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Purpose: To evaluate feasibility of measuring parenchymal blood volume (PBV) of malignant hepatic tumours using C-arm CT, test the changes in PBV following repeated transarterial chemoembolization (TACE) and correlate these changes with the change in tumour size in MRI., Methods: 111 patients with liver malignancy were included. Patients underwent MRI and TACE in a 4- to 6-week interval. During intervention C-arm CT was performed. Images were post-processed to generate PBV maps. Blood volume data in C-arm CT and change in size in MRI were evaluated. The correlation between PBV and size was tested using Spearman rank test., Results: Pre-interventional PBV maps showed a mean blood volume of 84.5 ml/1000 ml ± 62.0, follow-up PBV maps after multiple TACE demonstrated 61.1 ml/1000 ml ± 57.5. The change in PBV was statistically significant (p = 0.02). Patients with initial tumour blood volume >100 ml/1000 ml dropped 7.1% in size and 47.2% in blood volume; 50-100 ml/1000 ml dropped 4.6% in size and 25.7% in blood volume; and <50 ml/1000 ml decreased 2.8% in size and increased 82.2% in blood volume., Conclusion: PBV measurement of malignant liver tumours using C-arm CT is feasible. Following TACE PBV decreased significantly. Patients with low initial PBV show low local response rates and further increase in blood volume, whereas high initial tumour PBV showed better response to TACE., Key Points: Parenchymal blood volume assessment of malignant hepatic lesions using C-arm CT is feasible. The parenchymal blood volume is reduced significantly following transarterial chemoembolization. Parenchymal blood volume can monitor the response of tumours after transarterial chemoembolization. Although not significant, high initial parenchymal blood volume yields better response to TACE.

Purpose: The purpose of this study was the evaluation of prognostic factors for long-term survival and progression-free survival (PFS) after treatment of colorectal cancer (CRC) liver metastases with magnetic resonance-guided laser-induced interstital thermotherapy (LITT)., Patients and Methods: We included 594 patients (mean age, 61.2 years) with CRC liver metastases who were treated with LITT. The statistical analysis of the long-term survival and PFS were based on the Kaplan-Meier method. The Cox regression model tested different parameters that could be of prognostic value. The tested prognostic factors were the following: sex, age, the location of primary tumor, the number of metastases, the maximal diameter and total volume of metastases and necroses, the quotient of total volumes of metastases and necroses, the time of appearance of liver metastases and location in the liver, the TNM classification of CRC, extrahepatic metastases, and neoadjuvant treatments., Results: The median survival was 25 months starting from the date of the first LITT. The 1-, 2-, 3-, 4-, and 5-year survival rates were 78%, 50.1%, 28%, 16.4%, and 7.8%, respectively. The median PFS was 13 months. The 1-, 2-, 3-, 4-, and 5-year PFS rates were 51.3%, 35.4%, 30.7%, 25.4%, and 22.3%, respectively. The number of metastases and their maximal diameter were the most important prognostic factors for both long-term survival and PFS. Long-term survival was also highly influenced by the initial involvement of the lymph nodes., Conclusions: For patients treated with LITT for CRC liver metastases, the number and size of metastases, together with the initial lymph node status, are significant prognostic factors for long-term survival.

