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J Am Coll Radiol 2021 07 20;18(7):927-934. Epub 2021 Jan 20.

Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut. Electronic address:

Background: Several tumor response criteria on cross-sectional imaging have been used in hepatocellular cancer after locoregional, intra-arterial therapy. The cost implications of their efficacy and accuracy are not well established.

Purpose: To evaluate cost-effectiveness of quantitative European Association for Study of the Liver (qEASL) compared with Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST) response criteria. Read More

Eur Radiol 2021 May 30;31(5):2737-2746. Epub 2020 Oct 30.

Division of Medical Oncology, Department of Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.

Objectives: To compare 1D and 3D quantitative tumor response criteria applied to DCE-MRI in patients with advanced-stage HCC undergoing sorafenib therapy to predict overall survival (OS) early during treatment.

Methods: This retrospective analysis included 29 patients with advanced-stage HCC who received sorafenib for at least 60 days. All patients underwent baseline and follow-up DCE-MRI at 81. Read More

Eur J Radiol 2020 Dec 14;133:109351. Epub 2020 Oct 14.

Department of Radiology, New York University Langone Health, 660 First Ave, 3(rd)Floor, New York, NY, 10016, USA. Electronic address:

Objectives: To assess the inter-reader variability in response assessment for HCC treated with radioembolization (TARE) compared with 3D quantitative criteria (qEASL); and to evaluate their role in prediction of pathological necrosis and clinical outcomes.

Materials And Methods: 57 patients with 77 HCCs who underwent TARE were included. Five radiologists recorded multiple imaging features and assigned mRECIST/LIRADS Treatment Response (TR) categories on post-treatment MRI at 4-6 weeks and 6-9 months after TARE. Read More

Eur Radiol 2021 May 15;31(5):3002-3014. Epub 2020 Oct 15.

Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.

Objectives: To evaluate the prognostic potential of Lipiodol distribution for the pharmacokinetic (PK) profiles of doxorubicin (DOX) and doxorubicinol (DOXOL) after conventional transarterial chemoembolization (cTACE).

Methods: This prospective clinical trial ( ClinicalTrials.gov : NCT02753881) included 30 consecutive participants with liver malignancies treated with cTACE (5/2016-10/2018) using 50 mg DOX/10 mg mitomycin C emulsified 1:2 with ethiodized oil (Lipiodol). Read More

Diagn Interv Imaging 2021 Jan 1;102(1):35-44. Epub 2020 Oct 1.

Department of Medical Imaging, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Unité Inserm 955, équipe 18, IMRB, University of Paris Est Créteil, 94010 Créteil, France.

Purpose: To evaluate the potential of imaging criteria in predicting overall survival of patients with hepatocellular carcinoma (HCC) after a first transcatheter arterial yttrium-90 radioembolization (TARE) MATERIALS AND METHODS: From October 2013 to July 2017, 37 patients with HCC were retrospectively included. There were 34 men and 3 women with a mean age of 60.5±10. Read More

Eur Radiol 2020 Oct 19;30(10):5663-5673. Epub 2020 May 19.

Department of Radiology and Biomedical Imaging, Yale School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA.

Objectives: To investigate the predictive value of quantifiable imaging and inflammatory biomarkers in patients with hepatocellular carcinoma (HCC) for the clinical outcome after drug-eluting bead transarterial chemoembolization (DEB-TACE) measured as volumetric tumor response and progression-free survival (PFS).

Methods: This retrospective study included 46 patients with treatment-naïve HCC who received DEB-TACE. Laboratory work-up prior to treatment included complete and differential blood count, liver function, and alpha-fetoprotein levels. Read More

Eur Radiol 2020 Mar 6;30(3):1601-1608. Epub 2019 Dec 6.

Department of Radiology, Charité, Augustenburger Platz 1, 13353, Berlin, Germany.

Objectives: In this study, pre-treatment target lesion vascularisation in either contrast-enhanced (CE) CT or MRI and post-treatment lipiodol deposition in native CT scans were compared in HCC patients who underwent their first cTACE treatment. We analysed the impact of stratification according to cTACE selectivity on these correlations.

