Journal
ABDOMINAL RADIOLOGY
Volume 41, Issue 4, Pages 600-616Publisher
SPRINGER
DOI: 10.1007/s00261-016-0639-5
Keywords
Computed tomography (CT); HCC; Intra-arterial embolotherapies; Modified RECIST (mRECIST); MR imaging; Response assessment
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Purpose: To discuss guidelines and salient imaging findings of solid tumors treated with common intra-arterial procedures used in interventional oncology. Methods: A meticulous literature search of PubMed-indexed articles was conducted. Key words included imaging + embolization, imaging + TACE, imaging + radioembolization, imaging + Y90, mRECIST, and EASL. Representative post-treatment cross-sectional images were obtained from past cases in this institution. Results: Intra-arterial therapy (IAT) in interventional oncology includes bland embolization, chemoembolization, and radioembolization. Solid tumors of the liver are the primary focus of these procedures. Cross-sectional CT and/or MR are the main modalities used to image tumors after treatment. Traditional size-based response criteria (WHO and RECIST) alone are of limited utility in determining response to IAT; tumoral necrosis and enhancement must be considered. Specifically for HCC, the EASL and mRECIST guidelines are becoming widely adopted response criteria to assess these factors. DWI, FDG-PET, and CEUS are modalities that play an adjunctive but controversial role. Conclusions: Radiologists must be aware that the different forms of intra-arterial therapy yield characteristic findings on cross-sectional imaging. Knowledge of these findings is integral to accurate assessment of tumor response and progression.
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