Purpose: To evaluate local tumor control and survival rate after repeated transarterial chemoembolization using two different protocols in hepatocellular carcinoma (HCC) patients., Materials and Methods: A total of 190 patients (mean, 68 years) with HCC were repeatedly treated with transarterial chemoembolization in 4-week intervals. The chemotherapy protocol consisted of mitomycin C alone (n = 111) and mitomycin C with gemcitabine (n = 79). Embolization was performed with lipiodol and microspheres. Tumor response was evaluated by magnetic resonance imaging using Response Evaluation Criteria In Solid Tumors (RECIST) criteria. Survival rates were calculated using Kaplan-Meier method., Results: In the mitomycin C-only group, we observed partial response in 38.8% (43/111), stable disease in 27% (30/111), and progressive disease in 34.2% (38/111). In the mitomycin C/gemcitabine group (n = 79), partial response was observed in 43% (34/79), stable disease in 16.5% (13/79) and progressive disease in 40.5% (32/79). The overall 1- and 2-year survival rates were 56% and 28%, respectively. The overall median survival time from the start of transarterial chemoembolization treatment was 15 months. The median survival of patients treated with mitomycin C was 16.5 months and it was 12 months for patients treated with a combination of mitomycin C and gemcitabine. No statistically significant difference between the two groups was observed (P = .7)., Conclusion: Chemoembolization is an effective minimally invasive therapy option for palliative treatment of HCC patients. Mitomycin C only proves to be effective, the addition of gemcitabine was not advantageous., (Copyright © 2012 AUR. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate local tumor control and survival data after transarterial chemoembolization (TACE) with different drug combinations in the palliative third-line treatment of patients with ovarian cancer liver metastases., Methods: Sixty-five patients (mean age: 51.5 year) with unresectable hematogenous hepatic metastases of ovarian cancer who did not respond to systemic chemotherapy were repeatedly treated with TACE in 4-week intervals. The local chemotherapy protocol consisted of Mitomycin (group 1) (n=14; 21.5%), Mitomycin with Gemcitabine (group 2) (n=26; 40%), or Mitomycin with Gemcitabine and Cisplatin (group 3) (n=25; 38.5%). Embolization was performed with Lipiodol and starch microspheres. Local tumor response was evaluated by MRI according to RECIST criteria. Survival data were calculated according to the Kaplan-Meier method., Results: The local tumor control was: partial response (PR) in 16.9% (n=11), stable disease (SD) in 58.5% (n=38) and progressive disease (PD) in 24.6% (n=16) of patients. In group 1, we observed SD in 78.6% (11/14), and PD in 21.4% (3/14) of patients. In group 2, PR in 7.7% (2/26), SD in 57.7% (15/26), and PD in 34.6% (9/26) of patients. In group 3, PR in 36% (9/25), SD in 48% (12/25), and PD in 16% (4/25) of patients. Survival rate from the start of TACE was 58% after 1-year, 19% after 2-years, and 13% after 3-years. The median and mean survival times were 14 and 18.5 months without statistically significant difference for the 3 groups of patients (p=0.502)., Conclusion: Transarterial chemoembolization is effective palliative treatment in achieving local control in selected patients with liver metastases from ovarian cancer., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: To volumetrically analyze liver metastases and posttherapeutic findings of the thermally ablated area after thermal ablation with magnetic resonance (MR)-guided laser-induced thermotherapy in a long-term evaluation using contrast-enhanced MR imaging., Materials and Methods: The study was approved by the institutional review board, and informed consent was obtained from all patients. In 40 patients (27 women, 13 men; age range, 33-94 years; mean age, 62.5 years) in whom colorectal cancer (n = 20) and breast cancer (n = 20) had metastasized to the liver, initial tumor volume and thermal-induced necrosis after MR-guided laser-induced thermotherapy were retrospectively analyzed. All patients presented with oligonodular liver metastases and underwent follow-up with contrast-enhanced MR imaging for at least 3 years. No concomitant oncologic therapies were performed., Results: Volumetric MR imaging evaluation depicted 40 metastases with an initial tumor volume less than 5 mL (x = 1.75), nine metastases with initial volume of 5-20 mL (x = 12.35), and eight metastases with initial volume more than 20 mL (x = 50.57). The mean volume of the thermally damaged area was 498% of the initial volume for colorectal cancer metastases and 604% of the initial volume for breast cancer metastases. The ischemic and necrotic volume for colorectal cancer metastases had decreased by a mean of 48.6% after 3 months, by 63% after 6 months, by 70.2% after 12 months, and by 92.2% after 36 months. For breast cancer metastases at 36 months, the necrotic volume had decreased by 80.61%; the reduction in the volume of the thermally damaged region was statistically significantly lower than that of colorectal cancer metastases., Conclusion: MR-guided laser-induced thermotherapy induced a high volume of thermal ablation; the greatest reduction in the necrotic volume occurred in the first year, and lower values were seen in the next period. The reduction was statistically significantly higher in colorectal cancer metastases., (RSNA, 2008)

This study aims to evaluate the efficacy and safety of a neoadjuvant treatment protocol with repeated transarterial chemoembolization (TACE) before MR-guided laser-induced thermotherapy (LITT) for large-sized hepatocellular carcinomas (HCC). Repeated TACE (mean, 3.5 treatments per patient) was performed in 48 patients with neoadjuvant intention (the largest lesion was between 50 and 80 mm in diameter, and there were no more than five lesions). For the TACE treatment, we used 10 mg/m(2) mitomycin, 10 ml/m(2) Lipiodol and microspheres. The tumor volume was measured by MRI. Lipiodol retention of the tumors was evaluated with CT. After the diameter of the tumors had decreased to less than 50 mm, the patients were treated with MR-guided LITT 4 to 6 weeks after embolization. Repeated TACE reduced the tumor size in 32 patients (66.7%), forming the basis for performing MR-guided LITT procedures. These patients received one to four laser treatments (mean, 1.9 per patient) for tumor ablation, resulting in a median survival of 36.0 months after the first treatment. For the remaining patients, no reduction in tumor size was achieved in 12 patients and disease progression in 4 patients. Neoadjuvant TACE appears to be an effective treatment of large-sized HCC, which extends the indication for MR-guided LITT.

