Research Presentation Session: Interventional Radiology

RPS 1509 - Advanced imaging and challenging interventions in the liver

March 1, 14:00 - 15:30 CET

7 min
Trans-splenic antegrade coil-assisted transvenous occlusion (TACATO) of gastric varices associated with gastro-renal shunt in cirrhosis: a single-centre prospective preliminary study
Stefano Groff, Padova / Italy
Author Block: S. Groff, G. Cicognini, G. Barbiero, M. Battistel, S. Shalaby, M. Senzolo, G. De Conti; Padova/IT
Purpose: This study aimed to report the technical success and clinical efficacy of the sole antegrade trans-splenic approach for occlusion of gastric varices (GVs) associated with gastro-renal shunt (GRS) in cirrhotics.
Methods or Background: All patients who bled from GVs associated with GRS without severe ascites or large oesophagal varices were selected for evaluation. From February 2020 to July 2023, 29 patients were evaluated and 19 were included for treatment as secondary prophylaxis and prospectively followed-up (mean time of 15.3 months; range 3-43 months).
Splenoportography from trans-splenic access classified venous afferents to the GVs (Saad-Caldwell classification), which were selectively catheterized and embolized with coils+/-N-butyl-2-cyanoacrylate+methacryloxysulfolane and ethiodized oil (NBCA+LUF).
Final splenoportography assessed occlusion of GVs (technical success). The trans-splenic tract was sealed with NBCA+LUF. Access size, number-size of microcoils, use of NBCA+LUF and fluoroscopy time were recorded.
Postprocedural ultrasound and haemoglobin levels evaluated bleeding complications.
Follow-up included clinical evaluation, contrast-enhanced CT (CECT) and esophagogastroduodenoscopy (EGD).
Results or Findings: Splenoportography identified Saad-Caldwell type 1b GVs in two cases, type 2b in ten cases and type 3b in seven cases. Different introducer sheath and microcoils sizes were used, with a mean number of 8.4 microcoils per patient (range 1-20). Microcoils alone were used in four patients and with NBCA+LUF in 15 patients. Mean fluoroscopy time was 20.8 min (range 7.1-43.1 min). Final splenoportography documented total occlusion of GVs in 15 patients (79%) and partial occlusion in four patients (21%). No bleeding complications.
Clinical follow-up documented stable liver function, no re-bleeding from GVs nor development/worsening of ascites. CECT showed three cases of splenic/portal vein thrombosis. Follow-up EGD revealed the disappearance/reduction of GVs in all patients.
Conclusion: TACATO seems safe and effective for treating GVs associated with GRS and should be further evaluated in the algorithm of treatment.
Limitations: Preliminary study: larger number of patients required.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Padua University Hospital (HIC protocol #0034435)
7 min
Factors impacting survival after transarterial radioembolisation in patients with intrahepatic cholangiocarcinoma: a combined analysis of the prospective CIRT and CIRT-FR studies
Peter Reimer, Karlsruhe / Germany
Author Block: P. Reimer1, V. Vilgrain2, D. Arnold3, R. Loffroy4, B. Sangro5, M. Urdaniz6, H. Pereira7, N. de Jong6, T. K. Helmberger8; 1Karlsruhe/DE, 2Clichy/FR, 3Hambrug/DE, 4Dijon/FR, 5Pamplona/ES, 6Vienna/AT, 7Paris/FR, 8Munich/DE
Purpose: This study aimed to discuss the treatment option of Transarterial radioembolization (TARE) with Yttrium-90 resin microspheres for patients with intrahepatic cholangiocarcinoma (ICC). Optimizing the timing of TARE in relation to systemic therapies and patient selection remains challenging. We report here on the effectiveness, safety, and prognostic factors associated with TARE for ICC in an analysis of the prospective observational CIRT (CIRSE Registry for SIR-Spheres Therapy) studies (NCT02305459 and NCT03256994).
