Islet Cell Liver Metastases: Assessment of Volumetric Early Response with Functional MR Imaging after Transarterial Chemoembolization

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Our results show that volumetric functional changes at diffusion-weighted MR imaging and contrast-enhanced MR imaging can enable early assessment of response to transcatheter arterial chemoembolization and can serve as objective surrogate markers of tumor response.


To assess early response to transarterial chemoembolization by using volumetric functional magnetic resonance (MR) imaging in patients with islet cell liver metastases (ICLMs).

Materials and Methods

This retrospective institutional review board–approved HIPAA-compliant study included 215 ICLMs in 26 patients (15 men, 11 women; mean age, 59.7 years; age range, 37–79 years). Volumetric measurements were performed by an experienced radiologist on diffusion-weighted and contrast material–enhanced MR images at baseline and 1-month follow-up. Measurements included mean change (three-dimensional [3D] mean apparent diffusion coefficient [ADC], 3D mean enhancement) and percentage of tumor with change above a predetermined threshold (3D threshold ADC, 3D threshold enhancement). Response by volumetric measurements at 1-month follow-up was compared with Response Evaluation Criteria in Solid Tumors (RECIST) at 6-month follow-up. Lesions that had complete or partial response were considered responders, while those with stable or progressive disease were considered nonresponders. Statistical analysis included the t test, receiver operating characteristic (ROC) curve analysis, and logistic regression analysis.


RECIST criteria at 6-month follow-up indicated 78 (36.3%) lesions responded, while 137 (63.7%) did not. The increase in 3D mean ADC was significantly higher in responders than in nonresponders (median, 26.2% vs 10.9%; P < .001). The 3D threshold ADC was 71.1% in responders and 47.6% in nonresponders (P < .001). Decrease in 3D mean arterial enhancement (AE) was significantly higher in responders than in nonresponders (median, 40.5% vs 18.0%; P < .001). Decrease in 3D mean venous enhancement (VE) was significantly higher in responders than in nonresponders (median, 28.0% vs 10.0%; P < .001). The 3D threshold VE and 3D threshold AE did not differ between responders and nonresponders. In unadjusted logistic regression analyses, 3D mean ADC and 3D threshold ADC had the highest odds ratio (1.02 and 1.03, respectively) and the largest area under the ROC curve (0.698 and 0.695, respectively).


Volumetric functional MR imaging could be used to predict early response of hepatic ICLMs to therapy and to distinguish between responders and nonresponders.