Methods: Seventy-eight HCC patients who underwent their first cTACE procedure were retrospectively included. Read More

J Vasc Interv Radiol 2018 06 14;29(6):850-857.e1. Epub 2018 Mar 14.

Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520. Electronic address:

Purpose: To use magnetic resonance (MR) imaging and clinical patient data to create an artificial intelligence (AI) framework for the prediction of therapeutic outcomes of transarterial chemoembolization by applying machine learning (ML) techniques.

Materials And Methods: This study included 36 patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization. The cohort (age 62 ± 8. Read More

Cardiovasc Intervent Radiol 2018 Mar 30;41(3):433-442. Epub 2017 Oct 30.

Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.

Purpose: Our study aimed to evaluate quantitative tumor response assessment (quantitative EASL-[qEASL]) on computed tomography (CT) images in patients with hepatocellular carcinoma (HCC) treated using conventional transarterial chemoembolization (cTACE), compared to existing 1-dimensional and 2-dimensional methods (RECIST, mRECIST, EASL).

Materials And Methods: In this IRB-approved, single-institution retrospective cohort study, 52 consecutive patients with intermediate-stage HCC were consecutively included. All patients underwent contrast-enhanced CT scan at baseline and 4 weeks after cTACE. Read More

Clin Imaging 2017 Nov - Dec;46:1-7. Epub 2017 Jun 7.

Yale School of Medicine, Department of Radiology and Biomedical Imaging, 333 Cedar Street, New Haven, CT 06520, USA. Electronic address:

Purpose: To investigate whether bevacizumab compromises early response assessment after Transarterial Chemoembolization (TACE) in patients with hepatocellular carcinoma by 3D quantitative European Association for the Study of the Liver (qEASL) criteria in comparison to other imaging-based criteria.

Materials And Methods: Each of 14 patients receiving TACE and bevacizumab was matched with two patients receiving TACE alone. Baseline and Follow-up MRI was retrospectively analyzed regarding qEASL and other imaging-based criteria. Read More

Expert Rev Anticancer Ther 2017 Feb 27;17(2):119-127. Epub 2016 Dec 27.

b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA.

Introduction: Intra-arterial therapies (IATs) play an integral role in the management of unresectable hepatocellular carcinoma and liver metastases. The ability to accurately assess tumor response to intra-arterial therapies is crucial for clinical management. Several one- and two-dimensional manual imaging-based response assessment techniques, based both on tumor size or enhancement, have shown to be highly subjective and merely surrogate for the actual tumor as a whole. Read More

Transl Oncol 2016 Oct 12;9(5):377-383. Epub 2016 Sep 12.

Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA. Electronic address:

Purpose: Liver metastases from renal cell carcinoma (RCC) are not uncommon in the course of disease. However, data about tumor response to intraarterial therapy (IAT) are scarce. This study assessed whether changes of enhancing tumor volume using quantitative European Association for the Study of the Liver (qEASL) on magnetic resonance imaging (MRI) and computed tomography (CT) can evaluate tumor response and predict overall survival (OS) early after therapy. Read More

Radiology 2016 Jan 1;278(1):275-84. Epub 2015 Jul 1.

From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (V.T., R.D., H.Y., H.L., J.C., M.C., Z.W., J.H.S., J.F.G.), and Department of Surgery (T.P.), Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287; Department of U/S Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY (M.L.); Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.F.); and The Rothman Institute, Philadelphia, Pa (M.G.M.).

Purpose: To compare currently available non-three-dimensional methods (Response Evaluation Criteria in Solid Tumors [RECIST], European Association for Study of the Liver [EASL], modified RECIST [mRECIST[) with three-dimensional (3D) quantitative methods of the index tumor as early response markers in predicting patient survival after initial transcatheter arterial chemoembolization (TACE).

Materials And Methods: This was a retrospective single-institution HIPAA-compliant and institutional review board-approved study. From November 2001 to November 2008, 491 consecutive patients underwent intraarterial therapy for liver cancer with either conventional TACE or TACE with drug-eluting beads. Read More

Eur Radiol 2016 Jan 21;26(1):103-13. Epub 2015 May 21.

