Temporal evolution of the LI-RADS radiation treatment response assessment on multiphase CT/MRI in patients undergoing selective internal radiation therapy for hepatocellular carcinoma.

Abstract

To assess the temporal evolution and interobserver agreement of the early categories per the liver imaging reporting and data system (LI-RADS) radiation treatment response assessment (TRA) algorithm in patients receiving selective internal radiation therapy (SIRT) with Yttrium-90 for hepatocellular carcinoma (HCC). This single-center retrospective study included consecutive patients with treatment-naïve HCC who underwent serial contrast-enhanced CT/MRI before and after SIRT. Three masked radiologists independently evaluated response at 3-6 months. Another senior radiologist assessed response at 9, 12, 15, 18, 21, 24, and > 24 months after comprehensive review of available clinical-radiological information. 65 patients (mean age, 66.7 ± 11.2 years; 48 men) were included. At 3-6 months after SIRT, 47.7% (31/65) of lesions were assigned to the nonprogressing category, and the remaining 52.3% (34/65) to the nonviable category. Among early nonprogressing lesions, 64.5% (20/31) regressed to the nonviable category, 25.8% (8/31) remained nonprogressing, and 9.7% (3/31) evolved into the viable category at ≥ 12 months. The nonprogressing category decreased in number over time, with 61.3% (19/31) conversion to the nonviable category at 9 months. Among the early nonviable lesions, 91.2% (31/34) remained nonviable at ≥ 12 months, and 8.8% (3/34) evolved into the viable category. Agreement for the 3-6 months LR-TR category assignment was moderate (kappa = 0.46) with CT but almost perfect (kappa = 0.85) with MRI. SIRT induced a delayed and sustained response in the majority of HCC patients after ≥ 12 months. MRI demonstrated superior agreement over CT in assessing response at 3-6 months. Question Tumor response to SIRT can change; there is limited evidence on the evolution of the imaging appearance of HCC following SIRT. Findings Sixty-four and five-tenths of early nonprogressing lesions regressed to nonviable, and 91.2% of early nonviable lesions remained free of viability. LR-TR category assignment agreement was moderate with CT but almost perfect with MRI. Clinical relevance SIRT induced a delayed and sustained response in HCC, underscoring the necessity of dynamic evaluation of long-term changes in treated lesions. MRI with subtraction imaging may be preferred over CT for long-term monitoring, which may help prevent premature retreatment decisions.