Original Investigation CT-Based Hepatic Residual Volume and Predictors of Outcomes of Patients with Hepatocellular Carcinoma Unsuitable for Surgical Therapy Undergoing Transarterial Chemoembolization David E. Timaran Montenegro, MD 1 , Christian A. Torres Ramirez, MD, Yohana S. Mateo C, MD, Jovanni Govea Palma, MD, Julian C. Qui ~ nones, MD, Julita S. Orozco Vazquez, MD Rationale and Objectives: To assess the association between baseline CT-based volumetric parameters and biochemical hepatic evalu- ations, such as, Child-Pugh, MELD score, and modified MELD-Na score, on the prediction of outcomes of patients with HCC undergoing transarterial chemoembolization (TACE). Materials and Methods: A retrospective of a prospectively maintained database, single arm, and single center study was performed including 41 patients with diagnosis of hepatocellular carcinoma treated with TACE. Study endpoints included liver dysfunction (new events of ascites, encephalopathy, and/or death) and overall survival rate. Multi-phase CT-based volumetric analysis was performed to calculate total liver volume and tumor volume using portal and late arterial phases, respectively. Residual volume was calculated subtract- ing the tumor volume minus the total liver volume. Child-Pugh, MELD score, and MELD-Na score were measured during the baseline eval- uation. Results: At a median follow-up time of 8 months (IQR, 5À14), 16 patients (39%) were diagnosed with hepatic dysfunction. In patients with hepatic dysfunction, the median residual hepatic volume was 1002.1 cc (IQR, 633À1077.1 cc) compared to patients with normal liver function post-TACE with a median residual volume of 1233 cc (IQR, 1018.7À1437.6 cc) (p = 0.02). Survival analysis demonstrated an over- all survival rate of 95%, 90%, 85% at 30 days, 12 months, and 24 months, respectively. The overall survival rate in patients with Child- Pugh A was 100%, 97%, and 97% at 6, 12, and 24 months, respectively; compared to patients with Child Pugh B with an overall survival of rate of 86%, 78%, and 78% at 6, 12, and 24 months, respectively (p = 0.07). Median baseline MELD-Na score was higher in patients that died during the study period compared to patients that survived (6.7 [IQR, 5À14.2] versus 4.1 [IQR, 2.14À6.85]) (p = 0.09). Conclusion: Low baseline CT-based residual volume is associated with the occurrence of hepatic dysfunction at a median time of 8 months. Baseline Child-Pugh A patients were found to have higher survival rate than Child-Pugh B. Interestingly, higher baseline MELD- Na score was associated with mortality. Key Words: TACE; Hepatic residual volume; Hepatocellular carcinoma; Outcomes. © 2019 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved. INTRODUCTION H epatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the most common primary malignancy of the liver with a rising inci- dence in North-American countries. It is estimated that 39,230 cases of HCC were diagnosed in 2016 in the United States with approximately 27,170 HCC deaths (1). Patients on early stage of the disease may be treated with curative therapies including surgical alternatives such as tumor resec- tion and liver transplantation and/or minimal invasive meth- ods including local ablation (2), with a 5-year survival rate Acad Radiol 2019; &:1–8 From the Centro M edico Nacional 20 de Noviembre, Universidad Nacional Aut  onoma de M exico (UNAM), Mexico City, Mexico. Received June 9, 2019; revised September 3, 2019; accepted September 3, 2019. Address correspondence to: D.E.T.M. e-mail: david_timaran@yahoo.com 1 Present Address: Centro M edico Nacional 20 de Noviembre. Felix Cuevas 540, Col del Valle Sur, 03100. Ciudad de M exico, M exico. © 2019 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.acra.2019.09.003 ARTICLE IN PRESS