Predicting Infiltrative Hepatocellular Carcinoma Patient Outcome Post-TACE:MR Bias Field Correction

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Background and Aims:To investigate the impact of MR bias field correction on response determination and survival pre-diction using volumetric tumor enhancement analysis in pa-tients 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 ini-tial 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, re-spectively. 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 im-proved response calculation from baseline MR as well as sur-vival 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 predic-tion (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 sig-nificant 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 en-hancement analysis from baseline MR after initial TACE in pa-tients with infiltrative hepatocellular carcinoma.
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