© RSNA, 2012


  • 1 Rha SE, Jung SE, Lee KH, Ku YM, Byun JY, Lee JM. CT and MR imaging findings of endocrine tumor of the pancreas according to WHO classification. Eur J Radiol 2007;62(3):371–377. Crossref, MedlineGoogle Scholar
  • 2 Eckhauser FE, Cheung PS, Vinik AI, Strodel WE, Lloyd RV, Thompson NW. Nonfunctioning malignant neuroendocrine tumors of the pancreas. Surgery 1986;100(6):978–988. MedlineGoogle Scholar
  • 3 Tomassetti P, Campana D, Piscitelli L, et al.. Endocrine pancreatic tumors: factors correlated with survival. Ann Oncol 2005;16(11):1806–1810. Crossref, MedlineGoogle Scholar
  • 4 Chamberlain RS, Canes D, Brown KT, et al.. Hepatic neuroendocrine metastases: does intervention alter outcomes? J Am Coll Surg 2000;190(4):432–445. Crossref, MedlineGoogle Scholar
  • 5 McEntee GP, Nagorney DM, Kvols LK, Moertel CG, Grant CS. Cytoreductive hepatic surgery for neuroendocrine tumors. Surgery 1990;108(6):1091–1096. MedlineGoogle Scholar
  • 6 Mayo SC, de Jong MC, Bloomston M, et al.. Surgery versus intra-arterial therapy for neuroendocrine liver metastasis: a multicenter international analysis. Ann Surg Oncol 2011;18(13):3657–3665. Crossref, MedlineGoogle Scholar
  • 7 Liapi E, Geschwind JF, Vossen JA, et al.. Functional MRI evaluation of tumor response in patients with neuroendocrine hepatic metastasis treated with transcatheter arterial chemoembolization. AJR Am J Roentgenol 2008;190(1):67–73. Crossref, MedlineGoogle Scholar
  • 8 Kim JH, Yoon HK, Ko GY, et al.. Nonresectable combined hepatocellular carcinoma and cholangiocarcinoma: analysis of the response and prognostic factors after transcatheter arterial chemoembolization. Radiology 2010;255(1):270–277. LinkGoogle Scholar
  • 9 Carr BI, Kondragunta V, Buch SC, Branch RA. Therapeutic equivalence in survival for hepatic arterial chemoembolization and yttrium 90 microsphere treatments in unresectable hepatocellular carcinoma: a two-cohort study. Cancer 2010;116(5):1305–1314. Crossref, MedlineGoogle Scholar
  • 10 Eisenhauer EA, Therasse P, Bogaerts J, et al.. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45(2):228–247. Crossref, MedlineGoogle Scholar
  • 11 Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010;30(1):52–60. Crossref, MedlineGoogle Scholar
  • 12 Padhani AR, Liu G, Koh DM, et al.. Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia 2009;11(2):102–125. Crossref, MedlineGoogle Scholar
  • 13 Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005;42(5):1208–1236. Crossref, MedlineGoogle Scholar
  • 14 Kamel IR, Bluemke DA, Eng J, et al.. The role of functional MR imaging in the assessment of tumor response after chemoembolization in patients with hepatocellular carcinoma. J Vasc Interv Radiol 2006;17(3):505–512. Crossref, MedlineGoogle Scholar
  • 15 Kamel IR, Bluemke DA, Ramsey D, et al.. Role of diffusion-weighted imaging in estimating tumor necrosis after chemoembolization of hepatocellular carcinoma. AJR Am J Roentgenol 2003;181(3):708–710. Crossref, MedlineGoogle Scholar
  • 16 Kim S, Mannelli L, Hajdu CH, et al.. Hepatocellular carcinoma: assessment of response to transarterial chemoembolization with image subtraction. J Magn Reson Imaging 2010;31(2):348–355. Crossref, MedlineGoogle Scholar
  • 17 Cui Y, Zhang XP, Sun YS, Tang L, Shen L. Apparent diffusion coefficient: potential imaging biomarker for prediction and early detection of response to chemotherapy in hepatic metastases. Radiology 2008;248(3):894–900. LinkGoogle Scholar
  • 18 Buijs M, Vossen JA, Hong K, Georgiades CS, Geschwind JF, Kamel IR. Chemoembolization of hepatic metastases from ocular melanoma: assessment of response with contrast-enhanced and diffusion-weighted MRI. AJR Am J Roentgenol 2008;191(1):285–289. Crossref, MedlineGoogle Scholar
  • 19 Vossen JA, Kamel IR, Buijs M, et al.. Role of functional magnetic resonance imaging in assessing metastatic leiomyosarcoma response to chemoembolization. J Comput Assist Tomogr 2008;32(3):347–352. Crossref, MedlineGoogle Scholar
