Clinical Utility of Liver Stiffness Measurements on Magnetic Resonance Elastrography in Patients with Hepatocellular Carcinoma Treated with Radiofrequency Ablation
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Purpose: To determine whether liver stiffness (LS) measured by magnetic resonance elastography (MRE) can predict the outcome of radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients. Materials and Methods: A total of 107 patients with Child-Pugh class A liver function who were treated with RFA for single HCC and who had undergone a gradient-echo MRE within 6 months before RFA were included. We evaluated the relationship between the LS values and the ablation volume, local tumor progression (LTP), and intrahepatic distant recurrence (IDR). We also constructed receiver operating characteristic (ROC) curves to examine the role of LS in predicting liver function deterioration, which was defined as an increase of Child-Pugh score by one point or more at 1 year after RFA. Results: There was no significant correlation between LS and ablation volume, and neither time to LTP nor IDR was associated with LS. Among the 66 patients who did not have recurrence 1 year after RFA, 5 patients (7.6%) developed liver function deterioration. A high LS value was significantly associated with development of liver function deterioration after RFA and the area under the ROC curve was 0.764 (95% CI 0.598-0.929, P = 0.003). Conclusion: LS measured by MRE could not predict ablation volume and tumor recurrence. However, high LS values were significantly associated with development of liver function deterioration.
Abstract
Purpose: To determine whether liver stiffness (LS) measured by magnetic resonance elastography (MRE) can predict the outcome of radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients. Materials and Methods: A total of 107 patients with Child-Pugh class A liver function who were treated with RFA for single HCC and who had undergone a gradient-echo MRE within 6 months before RFA were included. We evaluated the relationship between the LS values and the ablation volume, local tumor progression (LTP), and intrahepatic distant recurrence (IDR). We also constructed receiver operating characteristic (ROC) curves to examine the role of LS in predicting liver function deterioration, which was defined as an increase of Child-Pugh score by one point or more at 1 year after RFA. Results: There was no significant correlation between LS and ablation volume, and neither time to LTP nor IDR was associated with LS. Among the 66 patients who did not have recurrence 1 year after RFA, 5 patients (7.6%) developed liver function deterioration. A high LS value was significantly associated with development of liver function deterioration after RFA and the area under the ROC curve was 0.764 (95% CI 0.598-0.929, P = 0.003). Conclusion: LS measured by MRE could not predict ablation volume and tumor recurrence. However, high LS values were significantly associated with development of liver function deterioration.
참고문헌 (52)
- El-Serag HB, "Epidemiology of viral hepatitis and hepatocellular carcinoma", Gastroenterology, 142, pp.1264~1273e1261 (2012)
- Raza A, "Hepatocellular carcinoma review:current treatment, and evidence-based medicine", World J Gastroenterol, 20, pp.4115~4127 (2014)
- European Association For The Study Of The Liver, "EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma", J Hepatol, 56, pp.908~943 (2012)
- Bruix J, "American Association for the Study of Liver Diseases Management of hepatocellular carcinoma:an update", Hepatology, 53, pp.1020~1022 (2011)
- Forner A, "Hepatocellular carcinoma", Lancet, 379, pp.1245~1255 (2012)
- Cho YK, "Hepatic resection versus radiofrequency ablation for very early stage hepatocellular carcinoma: a Markov model analysis", Hepatology, 51, pp.1284~1290 (2010)
- Cucchetti A, "Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma", J Hepatol, 59, pp.300~307 (2013)
- Clasen S, "Multipolar radiofrequency ablation with internally cooled electrodes:experimental study in ex vivo bovine liver with mathematic modeling", Radiology, 238, pp.881~890 (2006)
- Ahmed M, "Computer modeling of the combined effects of perfusion, electrical conductivity, and thermal conductivity on tissue heating patterns in radiofrequency tumor ablation", Int J Hyperthermia, 24, pp.577~588 (2008)
- Bosch J, "Complications of cirrhosis. I. Portal hypertension", J Hepatol, 32, pp.141~156 (2000)
- Liu Z, "Computer modeling of the effect of perfusion on heating patterns in radiofrequency tumor ablation", Int J Hyperthermia, 23, pp.49~58 (2007)
- Ahmed M, "Principles of and advances in percutaneous ablation", Radiology, 258, pp.351~369 (2011)
- 김진웅, "Ultrasound-Guided Percutaneous Radiofrequency Ablation of Liver Tumors: How We Do It Safely and Completely", Korean Journal of Radiology, 16(6), pp.1226~1239 (2015), 대한영상의학회[DOI]
- Tu R, "Assessment of hepatic functional reserve by cirrhosis grading and liver volume measurement using CT", World J Gastroenterol, 13, pp.3956~3961 (2007)
- Lu LG, "Grading and staging of hepatic fibrosis, and its relationship with noninvasive diagnostic parameters", World J Gastroenterol, 9, pp.2574~2578 (2003)
- Tsochatzis EA, "Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a metaanalysis of diagnostic accuracy", J Hepatol, 54, pp.650~659 (2011)
