Quantitative spleen and liver volume changes predict survival of patients with primary sclerosing cholangitis.

AIM: To assess the value of quantitative spleen and liver volume changes in predicting the survival of patients with primary sclerosing cholangitis (PSC). MATERIALS AND METHODS: This institutional review board-approved single-centre study included 89 PSC patients with baseline and follow-up liver imaging studies and laboratory data between 2000 and 2018. Change in spleen, total and lobar liver volumes, and lobar-to-total liver volume ratio was compared between patients with and without adverse outcome (liver transplantation, transplant waiting list, and death). Receiver operating characteristic (ROC) and Kaplan-Meier analysis were performed to identify the volumetric threshold for prediction of outcome and show how these thresholds predict survival, respectively. A p-value of <0.05 was considered statistically significant. RESULTS: The present cohort included 53 men (60%), with mean age of 42 years at baseline. The only volumetric parameters with significant differences in change between patients with and without adverse outcome were spleen volume (p<0.001) and left-to-total liver volume ratio (L/T; p=0.025). The probability of transplant-free survival at 36 months was 59.1% versus 11.9% for patients with spleen volume change <50 ml versus ≥50 ml, respectively (AUC=0.731); and 61.3% versus 13.8% for patients with L/T change <0.04 versus ≥0.04, respectively (AUC=0.638). The patients with changes below the cut-off in both spleen volume and L/T, had a higher probability of transplant-free survival at 36 months (76.8%), compared to those with change at or below the cut-offs in one or both of these two parameters (36.7%, 15%, respectively; p=0.001). CONCLUSION: Spleen volume change and L/T change might be useful biomarkers for prediction of transplant-free survival in patients with PSC.

Long-term follow-up of hepatic adenoma and adenomatosis: analysis of size change on imaging with histopathological correlation.

AIM: To analyse the change in size on follow-up of hepatic adenomas (HAs) and adenomatosis, and to investigate the relationship of imaging features with size change. MATERIALS AND METHODS: The study included 44 patients (142 lesions) who underwent magnetic resonance imaging (MRI) or computed tomography (CT) for diagnosis and follow-up of HA. The imaging features and percentage change in maximum tumour dimension were observed over a follow-up duration of up to 139 months. RESULTS: With an average follow-up of 43 months, 37% lesions decreased in size, 58% were stable, 4% increased; one lesion regressed completely. Adenomas were stratified into size groups (<3, 3-5, and ≥5 cm). Size change among the three groups was similar (p>0.05). Percent size change was different for lesions followed for ≤12 months (-7.2%) compared with lesions followed for 13-60 months (-20.5%), and those followed for ≥60 months (-23.5%; p<0.05); there was no difference between lesions followed for 13-60 months and ≥60 months (p=0.523). Baseline size and percent size change was similar between the hepatocyte nuclear factor 1α-inactivated HA (HA-H) and inflammatory HA (HA-I) subtype (p>0.05). CONCLUSION: Most adenomas were either stable or regressed on follow-up. Size change was independent of baseline size. After an initial size decrease within 5 years, no further size reduction was noted on extended follow-up. The percent size change in the HA-H and HA-I subtype was similar.

Functional hepatic imaging as a biomarker of primary and secondary tumor response to loco-regional therapies.

Objective criteria to measure tumor response are a key tenet for assessment of treatment efficacy when evaluating a therapeutic modality. Several response criteria have been proposed including the Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), RECIST 1-1, and European Association for the Study of the Liver (EASL) guidelines. Response following loco-regional therapies (LRT) can be particularly difficult to assess as post-treatment changes may not always relate to changes in lesion size. As imaging modalities and solid tumor therapies continue to advance, there has been growing recognition that measurement of actual tumoricidal activity may not always be related to tumor size, and accurate assessment of treatment response may vary by therapeutic modality. As such, the objective change in the physical size characteristics of a tumor may not accurately reflect biological response to treatment. Functional imaging encompasses methods that are capable of detecting or measuring changes in tissue metabolism, blood flow, or composition. Conventional imaging modalities such as magnetic resonance imaging (MRI) and computed topography (CT) now include techniques such as diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) maps, dynamic contrast enhancement (DCE-MRI), and perfusion CT (pCT). Use of functional cross-sectional imaging is particularly relevant to assess primary and secondary hepatic malignancies treated with LRT, such as trans-arterial chemoembolization (TACE), radiofrequency ablation (RFA), yttrium-90 (Y-90), and hepatic arterial infusion (HAI) chemotherapy. We herein review the imaging techniques, as well as the methodologies for measuring tumor response and survival, among patients treated with LRT for primary and secondary hepatic malignancies.