  • 20 Kamel IR, Liapi E, Reyes DK, Zahurak M, Bluemke DA, Geschwind JF. Unresectable hepatocellular carcinoma: serial early vascular and cellular changes after transarterial chemoembolization as detected with MR imaging. Radiology 2009;250(2):466–473. LinkGoogle Scholar
  • 21 Marugami N, Tanaka T, Kitano S, et al.. Early detection of therapeutic response to hepatic arterial infusion chemotherapy of liver metastases from colorectal cancer using diffusion-weighted MR imaging. Cardiovasc Intervent Radiol 2009;32(4):638–646. Crossref, MedlineGoogle Scholar
  • 22 Duke E, Deng J, Ibrahim SM, et al.. Agreement between competing imaging measures of response of hepatocellular carcinoma to yttrium-90 radioembolization. J Vasc Interv Radiol 2010;21(4):515–521. Crossref, MedlineGoogle Scholar
  • 23 Riaz A, Miller FH, Kulik LM, et al.. Imaging response in the primary index lesion and clinical outcomes following transarterial locoregional therapy for hepatocellular carcinoma. JAMA 2010;303(11):1062–1069. Crossref, MedlineGoogle Scholar
  • 24 Gupta S, Johnson MM, Murthy R, et al.. Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors: variables affecting response rates and survival. Cancer 2005;104(8):1590–1602. Crossref, MedlineGoogle Scholar
  • 25 Chenevert TL, McKeever PE, Ross BD. Monitoring early response of experimental brain tumors to therapy using diffusion magnetic resonance imaging. Clin Cancer Res 1997;3(9):1457–1466. MedlineGoogle Scholar
  • 26 Thoeny HC, De Keyzer F, Vandecaveye V, et al.. Effect of vascular targeting agent in rat tumor model: dynamic contrast-enhanced versus diffusion-weighted MR imaging. Radiology 2005;237(2):492–499. LinkGoogle Scholar
  • 27 Jennings D, Hatton BN, Guo J, et al.. Early response of prostate carcinoma xenografts to docetaxel chemotherapy monitored with diffusion MRI. Neoplasia 2002;4(3):255–262. Crossref, MedlineGoogle Scholar
  • 28 Youn BJ, Chung JW, Son KR, et al.. Diffusion-weighted MR: therapeutic evaluation after chemoembolization of VX-2 carcinoma implanted in rabbit liver. Acad Radiol 2008;15(5):593–600. Crossref, MedlineGoogle Scholar
  • 29 Kubota K, Yamanishi T, Itoh S, et al.. Role of diffusion-weighted imaging in evaluating therapeutic efficacy after transcatheter arterial chemoembolization for hepatocellular carcinoma. Oncol Rep 2010;24(3):727–732. Crossref, MedlineGoogle Scholar
  • 30 Koh DM, Scurr E, Collins D, et al.. Predicting response of colorectal hepatic metastasis: value of pretreatment apparent diffusion coefficients. AJR Am J Roentgenol 2007;188(4):1001–1008. Crossref, MedlineGoogle Scholar
  • 31 Bonekamp S, Jolepalem P, Lazo M, Gulsun MA, Kiraly AP, Kamel IR. Hepatocellular carcinoma: response to TACE assessed with semiautomated volumetric and functional analysis of diffusion-weighted and contrast-enhanced MR imaging data. Radiology 2011;260(3):752–761. LinkGoogle Scholar
  • 32 Castrucci M, Sironi S, De Cobelli F, Salvioni M, Del Maschio A. Plain and gadolinium-DTPA-enhanced MR imaging of hepatocellular carcinoma treated with transarterial chemoembolization. Abdom Imaging 1996;21(6):488–494. Crossref, MedlineGoogle Scholar
  • 33 Sun HY, Lee JM, Shin CI, et al.. Gadoxetic acid-enhanced magnetic resonance imaging for differentiating small hepatocellular carcinomas (, or =2 cm in diameter) from arterial enhancing pseudolesions: special emphasis on hepatobiliary phase imaging. Invest Radiol 2010;45(2):96–103. Crossref, MedlineGoogle Scholar
  • 34 Bae MS, Jahng GH, Ryu CW, Kim EJ, Choi WS, Yang DM. Effect of intravenous gadolinium-DTPA on diffusion tensor MR imaging for the evaluation of brain tumors. Neuroradiology 2009;51(12):793–802. Crossref, MedlineGoogle Scholar
  • 35 Buijs M, Kamel IR, Vossen JA, Georgiades CS, Hong K, Geschwind JF. Assessment of metastatic breast cancer response to chemoembolization with contrast agent enhanced and diffusion-weighted MR imaging. J Vasc Interv Radiol 2007;18(8):957–963. Crossref, MedlineGoogle Scholar

Article History

Received October 10, 2011; revision requested November 14; revision received January 9, 2012; accepted January 19; final version accepted February 7.
Published online: July 2012
Published in print: July 2012