Methods or Background: A separate analysis of all 174 ICC patients within CIRT studies was performed. Patient characteristics and treatment-related data were collected at baseline; time-to-event data (overall survival [OS], progression-free survival [PFS] and hepatic PFS) were collected at every follow-up visit. Log-rank tests and a multivariable Cox proportional hazard model were used to identify prognostic factors.
Results or Findings: Patients receiving a first-line strategy of TARE, in addition to any systemic treatment, had a median OS and PFS of 32.5 months and 11.3 months. Patients selected for first-line TARE alone showed a median OS and PFS of 16.2 months and 7.4 months, whereas TARE as 2nd or further treatment-line resulted in a median OS and PFS of 12 and 9.3 months (p=0.0028), and 5.1 and 3.5 months (p=0.0012), respectively. Partition model dosimetry was an independent predictor for better OS (HR 0.59 [95% CI 0.37-0.94], p=0.0259). No extrahepatic disease, no ascites, and <6.1 months from diagnosis to treatment were independent predictors for longer PFS.
Conclusion: This combined analysis indicates that in unresectable ICC, TARE in combination with any systemic treatment is a promising treatment option in the first line. Partition model dosimetry improved the effectiveness of TARE.
Limitations: Patients and physicians were not blinded within the prospective CIRSE Registry for SIR-Spheres therapy reflecting the real-world treatment situation.
Funding for this study: This study was funded by an unconditional research grant from Sirtex Medical Europe, GmbH.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by applicable regulatory bodies and/or ethics committees in Germany, Switzerland, Turkey, Italy, Spain, Israel, France, and Belgium as applicable for observational studies.
7 min
Simultaneous portal and hepatic vein embolisation in inducing future liver remnant hypertrophy: the impact of steatosis in hepatic regeneration
Domenico Santangelo, Milan / Italy
Author Block: D. Santangelo, D. Palumbo, M. Platì, C. Canevari, F. Ratti, L. Aldrighetti, F. De Cobelli; Milan/IT
Purpose: This study aimed to assess the impact of preoperative LS on complications after major liver surgery and to identify any eventual liver steatosis modification pattern after liver venous deprivation (LVD). Liver steatosis (LS) has been widely associated with post-surgical complications in different surgery fields.
Methods or Background: Patients who underwent, between 01/2019 and 12/2022, LVD were identified (n = 40). Those who ultimately underwent surgery (n = 27, 67.5%) were enrolled. LS was defined as mean liver density lower than 50 HU. Pre/post-procedural CT and scintigraphic data were collected. Data regarding post-surgical complications, in particular, post-hepatectomy liver failure (PHLF) were collected.
Results or Findings: Of the 27 patients undergoing surgery, 12 presented with LS at a preoperative CT scan. This subgroup demonstrated a higher chance of developing post-surgical complications (p < 0.05). Non-steatotic patients showed, after LVD, a rapid decrease of residual liver HU values (- 5.60 HU, +/- 4.91). On the contrary, patients with baseline steatosis did not experience significant changes (p < 0.001). Those who developed post-LVD steatosis (n = 7) did not show an increased risk of developing post-surgical complications when compared to those who remained in their steatosis group. Patients who developed post-LVD steatosis demonstrate a lower functional degree of hypertrophy (p < 0.05).
Conclusion: This proof-of-concept study suggests two conclusions: (1) Pre-LVD LS is a risk factor for the development of post-surgical complications, and (2) LVD seems to function as a trigger for a modification of residual liver density; such “induced” post-LVD steatosis differs from the metabolic one both in terms of lower post-surgical complications rate and impaired function of the liver remnant. We are possibly looking at two different histological entities brought together by a similar radiological appearance.
Limitations: The limitations of this study are that it was retrospective and it was a small population.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by Leatum 64/INT/2021.