Laser-induced thermotherapy, or laser ablation, is an established minimally invasive percutaneous technique of tumor ablation. It is performed routinely in hepatic tumors and in other indications. Most patients treated with laser-induced thermotherapy suffer from liver metastases from primary tumors, particularly colorectal cancer. In this review, the local control rate, including morphological response and local recurrence, is evaluated. Survival data, including median survival time and 1-, 2- and 3-year survival, are discussed; treatment complications are also explored. The method of treatment performance and evaluation, results, and the authors' views on the current status of treatment are outlined.

MR-guided LITT is a safe and effective treatment modality that improves survival in well-selected patients who have liver metastases. A major advantage of MR-guided LITT is that it can be easily performed under local anesthesia in an outpatient setting with a low complication rate.

Purpose: To evaluate the local tumor control rate and survival data for magnetic resonance (MR) imaging-guided laser ablation of breast cancer liver metastases by using laser-induced interstitial thermotherapy (LITT)., Materials and Methods: MR-guided LITT was performed in 232 female patients with 578 liver metastases from breast cancer. Survival rates were calculated with the Kaplan-Meier method. Indications for the procedure were defined for patients with no more than five metastases, none of which were larger than 5 cm in diameter, as follows: recurrent liver metastases after partial liver resection (8.2%), metastases in both liver lobes (45.2%), locally nonresectable tumors (19%), general contraindications for surgery (2.6%), or refusal to undergo surgical resection (25%)., Results: Local recurrence rate at 6-month follow-up after LITT was 2.3% (five of 213) for metastases up to 2 cm in diameter, 4.3% (seven of 162) for metastases 2-3 cm in diameter, 3.2% (two of 63) for metastases 3-4 cm in diameter, and 1.9% (one of 52) for metastases larger than 4 cm in diameter. No additional local tumor progression was observed beyond 6 months. The mean survival rate for all treated patients, with calculation started on the date of diagnosis of the metastases treated with LITT, was 4.9 years (95% confidence interval: 4.3, 5.4). The median survival was 4.3 years; 1-year survival, 96%; 2-year survival, 80%; 3-year survival, 63%; and 5-year survival, 41%. The mean survival after the first LITT treatment was 4.2 years (95% confidence interval: 3.6, 4.8)., Conclusion: MR-guided LITT yields high local tumor control and survival rates in patients with liver metastases from breast cancer.

Purpose: Traditionally, liver surgery relies on Couinaud's liver segment classification. As the position and shape of these segments are variable and their borders are hidden within the homogeneous liver mass, the accuracy of segment identification methods needs computer-aided reevaluation., Method: The segmental liver anatomy of 23 patients receiving diagnostic helical CT scans because of suspected intrahepatic lesion was analyzed with the aid of a computer-based operation-planning system. We compared the standard Couinaud classification, which depends particularly on the main stems of portal and hepatic veins, with a method that calculates the segment borders by analyzing the complete portal venous tree. Volume, shape, and position of the liver segments found by each method were compared., Results: With reference to the portal vein-based method, segmental volumes were overestimated by the classic Couinaud method by up to 24% and underestimated to 13%. Volumes of Couinaud segments 4a, 7, and 8 were generally larger compared with those obtained by the portal vein-based method, whereas segments 3 and 6 were smaller. Gross variations were found in segments 5, 7, and 8. When shape and position were considered, poor correlation was found for five segments (median kappa = 0.35-0.45). Only segments 2, 7, and 8 had kappa values clearly above 0.45 in the majority of cases. The plane that divides the two hemilivers along the middle hepatic vein and the border between the left sector (segments 2 and 3) and the medial sector (4a and 4b) were found in both methods with very good conformity (kappa > 0.75)., Conclusion: Couinaud's method of dividing the liver into eight autonomous liver segments has to be accepted as a good approximation. Nevertheless, the volume, position, and shape of these segments and their segmental borders show significant variability.