Utility of diffusion‑weighted imaging to assess hepatocellular carcinoma viability following transarterial chemoembolization

Yuan,Zheng; Li,Wen‑Tao; Ye,Xiao‑Dan; Peng,Wei‑Jun; Xiao,Xiang‑Sheng

doi:10.3892/ol.2014.2228

Utility of diffusion‑weighted imaging to assess hepatocellular carcinoma viability following transarterial chemoembolization

Authors:
- Zheng Yuan
- Wen‑Tao Li
- Xiao‑Dan Ye
- Wei‑Jun Peng
- Xiang‑Sheng Xiao
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Affiliations: Department of Radiology, Shanghai People's Liberation Army No. 85 Hospital, Shanghai 200052, P.R. China, Department of Radiology, Fudan University, Shanghai Cancer Center, Shanghai 200032, P.R. China, Department of Radiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200030, P.R. China, Department of Radiology, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, P.R. China
Published online on: June 5, 2014 https://doi.org/10.3892/ol.2014.2228
Pages: 831-836

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Abstract

The purpose of the present study was to evaluate whether diffusion‑weighted imaging (DWI) can be used to assess hepatocellular carcinoma (HCC) viability following transarterial chemoembolization (TACE). A total of 41 consecutive patients were treated according to chemoembolization protocols. The follow‑up was performed between six and eight weeks post‑chemoembolization by multidetector computed tomography [or enhanced magnetic resonance imaging (MRI)] and DW‑MRI on the same day. The presence of any residual tumor and the extent of tumor necrosis were evaluated according to the European Association for the Study of the Liver. The apparent diffusion coefficient (ADC) values of the entire area of the treated mass and the vital and necrotic tumor tissues were recorded. Correlation coefficients were also calculated to compare the percentage of necrosis with ADC values. The mean ADC values of the necrotic and vital tumor tissues were 2.22±0.31x10‑3 mm2/sec and 1.42±0.25x10‑3 mm2/sec, respectively (Mann‑Whitney U test, P<0.001). The results from the receiver operating characteristic analysis showed that the threshold ADC value was 1.84x10‑3 mm2/sec with 92.3% sensitivity and 100% specificity for identifying the necrotic tumor tissues. A significant linear regression correlation was identified between the ADC value of the entire area of the treated mass and the extent of tumor necrosis (r=0.58; P<0.001). In conclusion, DWI can be used to assess HCC viability following TACE.

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1	Jemal A, Bray F, Center MM, et al: Global cancer statistics. CA Cancer J Clin. 61:69–90. 2011.
2	Llovet JM, Real MI, Montaña X, et al: Arterial embolization or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomized controlled trial. Lancet. 359:1734–1739. 2002.
3	Takayama T, Makuuchi M, Hirohashi S, et al: Malignant transformation of adenomatous hyperplasia to hepatocellular carcinoma. Lancet. 336:1150–1153. 1990.
4	Kloeckner R, Otto G, Biesterfeld S, et al: MDCT versus MRI assessment of tumor response after transarterial chemoembolization for the treatment of hepatocellular carcinoma. Cardiovasc Intervent Radiol. 33:532–540. 2010.
5	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. 75:e9–e14. 2010.
6	Kamel IR, Bluemke DA, Ramsey D, et al: Role of diffusion-weighted imaging in estimating tumor necrosis after chemoembolization of hepatocellular carcinoma. AJR Am J Roentgenol. 181:708–710. 2003.
7	Dong S, Ye XD, Yuan Z, Xu LC and Xiao XS: Relationship of apparent diffusion coefficient to survival for patients with unresectable primary hepatocellular carcinoma after chemoembolization. Eur J Radiol. 81:472–477. 2012.
8	Bruix J, Sherman M, Llovet JM, et al: Clinical management of hepatocellular carcinoma: conclusions of the Barcelona 2000 EASL Conference. European Association for the Study of the Liver. J Hepatol. 35:421–430. 2001.
9	Lim HS, Jeong YY, Kang HK, Kim JK and Park JG: Imaging features of hepatocellular carcinoma after transcatheter arterial chemoembolization and radiofrequency ablation. AJR Am J Roentgenol. 187:W341–W349. 2006.
10	Mannelli L, Kim S, Hajdu CH, et al: Assessment of tumor necrosis of hepatocellular carcinoma after chemoembolization: diffusion-weighted and contrast-enhanced MRI with histopathologic correlation of the explanted liver. AJR Am J Roentgenol. 193:1044–1052. 2009.
11	Koh DM and Collins DJ: Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol. 188:1622–1635. 2007.
12	Sadowski EA, Bennett LK, Chan MR, et al: Nephrogenic systemic fibrosis: risk factors and incidence estimation. Radiology. 243:148–157. 2007.
13	Koh DM, Scurr E, Collins D, et al: Predicting response of colorectal hepatic metastasis: value of pretreatment apparent diffusion coefficients. AJR Am J Roentgenol. 188:1001–1008. 2007.
14	Theilmann RJ, Borders R, Trouard TP, et al: Changes in water mobility measured by diffusion MRI predict response of metastatic breast cancer to chemotherapy. Neoplasia. 6:831–837. 2004.
15	Kamel IR, Liapi E, Reyes DK, et al: Unresectable hepatocellular carcinoma: serial early vascular and cellular changes after transarterial chemoembolization as detected with MR imaging. Radiology. 250:466–473. 2009.
16	Galea N, Cantisani V and Taouli B: Liver lesion detection and characterization: role of diffusion-weighted imaging. J Magn Reson Imaging. 37:1260–1276. 2013.
17	Goshima S, Kanematsu M, Kondo H, et al: Evaluating local hepatocellular carcinoma recurrence post-transcatheter arterial chemoembolization: is diffusion-weighted MRI reliable as an indicator? J Magn Reson Imaging. 27:834–839. 2008.
18	Szafer A, Zhong J, Anderson AW and Gore JC: Diffusion-weighted imaging in tissues: theoretical models. NMR Biomed. 8:289–296. 1995.
19	Parikh T, Drew SJ, Lee VS, et al: Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology. 246:812–822. 2008.
20	Taouli B, Sandberg A, Stemmer A, et al: Diffusion-weighted imaging of the liver: comparison of navigator triggered and breath-hold acquisitions. J Magn Reson Imaging. 30:561–568. 2009.
21	Nasu K, Kuroki Y, Nawano S, et al: Hepatic metastases: diffusion-weighted sensitivity-encoding versus SPIO-enhanced MR Imaging. Radiology. 239:122–130. 2006.
22	Murtz P, Flacke S, Traber F, et al: Abdomen: diffusion-weighted MR imaging with pulse-triggered single-shot sequences. Radiology. 224:258–264. 2002.
23	Koh DM, Takahara T, Imai Y and Collins DJ: Practical aspects of assessing tumors using clinical diffusion-weighted imaging in the body. Magn Reson Med Sci. 6:211–224. 2007.
24	Coenegrachts K, Delanote J, Ter Beek L, et al: Improved focal liver lesion detection: comparison of single-shot diffusion-weighted echoplanar and single-shot T2 weighted turbo spin echo techniques. Br J Radiol. 80:524–531. 2007.
25	Zech CJ, Herrmann KA, Dietrich O, et al: Black-blood diffusion-weighted EPI acquisition of the liver with parallel imaging: comparison with a standard T2-weighted sequence for detection of focal liver lesions. Invest Radiol. 43:261–266. 2008.