Substantial arterial flow reduction to the tumor was defined as the technical end point of embolization; complete
occlusion of the tumor-feeding blood vessels was avoided to maintain the arterial pathway for potential retreatment. MR imaging Ponatinib nmr was performed at baseline and 3 to 4 weeks after the initial TACE by using a 1.5-T superconducting MR system (GE Signa; GE Medical Systems, Milwaukee, WI) and a phased-array torso coil for signal reception. The protocol included 1) axial T2-weighted fast spin-echo images (repetition time/echo time, 5000/100 milliseconds; matrix size, 256 × 256; section thickness, 8 mm; intersection gap, 2 mm; receiver bandwidth, 32 kHz), 2) axial T1-weighted dual fast gradient-recalled echo sequence, and 3) axial breath-hold unenhanced and contrast-enhanced [0.1 mmol per kilogram of body weight of intravenous gadodiamide (Omniscan; GE Healthcare, Princeton, NJ)] T1-weighted three-dimensional fat-suppressed spoiled gradient-recalled echo images (5.1/1.2; field of view, 320-400 mm; matrix size, 192 × 160; section thickness, 4-6 mm; receiver bandwidth, 64 kHz; flip angle, 15°) in the arterial, portal venous, and equilibrium
phases (20 seconds, 60-70 seconds, and 180-200 seconds after intravenous contrast material injection, respectively). Quantitative volumetric image analysis was performed by a radiologist (with 7 years of experience). Tumor response assessment was conducted by two radiologists (with 7 and 9 years of experience) during the same reading session to ensure careful Akt inhibitor comparison of pretreatment
and posttreatment findings. Any discrepancy was resolved by consensus. For each patient, 2 lesions in the treated lobe of the liver (target lesions) and 2 lesions in the untreated lobe (non-target lesions) were evaluated [30 target and 29 non-target 2-hydroxyphytanoyl-CoA lyase lesions (one patient had only one non-target lesion); a total of 59 lesions]. Lesions had a minimum diameter of 1 cm. To ensure independent sampling, the two largest lesions were evaluated in each lobe of the liver. The signal intensity of all the target and non-target lesions was graded on T2-weighted and T1-weighted images as isointense, hypointense, or hyperintense in relation to normal liver tissue. High signal intensity lesions on T2-weighted images were also compared to the spleen. In heterogeneous lesions on T2- and T1-weighted images (e.g., with areas of hypointensity and hyperintensity), the lesions were deemed isointense, hypointense, or hyperintense depending on the most prevalent signal in each respective lesion. In cases of lesions that had hyperintense signal intensities in relation to the liver tissue on unenhanced T1-weighted images, subtraction was performed to assess tumor enhancement.