7 min
CT-guided high-dose-rate brachytherapy induces systemic proteins of proliferation and angiogenesis predicting outcome in HCC
Matthias Max Rudolf Stechele, Munich / Germany
Author Block: M. M. R. Stechele1, S. N. Goldberg2, M. Wildgruber1, P. M. Kazmierczak1, L. Salvermoser1, M. Alunni-Fabbroni1, J. Ricke1; 1Munich/DE, 2Jerusalem/IL
Purpose: This study aimed to assess the potential prognostic value of proliferation and angiogenesis markers following CT-guided high-dose-rate brachytherapy (HDR-BT) of hepatocellular carcinoma (HCC).
Methods or Background: For this prospective study, HDR-BT (1x15Gy) was performed in 24 HCC patients. Plasma was obtained at baseline and 48 hours post-HDR-BT and analysed using an Olink proteomics Target-96 immuno-oncology-panel, including multiple markers of angiogenesis and proliferation. Protein fold-change (FC) ratios were calculated. Patients without progression within 6m or systemic progression within two years were classified as responders (R; n=12). Patients with recurrence within 6m and/or tumour progression or extrahepatic disease within two years were classified as non-responders (NR; n=12).
Results or Findings: Angiopoietin-1 (median R: 0.86; NR: 1.29; p= 0.008) and PDGF-B (R: 0.89; NR: 1.25; p= 0.033) were significantly elevated in non-responders compared to responders. FC between responders and non-responders did not differ significantly for Angiopoietin-2, VEGF-A, and VEGFR-2. FC of EGF (R: 0.67; NR: 1.51; p= 0.028) was significantly elevated in non-responders compared to responders with no significant difference for FGF-2, HGF, and PGF. Kaplan-Meier analyses demonstrated a significantly shorter time to systemic progression for increased Angiopoietin-1 and EGF (p= 0.011 and 0.019 respectively), but not for remaining proteins (all p >0.1). Pooled analysis for all 9 proteins showed significantly shorter systemic progression for FC ≥ 1.3 in ≥ 3 proteins (p= 0.022).
Conclusion: Increased plasma levels of Angiopoietin-1 and EGF after HDR-BT for HCC are associated with poor response and may therefore function as predictive biomarkers of outcome.
Limitations: Given a small cohort, further expansion of protein panels and evaluation of potential dynamic changes of target proteins over time are needed to achieve optimal biomarker potential.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: In this monocentric clinical study, we analysed prospectively from acquired
data of 24 patients from the “ESTIMATE” patient cohort (Studiennummer:
DRKS00010587, Deutsches Register Klinischer Studien). Ethical approval was
provided by the ethics committee Ethikkommission bei der LMU München:
(reference number “17-346”) on June 20, 2017, and August 26, 2020.
7 min
Transjugular intrahepatic porto-systemic shunt in paediatric patients: comparison between standard approach and alternative techniques
Paolo Marra, Bergamo / Italy
Author Block: P. Marra1, R. Muglia1, N. Liggeri1, C. Sallemi2, L. Dulcetta1, F. S. Carbone1, S. Sironi1; 1Bergamo/IT, 2Brescia/IT
Purpose: This study aimed to compare technical success, safety and clinical outcomes of TIPS performed with conventional technique or assisted by percutaneous approach in paediatric patients and difficult anatomies.
Methods or Background: From January 2019, paediatric patients or young adults with native liver or split liver grafts undergoing TIPS were retrospectively reviewed. Group A underwent TIPS through a standard transjugular approach. Group B underwent standard DIPS or "gun-sight" TIPS assisted by transhepatic and transsplenic approaches. Technical success in terms of correct TIPS placement, safety in terms of complications and clinical outcomes in terms of bleeding and ascites control were assessed and compared between groups.
Results or Findings: 16 patients underwent TIPS placement due to portal hypertension and variceal bleeding (n=7), portal vein thrombosis (n=6), Budd-Chiari syndrome (n=1) or refractory ascites (n=1). Out of six patients with portal vein thrombosis, four were affected by chronic portal vein thrombosis and cavernous transformation, and failed percutaneous portal vein recanalization or surgical meso-rex shunt. In two cases, TIPS was a bridge to liver transplant. In group A, eight patients (n=3 with regular anatomy; n=3 with cavernoma; n=2 with Budd-Chiari) successfully underwent TIPS with septic shock in one case. In group B, eight patients (n=4 with regular anatomy; n=4 with cavernoma; none with Budd-Chiari) successfully received TIPS with severe bleeding and precipitating liver failure in one case. No technical failures were recorded. Clinical outcome was good in all patients.
