Evaluation of antiangiogenic efficacy in advanced hepatocellular carcinoma: Biomarkers and functional imaging

Table 8 Value of functional imaging in patients with hepatocellular carcinoma treated with antiangiogenic agents

Ref.	Imaging tools	Patients (n)	Study design	Treatment	Imaging findings and clinical impact	Conclusion/comments
Sugimoto et al[152]	DCE-US	37	Prospective	Sorafenib	Tumor vascularity decreases and blood volume within seven days trends towards better PFS and OS	These studies enrolled small cohort of patients hampering adequate interpretation. However, DCE-US remains a promising noninvasive imaging, but operator dependent, to predict response in patients with HCC treated with sorafenib and larger cohort of patients should be evaluated
Zocco et al[153]		28	Prospective	Sorafenib	An early decrease in AUC and increase of median transit time was associated with better PFS and OS
Zhu et al[91]	DCE-MRI	34	Prospective	Sunitinib	Decrease in vascular permeability was associated with better disease control	The decrease of vascular permeability induced by antiangiogenic agents seems to be a good predictive of tumor response and clinical benefit. These promising findings should be confirmed by largest cohort of patient
Hsu et al[156]		31	Prospective	Sorafenib + mT/U	A ≥ 40% decrease in vascular permeability with 14 d was associated with better PFS and OS
Lee et al[159]	FGD-PET	29	Retrospective	Sorafenib	SUV < 5.00 correlated with longer PFS and OS	Prospective studies are needed to evaluate the predictive value of the FDG-PET in HCC

AUC: Area under the time-intensity curve; DCE-US: Dynamic contrast-enhanced ultrasound; DCE-MRI: Dynamic contrast-enhanced magnetic resonance imaging; FGD-PET: 18F-fluorodeoxyglucose - positron-emission tomography; PFS: Progression-free survival; OS: Overall Survival; mT/U: Metronomic tegafur/uracil.