Unresectable intrahepatic cholangiocarcinoma: Multiparametric MR imaging to predict patient survival

Ankur Pandey, Pallavi Pandey, Mounes Aliyari Ghasabeh, Farnaz Najmi Varzaneh, Nannan Shao, Pegah Khoshpouri, Manijeh Zarghampour, Daniel Fadaei Fouladi, Robert Liddell, Ihab R. Kamel

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Purpose: To determine the performance of magnetic resonance (MR) imaging–based tumor metrics for evaluation of response to transarterial chemoembolization (TACE) in patients with unresectable intrahepatic cholangiocarcinoma (ICCA). Materials and Methods: Ninety-four patients with unresectable ICCA underwent baseline and follow-up MR imaging after TACE and were followed up until death or end of study duration. Lesions were analyzed for anatomic (Response Evaluation Criteria in Solid Tumors [RECIST] and tumor volume) and functional (viable tumor volume, viable tumor burden, and apparent diffusion coefficient [ADC]) volumetric MR parameters by using semiautomatic software. Response was assessed by using changes in viable tumor volume by using modified RECIST (mRECIST)–derived thresholds (three-dimensional mRECIST), viable tumor burden, and ADC. Overall survival was the primary endpoint. Cox-regression and Kaplan-Meier survival analysis were used. Results: Tumor volume did not change after TACE (P = .07) whereas RECIST diameter showed a small change (22.6%; P = .02). There was an increase in ADC (20.7%) and a decrease in viable tumor volume (229.3%) and viable tumor burden (229.1%; P , .001 for all). Higher overall survival was noted among responders by using thresholds of 25% increase in ADC, 66% decrease in viable tumor volume, and 50% decrease in viable tumor burden (log-rank test, P , .05). Hazard ratio for nonresponders by using ADC, three-dimensional mRECIST, and viable tumor burden at multivariable analysis was 2.9 (P = .004), 4.1 (P = .009), and 4.0 (P = .002), respectively. Survival differences were noted for patients who showed response by using all three parameters (ADC, three-dimensional mRECIST, and viable tumor burden) versus those who showed response by using either one or two of these parameters versus those who showed no response (P , .001). Conclusion: Changes in volumetric ADC, viable tumor volume, and viable tumor burden at MR imaging provide prognostic information among patients with unresectable ICCA who undergo TACE.

Original languageEnglish (US)
Pages (from-to)109-117
Number of pages9
Issue number1
StatePublished - Jul 2018

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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