Tumor enhancement at contrast-enhanced CT and Gd-enhanced MRI for the assessment of treatment response of hepatocellular carcinoma (HCC) after sorafenib

Scopo: To investigate whether arterial enhancement of advanced HCC during pre-treatment and follow-up contrast-enhanced CT (CECT) or Gd-enhanced MRI (Gd-MRI) can be used to predict tumor response to sorafenib. Materiali e metodi: Seventeen patients (12M, 5F; mean age: 69 years) receiving sorafenib for inoperable HCC between 2007 and 2010 were included. Median interval time between pre-treatment and follow-up CECT or Gd-MRI was 160 days. Tumor arterial enhancement was measured at baseline and follow-up: (tumor attenuation/intensity on arterial phase – tumor attenuation/intensity on unenh! anced images)/(tumor attenuation/intensity on unenhanced images) x 100. Response was assessed according to modified RECIST (mRECIST) criteria (one-dimensional measurement of viable tumor). Mann-Whitney-U test was used to assess significance of difference of tumor enhancement at baseline, change in tumor enhancement at follow-up, and tumor response. Risultati: Three (18%) patients had progressive disease (PD), 3 (18%) partial response (PR), and 11 (64%) stable disease (SD) according to mRECIST. Mean tumor enhancement at baseline was significantly higher in PD (281.6% ± 166.1) compared to SD (112.8% ± 50.7) or PR (141.4% ± 90.1) (p = 0.007). In patients with PR, the decrease in mean tumor enhancement at follow-up (-76.1% ± 13.6) was significantly larger than in patients with SD (8.8% ± 148.4) or PD (-32.9% ± 7.4) (p = 0.013). Conclusioni: Higher tumor enhancement at baseline CECT or Gd-MRI can predict response after treatment with sorafenib in patients with advanced HCC. Larger decrease in tumor enhancement at follow-up correlates with response according to mRECIST criteria.