Predicting Infiltrative Hepatocellular Carcinoma Patient Outcome Post-TACE: MR Bias Field Correction Effect on 3D-quantitative Image Analysis

Cuihong Liu; Susanne Smolka; Xenophon Papademetris; Duc Do Minh; Geliang Gan; Yanhong Deng; MingDe Lin; Julius Chapiro; Ximing Wang; Christos Georgiades; Kelvin Hong

doi:10.14218/JCTH.2020.00054

Predicting Infiltrative Hepatocellular Carcinoma Patient Outcome Post-TACE: MR Bias Field Correction Effect on 3D-quantitative Image Analysis

J Clin Transl Hepatol. 2020 Sep 28;8(3):292-298. doi: 10.14218/JCTH.2020.00054. Epub 2020 Aug 18.

Authors

Cuihong Liu^{1

2}, Susanne Smolka^{2

3}, Xenophon Papademetris⁴, Duc Do Minh^{2

3}, Geliang Gan⁵, Yanhong Deng⁵, MingDe Lin², Julius Chapiro², Ximing Wang^{6

7}, Christos Georgiades⁸, Kelvin Hong⁸

Affiliations

¹ Department of Ultrasound Diagnosis and Treatment, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
² Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
³ Department of Diagnostic and Interventional Radiology, Charité University Hospital, Berlin, Germany.
⁴ Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
⁵ School of Public Health, Yale University, New Haven, CT, USA.
⁶ Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
⁷ Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
⁸ Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA.

Abstract

Background and Aims: To investigate the impact of MR bias field correction on response determination and survival prediction using volumetric tumor enhancement analysis in patients with infiltrative hepatocellular carcinoma, after transcatheter arterial chemoembolization (TACE). Methods: This study included 101 patients treated with conventional or drug-eluting beads TACE between the years of 2001 and 2013. Semi-automated 3D quantification software was used to segment and calculate the enhancing tumor volume (ETV) of the liver with and without bias-field correction on multi-phasic contrast-enhanced MRI before and 1-month after initial TACE. ETV (expressed as cm³) at baseline imaging and the relative change in ETV (as % change, ETV%) before and after TACE were used to predict response and survival, respectively. Statistical survival analyses included Kaplan-Meier curve generation and Cox proportional hazards modeling. Q statistics were calculated and used to identify the best cut-off value for ETV to separate responders and non-responders (ETV cm³). The difference in survival was evaluated between responders and non-responders using Kaplan-Meier and Cox models. Results: MR bias field correction correlated with improved response calculation from baseline MR as well as survival after TACE; using a 415 cm³ cut-off for ETV at baseline (hazard ratio: 2.00, 95% confidence interval: 1.23-3.26, p=0.01) resulted in significantly improved response prediction (median survival in patients with baseline ETV <415 cm³: 19.66 months vs. ≥415 cm³: 9.21 months, p<0.001, log-rank test). A ≥41% relative decrease in ETV (hazard ratio: 0.58, 95%confidence interval: 0.37-0.93, p=0.02) was significant in predicting survival (ETV ≥41%: 19.20 months vs. ETV <41%: 8.71 months, p=0.008, log-rank test). Without MR bias field correction, response from baseline ETV could be predicted but survival after TACE could not. Conclusions: MR bias field correction improves both response assessment and accuracy of survival prediction using whole liver tumor enhancement analysis from baseline MR after initial TACE in patients with infiltrative hepatocellular carcinoma.

Keywords: 3D volume measurement; Bias field correction; Infiltrative HCC; Segmentation; TACE.

Grants and funding

UL1 TR001863/TR/NCATS NIH HHS/United States