- Chang W, "Liver fibrosis staging with MR elastography: comparison of diagnostic performance between patients with chronic hepatitis B and those with other etiologic causes", Radiology, 280, pp.88~97 (2016)
- Maurice JB, "Validation of the Baveno VI criteria to identify low risk cirrhotic patients not requiring endoscopic surveillance for varices", J Hepatol, 65, pp.899~905 (2016)
- Augustin S, "Ruling in and ruling out with elastography in compensated advanced chronic liver disease", Gut, 66, pp.197~198 (2017)
- Shin SU, "Prediction of esophageal varices in patients with cirrhosis: usefulness of threedimensional MR elastography with echo-planar imaging technique", Radiology, 272, pp.143~153 (2014)
- Yoon JH, "Hepatic fibrosis: prospective comparison of MR elastography and US shear-wave elastography for evaluation", Radiology, 273, pp.772~782 (2014)
- Huber A, "State-of-theart imaging of liver fibrosis and cirrhosis: a comprehensive review of current applications and future perspectives", Eur J Radiol Open, 2, pp.90~100 (2015)
- Venkatesh SK, "Magnetic resonance elastography of liver", Magn Reson Imaging Clin N Am, 22, pp.433~446 (2014)
- Mitchell DG, "LI-RADS (Liver Imaging Reporting and Data System): summary, discussion, and consensus of the LI-RADS Management Working Group and future directions", Hepatology, 61, pp.1056~1065 (2015)
- Motosugi U, "Effects of gadoxetic acid on liver elasticity measurement by using magnetic resonance elastography", Magn Reson Imaging, 30, pp.128~132 (2012)
- Huwart L, "Liver fibrosis: noninvasive assessment with MR elastography", NMR Biomed, 19, pp.173~179 (2006)
- Manduca A, "Magnetic resonance elastography: non-invasive mapping of tissue elasticity", Med Image Anal, 5, pp.237~254 (2001)
- Silva AM, "Magnetic resonance elastography: evaluation of new inversion algorithm and quantitative analysis method", Abdom Imaging, 40, pp.810~817 (2015)
- Nedredal GI, "Portal hypertension correlates with splenic stiffness as measured with MR elastography", J Magn Reson Imaging, 34, pp.79~87 (2011)
- Woo S, "Small- and medium-sized hepatocellular carcinomas: monopolar radiofrequency ablation with a multiple-electrode switching system-midterm results", Radiology, 268, pp.589~600 (2013)
- Lu DS, "Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors", J Vasc Interv Radiol, 14, pp.1267~1274 (2003)
- Goldberg SN, "Image-guided tumor ablation: standardization of terminology and reporting criteria", Radiology, 235, pp.728~739 (2005)
- Wright AS, "Radiofrequency versus microwave ablation in a hepatic porcine model", Radiology, 236, pp.132~139 (2005)
- 이현석, "Thrombocytopenia represents a risk for deterioration of liver function after radiofrequency ablation in patients with hepatocellular carcinoma", Clinical and Molecular Hepatology, 18(3), pp.302~308 (2012), 대한간학회[DOI]
- Kuroda H, "Changes in liver function parameters after percutaneous radiofrequency ablation therapy in patients with hepatocellular carcinoma", Hepatol Res, 40, pp.550~554 (2010)
- Ishikawa M, "Clarification of risk factors for hepatectomy in patients with hepatocellular carcinoma", Hepatogastroenterology, 49, pp.1625~1631 (2002)
- Farges O, "Risk of major liver resection in patients with underlying chronic liver disease: a reappraisal", Ann Surg, 229, pp.210~215 (1999)
- Bensamoun SF, "Measurement of liver stiffness with two imaging techniques: magnetic resonance elastography and ultrasound elastometry", J Magn Reson Imaging, 28, pp.1287~1292 (2008)
- Sun HY, "Usefulness of MR elastography for predicting esophageal varices in cirrhotic patients", J Magn Reson Imaging, 39, pp.559~566 (2014)
- Goldberg SN, "Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance", AJR Am J Roentgenol, 174, pp.323~331 (2000)
- Moreno AH, "Portal blood flow in cirrhosis of the liver", J Clin Invest, 46, pp.436~445 (1967)
- Zurbuchen U, "Determination of the temperature-dependent electric conductivity of liver tissue ex vivo and in vivo: Importance for therapy planning for the radiofrequency ablation of liver tumours", Int J Hyperthermia, 26, pp.26~33 (2010)
- Tung-Ping Poon R, "Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma", Ann Surg, 232, pp.10~24 (2000)
- Ng IO, "Prognostic significance of pathologic features of hepatocellular carcinoma. A multivariate analysis of 278 patients", Cancer, 76, pp.2443~2448 (1995)
- Wu JC, "Risk factors for early and late recurrence in hepatitis B-related hepatocellular carcinoma", J Hepatol, 51, pp.890~897 (2009)
- Poon RT, "Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma", Cancer, 89, pp.500~507 (2000)
- Fernandez M, "Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease", Eur J Gastroenterol Hepatol, 27, pp.1074~1079 (2015)
- Kim SU, "Transient elastography in chronic hepatitis B: an Asian perspective", World J Gastroenterol, 16, pp.5173~5180 (2010)
- Motosugi U, "Cross-validation of MR elastography and ultrasound transient elastography in liver stiffness measurement: discrepancy in the results of cirrhotic liver", J Magn Reson Imaging, 35, pp.607~610 (2012)
- Oudry J, "Cross-validation of magnetic resonance elastography and ultrasound-based transient elastography: a preliminary phantom study", J Magn Reson Imaging, 30, pp.1145~1150 (2009)
- Sturm N, "Comparative assessment of liver fibrosis by computerized morphometry in naive patients with chronic hepatitis B and C", Liver Int, 33, pp.428~438 (2013)
- Pinzani M, "Fibrosis in chronic liver diseases: diagnosis and management", J Hepatol, 42(Suppl), pp.S22~S36 (2005)