Conclusion: Alternative techniques for TIPS placement have a great success rate with good clinical outcomes. In paediatric patients and difficult anatomies DIPS and "gun-sight" TIPS might be considered.
Limitations: Small sample and potential selection bias.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study Portal_01 was approved by the Ethical Committee of Bergamo (reg.92-21).
7 min
Feasibility, safety and mid-term outcomes of non-expandable biodegradable biliary stents in paediatric liver transplants
Paolo Marra, Bergamo / Italy
Author Block: P. Marra, R. Muglia, F. S. Carbone, L. Dulcetta, S. Sironi; Bergamo/IT
Purpose: This study aimed to report the mid-term outcomes of percutaneous biliary drainage with double biodegradable stent placement for the treatment of benign anastomotic biliary strictures in paediatric liver transplants (PLT).
Methods or Background: From March 2022, consecutive patients with PLT who underwent percutaneous transhepatic cholangiography (PTC), bilioplasty and placement of two side-by-side 10F helical-shaped (non-expandable) biodegradable (slow degradation profile of 11 weeks) biliary stents were prospectively enrolled. Feasibility of double stent placement, safety in terms of procedure-related complications, freedom from stricture recurrence at imaging and absence of symptoms/signs of cholestasis were assessed.
Results or Findings: Percutaneous transhepatic stent placement was performed in 19 patients (10 females; median age 7 years, range 3-11 years) for the treatment of perianastomotic strictures (18 hepatico-jejunostomy; 1 duct-to-duct anastomosis). Stenting was performed after indwelling of trans-anastomotic biliary drainage for a median time of 28 days (range 11.5-53 days). Double stent placement in a side-by-side fashion was technically successful in 15/19 (79%) patients; in four patients a single trans-anastomotic stent was implanted. Stent fragmentation/migration before the expected degradation time was observed in 4/19 (21%) patients. One patient was readmitted with cholangitis and conservatively treated; no other complications occurred. Stricture recurrence was observed during a median follow-up of 233.5 days (range 182.5-263 days) in 6/19 (32%) patients who required new PTC procedures.
Conclusion: Preliminary data suggests that the placement of biodegradable biliary stents may mitigate concerns related to the maintenance of external biliary drainage in PLT patients affected by benign perianastomotic biliary strictures. However, the long-term efficacy of non-expandable stents is limited and needs to be compared with that of expandable devices in the PLT population.
Limitations: This study had a limited sample and lacked case-control analysis.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by Reg. Sperim. N. 061/23
7 min
Role of different stent types in endoluminal IRE for recanalization of an occluded metal stent: mathematical model of temperature distribution
Peter Matkulcik, Brno / Czechia
Author Block: P. Matkulcik, M. Hemzal, T. Andrasina, T. Rohan, M. Straka; Brno/CZ
Purpose: This study aimed to analyse the temperature distribution of endoluminal IRE for stent recanalization using a mathematical model in exact stent models.
Methods or Background: Endoluminal IRE for recanalization of different uncovered metal stents (Ella-CS, Boston Scientific, S&G Biotech and Micro-Tech medical) using a 3-electrode IRE catheter was simulated in a mathematical model of perfused liver tissue. The obstruction of the metal stent was simulated by 1, 2 and 3 mm layers of interposed tissue. 2D and 3D calculations by finite element software (COMSOL Multiphysics) defined the extent of thermal distribution zones in different IRE protocols (100 100 μs pulses, 1 Hz at 300 V, 650 V, 1000 V,1300 V). Differences in temperatures at the electrode, on the stent and 1 mm outside of the stent depending on stent type, voltage and width of interposed tissue were investigated.
