@article{3110878,
    title = "mRECIST criteria and contrast-enhanced US for the assessment of the response of hepatocellular carcinoma to transarterial chemoembolization",
    author = "Moschouris, H. and Malagari, K. and Papadaki, M.G. and Kornezos, I. and Stamatiou, K. and Anagnostopoulos, A. and Chatzimichael, K. and Kelekis, N.",
    journal = "Diagnostic and Interventional Radiology",
    year = "2014",
    volume = "20",
    number = "2",
    pages = "136-142",
    publisher = "Turkish Society of Radiology",
    issn = "1305-3825, 1305-3612",
    doi = "10.5152/dir.2013.13282",
    keywords = "contrast medium;  doxorubicin;  gadolinium;  sonovue;  sorafenib;  sulfur hexafluoride, adult;  aged;  article;  chemoembolization;  clinical article;  computer assisted tomography;  death;  disease course;  echography;  female;  follow up;  human;  kappa statistics;  liver cell carcinoma;  male;  microcatheter;  nuclear magnetic resonance imaging;  overall survival;  retrospective study;  sensitivity and specificity;  treatment planning;  artery;  cancer staging;  Carcinoma, Hepatocellular;  echography;  evaluation study;  Liver Neoplasms;  middle aged;  procedures;  very elderly, Aged;  Aged, 80 and over;  Arteries;  Carcinoma, Hepatocellular;  Chemoembolization, Therapeutic;  Contrast Media;  Female;  Humans;  Liver Neoplasms;  Male;  Middle Aged;  Response Evaluation Criteria in Solid Tumors;  Retrospective Studies;  Ultrasonography",
    abstract = "Purpose We aimed to evaluate the combination of the modified Response Evaluation Criteria In Solid Tumors (mRECIST) and contrast-enhanced ultrasonography (CEUS) as a tool for the assessment of hepatocellular carcinoma treated with transarterial chemoembolization. MATERIALS AND Methods Forty-seven hepatocellular carcinoma patients (80 target tumors suitable for mRECIST measurements) were studied. They were treated with scheduled transarterial chemoembolization with doxorubicin-eluting microspheres every 5-7 weeks. Imaging follow-up (performed one month after each transarterial chemoembolization) included a standard, contrast- enhanced modality (computed tomography [CT] in 12 patients or magnetic resonance imaging [MRI] in 35 patients) and CEUS. The study focused on response evaluation after the third transarterial chemoembolization. CEUS required a bolus injection of an echo-enhancer and imaging with a dedicated, low mechanical index technique. The longest diameters of the enhancing target tumors were measured on the CEUS or CT/MRI, and mRECIST criteria were applied. Radiologic responses were correlated with overall survival and time to progression. Results The measurements of longest diameters of the enhancing target tumors were easily performed in all patients. According to mRECIST-CEUS and mRECIST-CT/MRI, complete response was recorded in five and six patients, partial response in 22 and 21 patients, stable disease in 16 and 14 patients, and progressive disease in four and six patients, respectively. There was a high degree of concordance between CEUS and CT/MRI (kappa coefficient=0.84, P < 0.001). Responders (complete+partial response) according to mRECIST-CEUS had a significantly longer mean overall survival and time to progression compared to nonresponders (37.1 vs. 11.0 months, P < 0.001 and 24.6 vs. 10.9 months, P = 0.007, respectively). Conclusion The mRECIST-CEUS combination is feasible and has prognostic value in the assessment of hepatocellular carcinoma following transarterial chemoembolization. © Turkish Society of Radiology 2014."
}