# Quantitative Multimodal Image Guidance for Improved Liver Cancer Treatment

> **NIH NIH R01** · YALE UNIVERSITY · 2020 · $601,618

## Abstract

Project Summary/Abstract
 Liver cancer is the second most common cause of cancer-related death worldwide and is likely to grow even
more in the next decade given the epidemic levels of hepatitis B and C and the emergence of non-alcoholic
steatohepatitis (NASH) due to obesity in the US. Most liver cancer patients present with disease that cannot
be treated surgically. Minimally invasive, catheter-based, intra-arterial therapies such as TACE (transarterial
chemoembolization) have become the mainstay therapy and are included in all treatment guidelines because of
their ability to achieve local tumor control and extend survival. TACE overcomes the problem of chemoresistance
in cancer cells by delivering high dose chemotherapy through image guidance and embolization of the tumor
feeding blood vessel. TACE most commonly uses an oily medium (Lipiodol) as a radiopaque drug delivery mate-
rial by creating an emulsion between drugs and oil. The recent introduction of drug-eluting bead (DEB) technol-
ogy provides an opportunity to achieve the goal of controlled and sustainable drug release to tumors, which was
not possible with oily TACE. Although TACE clearly improves patient survival, limitations still exist – specifically,
incomplete treatment and tumor recurrence – attributed to the stimulation of angiogenesis. Most of these issues
can be addressed with a greater understanding of the tumor microenvironment, in particular the relationship that
exists between hypoxia, acidosis and angiogenesis. In fact, the development of imaging biomarkers reflecting
changes within the tumor microenvironment is increasingly being pursued to individualize cancer therapies and
increase their potency. Yet, our ability to characterize the tumor microenvironment using current imaging tech-
nology is extremely limited. TACE has had to rely on 2D X-ray angiography until recently when the emergence of
intra-procedural dual phase cone beam CT (DP-CBCT) contributed significantly to improving tumor visualization,
microcatheter guidance, and treatment endpoint. It is precisely through the longstanding close partnership be-
tween Philips, Johns Hopkins and now Yale that this technology was optimized and became broadly accepted as
the new standard of practice for TACE, demonstrating the prompt successful translation of research findings to
clinical practice. However, the targeting of tumors and assessment of outcomes continues to be limited, relying
on qualitative/semi-quantitative enhancement patterns from DP-CBCT and single parameter MR images. The
unique partnership between Yale & Philips provides innovative technology that will directly enhance the role of
image-guided intervention and address this unmet need by quantitatively characterizing the tumor microenvi-
ronment and tumor tissue composition in order to maximize treatment potency and improve outcomes. We will
integrate advanced, multiparameter MR with active CBCT imaging and create valuable biomarkers derived from
novel machine...

## Key facts

- **NIH application ID:** 9982672
- **Project number:** 5R01CA206180-05
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** JAMES S DUNCAN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $601,618
- **Award type:** 5
- **Project period:** 2016-08-01 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9982672

## Citation

> US National Institutes of Health, RePORTER application 9982672, Quantitative Multimodal Image Guidance for Improved Liver Cancer Treatment (5R01CA206180-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9982672. Licensed CC0.

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