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Communications  n 

Letters to the Editor

From Xiao-Dan Ye, MD,* Wen-Tao Li, MD,† and Zheng Yuan, MD‡ Department of Radiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China* Department of Radiology, Shanghai Cancer Hospital, Fudan University, Shanghai, China† Department of Radiology, Shanghai No. 85 Hospital, 1328 Hua Shan Rd, Shanghai 200032, China‡ e-mail: [email protected] Editor: We read with great interest the article by Dr Bonekamp and colleagues in the August 2013 issue of Radiology titled “Unresectable Hepatocellular Carcinoma: MR Imaging after Intraarterial Therapy. Part II. Response Stratification Using Volumetric Functional Criteria after Intraarterial Therapy” (1). The results showed that volumetric functional magnetic resonance (MR) imaging response 3–4 weeks after initial intraarterial therapy showed improved overall survival. Volumetric functional MR imaging was superior to current imaging (Response Evaluation Criteria in Solid Tumors [RECIST], modified RECIST [mRECIST], and European Association for the Study of the Liver [EASL]) and biochemical (a-fetoprotein level) response criteria. Our previous studies also showed that functional MR imaging was useful for evaluating the early response and predicting survival of patients with hepatocellular carcinoma treated with chemoembolization (2–4). Recent studies showed that transarterial chemoembolization (TACE) with drug-eluting beads resulted in better Radiology: Volume 271: Number 2—May 2014   n  radiology.rsna.org

treatment response and delayed tumor progression compared with conventional TACE (5). However, no differences were observed in survival (6). In the study by Dr Bonekamp and colleagues, patients who underwent different intraarterial therapy procedures, including conventional TACE and TACE with drug-eluting beads loaded with doxorubicin, were analyzed. This may have affected the identification of the optimal thresholds for determining functional MR imaging response criteria based on the data in this heterogeneous group of patients. Furthermore, patients who underwent different treatment regimens may have different optimal thresholds for functional MR imaging response criteria. That is to say, the optimal cutoffs selected in this study may have limited reference value in clinical practice. In addition, Dr Bonekamp and colleagues concluded that volumetric functional MR imaging response was superior to current imaging response criteria (RECIST, mRECIST, and EASL) by comparing functional MR imaging response with anatomic response criteria based only on one or two target lesions. There is no comparison of volumetric functional MR imaging response with the overall response of anatomic response criteria. Thus, this conclusion is not convincing. The proportion of patients with multifocal lesions in the study population could influence prognostic values in predicting overall survival by targeting response. Although prognostic values for predicting overall survival were similar regardless of the number of target lesions (7), EASL and mRECIST overall response rates are associated with survival and should be used in preference to RECIST 1.1 or target responses (8). Disclosures of Conflicts of Interest: X.D.Y. No relevant conflicts of interest to disclose. W.T.L. No relevant conflicts of interest to disclose. Z.Y. No relevant conflicts of interest to disclose.

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LetterS to the Editor

Is Volumetric Functional MR Imaging Superior to Current Anatomic Imaging Response Criteria for Hepatocellular Carcinoma after Intraarterial Therapy?

LETTERS TO THE EDITOR

References

embolization for treatment of hepatocellular carcinoma. J Hepatol 2012;57(6):1244–1250.

1. Bonekamp S, Halappa VG, Geschwind JF, et al. Unresectable hepatocellular carcinoma: MR imaging after intraarterial therapy. II. Response stratification using volumetric functional criteria after intraarterial therapy. Radiology 2013;268(2):431–439.

6. Sacco R, Bargellini I, Bertini M, et al. Conventional versus doxorubicin-eluting bead transarterial chemoembolization for hepatocellular carcinoma. J Vasc Interv Radiol 2011;22(11):1545–1552.

2. Yuan Z, Li WT, Peng WJ. Pre-treatment apparent diffusion coefficient is imaging biomarker for prediction of response to chemoembolization in hepatocellular carcinoma. Eur J Radiol 2013;82(12):e901–e902.

7. Kim BK, Kim SU, Kim MJ, et al. Number of target lesions for EASL and modified RECIST to predict survival in hepatocellular carcinoma treated with chemoembolization. Clin Cancer Res 2013;19(6):1503–1511.

3. Yuan Z, Ye XD, Dong S, et al. Role of magnetic resonance diffusion-weighted imaging in evaluating response after chemoembolization of hepatocellular carcinoma. Eur J Radiol 2010;75(1):e9–e14.

8. Gillmore R, Stuart S, Kirkwood A, et al. EASL and mRECIST responses are independent prognostic factors for survival in hepatocellular cancer patients treated with transarterial embolization. J Hepatol 2011;55(6):1309– 1316.

4. Dong S, Ye XD, Yuan Z, et al. Relationship of apparent diffusion coefficient to survival for patients with unresectable primary hepatocellular carcinoma after chemoembolization. Eur J Radiol 2012;81(3):472–477. 5. Song MJ, Chun HJ, Song Do S, et al. Comparative study between doxorubicin-eluting beads and conventional transarterial chemo-

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Page 55, Abstract, Results, the second to the last sentence should read as follows: Mean cancer detection rate was 4.7 per 1000, and the median size of invasive cancers was 13 mm. “Clinical Digital Breast Tomosynthesis System: Dosimetric Characterization.” Radiology 2012;263(1):35–42 Page 40, Tables 4 and 5, The data reported in these tables are not normalized to reference air kerma (in milligrays per milligray of air kerma), as stated in the Note. The data are normalized to reference exposure (in milligrays per roentgen). To convert the data provided to milligrays per milligray of air kerma, divide by 8.73.

Errata “Performance Benchmarks for Screening Mammography.” Radiology 2006; 241(1):55–66

radiology.rsna.org  n  Radiology: Volume 271: Number 2—May 2014

Is volumetric functional MR imaging superior to current anatomic imaging response criteria for hepatocellular carcinoma after intraarterial therapy?

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