Results or Findings: The biggest differences - up to 21% - were observed with 1 mm interposed tissue at voltages set to 1000 V at the electrode and at the stent (52.606-64.433 °C and 52.643-63.687 °C respectively). The highest temperatures were observed in simulations with Ella-CS stent, on the other hand, the lowest temperatures were observed in simulations with Microtech stent across all simulations. At voltages set to 1300 V, temperatures at the electrode and at the stent with 1 mm interposed tissue were 72.146-83.073 °C and 72,556-81,921 °C respectively, thus IRE in those scenarios was producing also thermal effects of ablation.
Conclusion: In the mathematical model, substantial differences in temperatures were observed between the specific stents analysed. In the highest voltages with 1 mm interposed tissue, thermal effects of ablation were present.
Limitations: This was a computer simulation.
Funding for this study: This study was funded by the Ministry of Health, Czech Republic: grant No.: NU21-08-00561.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Ethics committee approval was not necessary in this study.
7 min
Multiparametric MRI-based radiomics nomogram predicts the recurrence of hepatocellular carcinoma after postoperative adjuvant transarterial arterial chemoembolisation (PA-TACE)
Xinyu Guo, Lishui / China
Author Block: X. Guo, L. Zheng, J. Ji; Lishui/CN
Purpose: This study aimed to develop and validate a multiparametric MRI-based radiomics model for predicting the recurrence in hepatocellular carcinoma (HCC) patients after postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE).
Methods or Background: In this retrospective study, 117 HCC patients (81 for training and 36 for validation) treated with PA-TACE were included. Multiparametric radiomics features were extracted from T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) (b=800), and hepatic arterial phase (AP). Least absolute shrinkage and selection operator (LASSO)-COX regression was utilised to select radiomics features and calculate the radiomics score (Rad-score). Optimal clinical characteristics selected by univariate and multivariate Cox analysis were integrated with Rad-score to develop a recurrence-free survival (RFS) prediction model.
Results or Findings: 15 radiomics features were selected from three sequences of MRI. The significant difference in RFS between the high-risk and low-risk signature groups based on the Rad-score median value of 0.434 was confirmed in two cohorts (P < 0.05). The clinical independent predictors were neutrophil to lymphocyte ratio (NLR) (HR= 1.49, 95% CI: 1.1-2.1, P= 0.022) and tumour size (HR= 1.28, 95% CI: 1.1-1.5, P= 0.001). The clinical-radiomics model developed by Rad-score, NLR, and tumour size demonstrated favourable performance for predicting recurrence. The AUCs at 1-, 3- and 5-year time-dependent ROC curves based on the combined model were 0.82-0.91, and 0.75-0.91 in the two cohorts respectively.
Conclusion: The multiparametric MRI-based radiomics nomogram can well predict recurrence in HCC patients treated with PA-TACE and can serve as a valuable tool for clinical prognosis.
Limitations: Firstly, the study was retrospective. Secondly, all participants of this study were diagnosed with hepatitis B virus (HBV)-related HCC in China. Thirdly, our study did not explore tissue-related biomarkers such as specific gene mutations and signatures.
Funding for this study: Funding for this study was received from the National Natural Science Foundation of China (82102162 and 82072026), Natural Science Foundation of Zhejiang Province (LGF21H180002) and the Zhejiang Medical and Health Science Project (2022RC087).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Institutional Review Board and Human Ethics Committee of Lishui Hospital of Zhejiang University. The requirement for informed consent was waived.
7 min
The challenge of percutaneous recanalisation of chronic portal vein thrombosis: from the lack of evidence to clinical experience
Paolo Marra, Bergamo / Italy
Author Block: L. Dulcetta, P. Marra, F. S. Carbone, R. Muglia, S. Sironi; Bergamo/IT
Purpose: This study aimed to report the experience of a tertiary referral centre for pediatric and adult liver disease and transplantation in the IR management of chronic complete PVT. Complete chronic portal vein thrombosis (PVT) is a condition often requiring treatment to avoid potentially serious complications.
