Inter-reader agreement in LR-TRA application and NLR association in HCC patients treated with endovascular vs ablative procedures

ObjectivesThis study aimed to assess the association between NLR and inter-reader agreement in LR-TRA application in HCC patients treated with Microwave Ablation (MWA) and Transarterial Embolization (TAE).MethodsA retrospective analysis was conducted on 78 HCC patients treated with MWA or TAE. Two independent radiologists evaluated post-treatment imaging according to the LR-TRA and their agreement was assessed using Cohen's kappa statistic. NLR was measured at baseline, 3 and 30 days after treatment and differences in subgroups of patients were analysed by Mann-Whitney U test and mixed ANOVA.ResultsThe inter-reader agreement in the LR-TRA application was “substantial” in the cases of MWA treatment evaluation (κ=0.65), and “moderate” in the cases of TAE treatment evaluation (κ=0.51). The differences in inter-reader agreement were found to be expressions of different levels of NLR mean value in different time frames evaluated. At 3 days after treatment, NLR increased significantly in TAE groups. At 30 days, NLR had returned close to baseline levels but with NLR persisting higher in the TAE group. There was a statistically significant difference in NLR between the "mismatch" group (those with discrepant LR-TRA readings) and the "match" group at 3 days (p=0.004) and late evaluation (30+ days).DiscussionThe literature has neglected to account for the role of the different locoregional treatments in influencing LR-TRA evaluation and inter-reader agreement, a shortcoming this thesis addresses. The role of the inflammatory microenvironment and immunologic response after treatments as in cases of coagulative necrosis generated by MWA and blood supply block (TAE) may have repercussions on imaging evaluation. ConclusionThis study has shown that NLR levels can be used to predict inter-reader discrepancies in LR-TRA assessment and that combining LR-TRA and NLR for a more comprehensive assessment of tumour response and inflammatory dynamics is promising.