U/S Imaging and Interventions (UII), Philips Research North America, Briarcliff Manor, NY, USA.

Objectives: To investigate the influence of region-of-interest (ROI) placement on 3D tumour enhancement [Quantitative European Association for the Study of the Liver (qEASL)] in hepatocellular carcinoma (HCC) patients treated with transcatheter arterial chemoembolization (TACE).

Methods: Phase 1: 40 HCC patients had nine ROIs placed by one reader using systematic techniques (3 ipsilateral to the lesion, 3 contralateral to the lesion, and 3 dispersed throughout the liver) and qEASL variance was measured. Intra-class correlations were computed. Read More

Eur Radiol 2015 Jul 31;25(7):1993-2003. Epub 2015 Jan 31.

Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD, 21287, USA.

Objectives: This study evaluated the predictive role of 1D, 2D and 3D quantitative, enhancement-based MRI regarding overall survival (OS) in patients with colorectal liver metastases (CLM) following intra-arterial therapies (IAT).

Methods: This retrospective analysis included 29 patients who underwent transarterial chemoembolization (TACE) or radioembolization and received MRI within 6 weeks after therapy. Tumour response was assessed using 1D and 2D criteria (such as European Association for the Study of the Liver guidelines [EASL] and modified Response Evaluation Criteria in Solid Tumors [mRECIST]). Read More

Eur J Radiol 2015 Mar 13;84(3):424-430. Epub 2014 Dec 13.

Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, USA 21287. Electronic address:

Background: The clinical management of patients with metastatic soft-tissue sarcoma of the liver is complicated by the paucity of reliable clinical data. This study evaluated the safety profile, survival outcome as well as the role of imaging biomarkers of tumor response in metastatic soft-tissue sarcoma (mSTS) of the liver treated with conventional transarterial chemoembolization (cTACE).

Materials/methods: This retrospective analysis included 30 patients with mSTS of the liver treated with cTACE. Read More

Expert Rev Anticancer Ther 2015 Feb 5;15(2):199-205. Epub 2014 Nov 5.

The Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower, Suite 7203, Baltimore, MD 21287, USA.

Assessing the tumor response of liver cancer lesions after intraarterial therapies is of major clinical interest. Over the last two decades, tumor response criteria have come a long way from purely size-based, anatomic methods such as the Response Evaluation Criteria in Solid Tumors towards more functional, enhancement- and diffusion-based parameters with a strong emphasis on MRI as the ultimate imaging modality. However, the relatively low reproducibility of those one- and 2D techniques (modified Response Evaluation Criteria in Solid Tumors and the European Association for the Study of the Liver criteria) provided the rationale for the development of new, 3D quantitative assessment techniques. Read More

Transl Oncol 2014 Aug 20;7(4):447-55. Epub 2014 Jun 20.

Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address:

Purpose: To determine whether volumetric changes of enhancement as seen on contrast-enhanced magnetic resonance (MR) imaging can help assess early tumor response and predict survival in patients with metastatic uveal melanoma after one session of transarterial chemoembolization (TACE).

Materials And Methods: Fifteen patients with 59 lesions who underwent MR imaging before and 3 to 4 weeks after the first TACE were retrospectively included. MR analysis evaluated signal intensities, World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), European Association for the Study of the Liver (EASL), modified RECIST (mRECIST), tumor volume [volumetric RECIST (vRECIST)], and volumetric tumor enhancement [quantitative EASL (qEASL)]. Read More

J Vasc Interv Radiol 2012 Dec;23(12):1629-37

Clinical Informatics, Interventional, and Translational Solutions (CIITS), Philips Research North America, Briarcliff Manor, New York, USA.

Purpose: To show that hepatic tumor volume and enhancement pattern measurements can be obtained in a time-efficient and reproducible manner on a voxel-by-voxel basis to provide a true three-dimensional (3D) volumetric assessment.

Materials And Methods: Magnetic resonance (MR) imaging data obtained from 20 patients recruited for a single-institution prospective study were retrospectively evaluated. All patients had a diagnosis of hepatocellular carcinoma (HCC) and underwent drug-eluting beads (DEB) transcatheter arterial chemoembolization for the first time. Read More