 %. In the LT group, mean predicted tumour necrosis by dual imaging modalities was 77.6 % ±
27.2 %; mean percentage necrosis at pathology was 78.7 % ± 31.5 %. There was a strong significant correlation between
predicted tumour necrosis and volumetric necrosis on MRI follow-up (r = 0.889, p<0.001) and between predicted tumour
necrosis and pathological necrosis (r = 0.871, p<0.001).
Conclusion Volumetric pre-TACE enhancement on MRI and post-TACE oil deposition in CT may accurately predict necrosis in
treated HCC lesions.
• Imaging-based tumour response can assist in therapeutic decisions.
• Lipiodol retention as carrier agent in cTACE is a tumour necrosis biomarker.
• Predicting tumour necrosis with dual imaging potentially obviates immediate post-treatment MRI.
• Predicting tumour necrosis would facilitate further therapeutic decisions in HCC post-cTACE.
• Pre-TACE MRI and post-TACE CT predict necrosis in treated HCC.
Keywords Carcinoma, hepatocellular/pathology
ADC Apparent diffusion coefficient
CI Confidence interval
CT Computed tomography
cTACE Conventional TACE
DEB-TACE Drug-eluting bead-TACE
EASL European Association for Study of Liver Disease
HAP Hepatic arterial phase
HCC Hepatocellular carcinoma
ICC Intra-class Correlation Coefficient
LT Liver transplant
mRECIST modified RECIST
MRI Magnetic resonance imaging
PVP Portal venous phase
RECIST Response Evaluation Criteria in Solid Tumors
SD Standard deviation
TACE Transarterial chemoembolization
* Ihab R. Kamel
The Russell H. Morgan Department of Radiology and Radiological
Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI
143, Baltimore, MD 21287, USA
Department of Pathology, The Johns Hopkins University School of
Medicine, Baltimore, MD 21205, USA
European Radiology (2018) 28:3032–3040