Methods or Background: A retrospective search was performed to identify pediatric and adult patients with an imaging diagnosis of chronic complete PVT and with clinical signs of severe portal hypertension who underwent successful percutaneous portal vein recanalization (PVR) from January 2020 to October 2023. Clinical and imaging follow-up was analysed.
Results or Findings: 12 patients (median age=18,5 years, IQ=41 years; 9 males) with chronic complete PVT who underwent at least one attempt of IR treatment from January 2020 to October 2023 were retrieved. Six patients were paediatrics and 7 patients (58%) were liver transplant recipients. All patients had chronic occlusion of the main portal vein, either with (n=2) or without (n=10) occlusion of the superior mesenteric and/or the splenic veins. Cavernomatous transformation was noted in 11/12 (92%) patients. At the time of treatment, all patients presented clinical signs of portal hypertension. A total of 20 percutaneous transhepatic, transsplenic and/or transjugular procedures were performed.
Overall technical success, defined as patency of the portal vein after at least one procedure, was achieved in all patients. After a median follow-up of 12 months, clinical success in terms of the absence of clinical signs of severe portal hypertension was achieved in all patients. No major complications occurred.
Conclusion: PVR is a feasible, safe, effective and minimally invasive procedure with excellent technical and clinical success for the management of chronic complete PVT in both pediatric and adult patients.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: No information provided by submitter.
7 min
Improved identification of good candidates for the treatment of intermediate/advanced hepatocellular carcinoma by Yttrium-90 transarterial radioembolisation
Inès Oreistein, Angers / France
Author Block: I. Oreistein, C. Vitellius, C. Aubé, F. Oberti, J. Boursier, A. Bouvier, F. Lacoeuille, L. Vervueren, S. Poulard; Angers/FR
Purpose: This study aimed to validate the prognostic score for HCC treated with TARE recently proposed by Spreafico and to improve prediction by considering also pre-operative dosimetry. Yttrium-90 transarterial radioembolisation is a treatment for intermediate/advanced hepatocellular carcinoma, but its position in the therapeutic arsenal remains poorly defined.
Methods or Background: 86 patients with HCC treated by SIRT in our centre were included. The provisional tumoral dose of 90Yttrium was calculated during the work-up. The Spreafico prognostic score was calculated as previously described and delineated three patient groups with “favourable”, “intermediate”, and “dismal” prognosis. The main study outcome was overall survival and the secondary outcome was progression-free survival.
Results or Findings: Fifty-three patients (62%) were treated with Therasphere®, and 33 patients (38%) were treated with Sirsphere®. Median OS was 12.0 months (95% CI: 9.0-15.0), and median PFS was 5.0 months (95% CI: 3.5-6.5). OS was 15, 10 and 4 months in the three prognostic groups defined by the Spreafico score (p< 0.001). Independent predictors of OS were the presence of cirrhosis, an optimal provisional tumoral dose, and the ALBI grade. The CODAG score developed as the sum of points attributed to these three independent predictors, identified three patient groups: good (0-1 point), intermediate (2 points) and poor (3-4 points) candidates. The CODAG score better discriminated the prognosis with median OS in the three groups being respectively 32, 11, and 4 months (p < 0.001). Median PFS was respectively 8, 5 and 3 months in the three CODAG groups (p< 0.001). The provisional and the received tumoral doses were very well correlated (Rs=0.814, p< 0.001).
Conclusion: The CODAG score improves the identification of good candidates for the treatment of intermediate/advanced hepatocellular carcinoma with transarterial radioembolisation.
Limitations: This study needs to be validated with an external cohort. The CODAG score better discriminated the prognosis than the Spreafico score.
Funding for this study: No information was provided by the submitter.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The data collection is in agreement with the ethics committee.
Retrospective collection data in ANGERS.
