Response Evaluation of Malignant Liver Lesions After TACE/SIRT: Comparison of Manual and Semi-Automatic Measurement of Different Response Criteria in Multislice CT

Abstract

Purpose To compare measurement precision and interobserver variability in the evaluation of hepatocellular carcinoma (HCC) and liver metastases in MSCT before and after transarterial local ablative therapies.

Materials and Methods Retrospective study of 72 patients with malignant liver lesions (42 metastases; 30 HCCs) before and after therapy (43 SIRT procedures; 29 TACE procedures). Established (LAD; SAD; WHO) and vitality-based parameters (mRECIST; mLAD; mSAD; EASL) were assessed manually and semi-automatically by two readers. The relative interobserver difference (RID) and intraclass correlation coefficient (ICC) were calculated.

Results The median RID for vitality-based parameters was lower from semi-automatic than from manual measurement of mLAD (manual 12.5 %; semi-automatic 3.4 %), mSAD (manual 12.7 %; semi-automatic 5.7 %) and EASL (manual 10.4 %; semi-automatic 1.8 %). The difference in established parameters was not statistically noticeable (p > 0.05). The ICCs of LAD (manual 0.984; semi-automatic 0.982), SAD (manual 0.975; semi-automatic 0.958) and WHO (manual 0.984; semi-automatic 0.978) are high, both in manual and semi-automatic measurements. The ICCs of manual measurements of mLAD (0.897), mSAD (0.844) and EASL (0.875) are lower. This decrease cannot be found in semi-automatic measurements of mLAD (0.997), mSAD (0.992) and EASL (0.998).

Conclusion Vitality-based tumor measurements of HCC and metastases after transarterial local therapies should be performed semi-automatically due to greater measurement precision, thus increasing the reproducibility and in turn the reliability of therapeutic decisions.

Key points 

• Liver lesion measurements according to EASL and mRECIST are more precise when performed semi-automatically.

• The higher reproducibility may facilitate a more reliable classification of therapy response.

• Measurements according to RECIST and WHO offer equivalent precision semi-automatically and manually.

Citation Format

• Höink AJ, Schülke C, Koch R et al. Response Evaluation of Malignant Liver Lesions After TACE/SIRT: Comparison of Manual and Semi-Automatic Measurement of Different Response Criteria in Multislice CT. Fortschr Röntgenstr 2017; 189: 1067 – 1075

Zusammenfassung

Ziel Vergleich von Messgenauigkeit und Interobserver-Variabilität in der computertomografischen Beurteilung von hepatozellulären Karzinomen (HCC) und Lebermetastasen vor und nach transarteriellen selektiven Therapien.

Material und Methoden Retrospektive Studie an 72 Patienten mit malignen Leberläsionen (42 Metastasen, 30 HCC) vor und nach Therapie mit SIRT (n = 42) oder TACE (n = 29). Etablierte (LAD, SAD, WHO) und Vitalitäts-assoziierte Größenparameter (mRECIST, mLAD, mSAD, EASL) wurden manuell und semiautomatisch von zwei Auswertern bestimmt. Die relative Interobserverdifferenz (RID) und der Intraclass Korrelationskoeffizient (ICC) wurden berechnet.

Ergebnisse Die mediane RID der Vitalitäts-assoziierten Parameter war für die semiautomatischen niedriger als für die manuellen Messverfahren, im Einzelnen: für mLAD 3,4 % gegenüber 12,5 %; für mSAD 5,7 % gegenüber 12,7 %; für EASL 1,8 % gegenüber 10,4 %. Statistisch signifikante Unterschiede zwischen den etablierten Messverfahren bestanden nicht (p > 0.05). Der ICC für LAD (manuell 0,984; semiautomatisch 0,982), SAD (manuell 0,975; semiautomatisch 0,958) und WHO (manuell 0,984; semiautomatisch 0,978) ist für manuelle und semiautomatische Messungen gleichermaßen hoch. Der ICC für manuelle Messungen von mLAD (0,897), mSAD (0,844) und EASL (0,875) ist im Vergleich hierzu niedriger. Diese Reduktion bestand jedoch nicht für die semiautomatischen Messungen von mLAD (0,997), mSAD (0,992) und EASL (0,998).

Schlussfolgerung Die Bestimmung Vitalitäts-assoziierter Größenparameter von HCC und Metastasen nach transarterieller selektiver Therapie ist mit semiautomatischen Messverfahren präziser durchzuführen als mit manuellen Messverfahren. Die hieraus resultierende höhere Reproduzierbarkeit kann die Verlässlichkeit der therapeutischen Entscheidungen verbessern.

Kernaussagen 

• Die Größenbestimmung von Leberläsionen nach EASL und mRECIST ist semiautomatisch präziser als manuell.

• Die höhere Präzision ermöglicht eine verlässlichere Klassifikation des Therapieansprechens.

• Die Größenbestimmung nach RECIST und WHO ist semiautomatisch und manuell vergleichbar präzise.

Key words

CT - semi-automatic - tumor response - interventional oncology - interobserver variability

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