7 min
AI-derived body composition parameters as prognostic factors in patients with HCC undergoing TACE: results from a multicentre study
Lukas Müller, Mainz / Germany
Author Block: L. Müller1, T. A. Auer2, J. Haubold3, F. Nensa3, M. Eisenblaetter4, V. Steinle5, D. Pinto Dos Santos6, R. Klöckner7; 1Mainz/DE, 2Berlin/DE, 3Essen/DE, 4Freiburg/DE, 5Heidelberg/DE, 6Frankfurt/Köln/DE, 7Lübeck/DE
Purpose: This study aimed to investigate the role of BCA parameters for prognosis prediction in patients with HCC undergoing transarterial chemoembolization (TACE). Body composition assessment (BCA) parameters have recently been identified as relevant prognostic factors for patients with hepatocellular carcinoma (HCC).
Methods or Background: This retrospective multicentre study included a total of 754 treatment-naïve patients with HCC who underwent TACE at six tertiary care centres between 2010–2020. Fully automated artificial intelligence-based quantitative 3D volumetry of abdominal cavity tissue composition was performed to assess skeletal muscle volume (SM), total adipose tissue (TAT), intra- and intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) on pre-intervention computed tomography scans. BCA parameters were normalized to the slice number of the abdominal cavity. We assessed the influence of BCA parameters on median overall survival (OS) and performed multivariate analysis including established estimates of survival.
Results or Findings: Univariate survival analysis revealed that impaired median OS was predicted by low SM volume (p< 0.001), high TAT volume (p= 0.013), and high SAT volume (p= 0.006). In multivariate survival analysis, SM remained an independent prognostic factor (p= 0.039), while TAT and SAT volumes no longer showed predictive ability.
Conclusion: Skeletal muscle volume is an independent prognostic factor for survival prediction. Thus, the integration of SM into novel scoring systems could potentially improve survival prediction and clinical decision-making. Fully automated approaches are needed to foster the implementation of this imaging biomarker into daily routine.
Limitations: This study used retrospective data analysis and images were acquired using different scanner types.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study protocol was approved by the Ethics Committee of the Medical Association of Rhineland-Palatinate, Germany (permit number 15913).
7 min
TARE of "multipedicular" malignant liver tumours: can we redistribute the blood flow?
Rachele Fruzza, Pisa / Italy
Author Block: R. Fruzza1, E. Bozzi1, G. Lorenzoni1, R. Cervelli1, I. Bargellini2, L. Crocetti1, R. Cioni1, E. Neri1; 1Pisa/IT, 2Candiolo/IT
Purpose: This study aimed to demonstrate that “multipedicular” liver tumours (MPLT, i.e. tumours with more than one feeding artery) can be treated by reducing the number of injection points through redistribution of flow, achieving complete coverage and response in the target lesion.
Methods or Background: We retrospectively analysed our database of patients submitted to TARE between 2018 to 2022 and selected patients with MPLT. Diagnostic work-up before radioembolisation was evaluated, and all tumours with an embolised intra-hepatic feeding artery were identified. Careful evaluation of perfusion patterns was performed by SPECT-CT imaging 1 h after 99mTc-MAA injection and a PET-CT scan was performed after Y90 treatment. Tumour response of MPLT was evaluated after 40 days and after 3 months by CT using mRECIST criteria for primary tumours and RECIST 1.1 for liver metastases.
Results or Findings: We performed 230 cases of TARE. In 25 patients, accessory branch supplies were embolised using microcoils. Cross-perfusion in the embolised territory was evidenced by SPECT-CT in 22 cases and by PET-CT after Y90 injection in the other 3 cases. At 40 days follow-up we observed: 18 PR, 2 SD, 3 PD, and 2 patients were lost at follow-up. At 3 months follow-up: 10 PR, 1 CR, 4 PD, and 10 patients were lost to follow-up. No complications were reported after embolisation and 90Y administration.
Conclusion: Flow redistribution after embolisation of the accessory branches in MPLT was visible and achieved in all cases. Our results confirmed that intratumoral flow redistribution after embolisation, in terms of toxicity, median administered dose and radiological response, is safe and effective.
Limitations: No limitations were identified.
Funding for this study: No funding was provided for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: No information provided by the submitter.

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