Transarterial Chemoembolization Of Hepatocellular Carcinoma: Can Early Diffusion Weighted Imaging Predict Response?

Gulzar Asma, Shera Tahleel, Shah Omair, Choh Naseer, Gojwari Tariq, Bhat Mudaisr, Maqsood Shadab
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Abstract

PURPOSE: We evaluated the role of early diffusion weighted imaging (DWI) in predicting response to TACE in patients with HCC and compare the results with contrast enhanced magnetic resonance imaging. Methods: 24 patients with documented HCC were taken up for TACE after a pre-procedural contrast CT and MRI. Post procedural DWI was taken on day 5-7 and the mean ADC values were documented and compared to pre procedural values. The change in ADC values was grouped into 4 categories: group 1- <25%, group 2 26-50%, group 3- 51-75% and group 4- >75%. The increase in ADC values signifying response was correlated with 5 week CEMRI scan (which has been the traditional gold standard for response evaluation) and a threshold ADC increase signifying response in majority of the cases was calculated. Results: The mean ADC of the lesions changed from 1.21× 10-3 (pre TACE) to 2.02× 10-3 mm2/sec (post TACE) [p<0.001]. Taking CE MRI as gold standard, DWI imaging had a sensitivity of 80%, specificity of 94.7% with a positive predictive value of 80%, negative predictive value of 94.7% and overall accuracy of 91.7%. Complete response was seen in19 (79%) and incomplete in 5 (21%) patients in our study. The change in ADC was significantly higher in responders (884.15 ± 161.60) as compared to non responders (564.80 ± 221.05) [p =0.001]. Conclusion: Early DWI after TACE can predict response of a HCC lesion to chemoembolization. The change in ADC values can earmark responders from non-responders. Early DWI results are concordant with CEMRI results in most of the cases. DWI can act as a substitute to CEMRI when contrast administration is not advised.
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肝细胞癌经动脉化疗栓塞:早期弥散加权成像能预测疗效吗?
目的:我们评估早期弥散加权成像(DWI)在预测HCC患者对TACE的反应中的作用,并将结果与增强磁共振成像进行比较。方法:24例确诊HCC患者行术前对比CT和MRI检查后行TACE。术后第5-7天取DWI,记录平均ADC值,并与术前值进行比较。ADC值变化分为4组:1组- 75%组。表明缓解的ADC值的增加与5周的CEMRI扫描(这是评估缓解的传统金标准)相关,并且计算了大多数情况下表明缓解的阈值ADC增加。结果:病变的平均ADC由TACE前的1.21× 10-3 mm2/sec变为TACE后的2.02× 10-3 mm2/sec [p<0.001]。以CE MRI为金标准,DWI成像的敏感性为80%,特异性为94.7%,阳性预测值为80%,阴性预测值为94.7%,总体准确率为91.7%。在我们的研究中,19例(79%)患者出现完全缓解,5例(21%)患者出现不完全缓解。有应答者ADC的变化(884.15±161.60)明显高于无应答者(564.80±221.05)[p =0.001]。结论:TACE术后早期DWI可以预测肝癌病变对化疗栓塞的反应。ADC值的变化可以区分有反应者和无反应者。多数病例早期DWI结果与CEMRI结果一致。当不建议使用造影剂时,DWI可以替代CEMRI。
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审稿时长
12 weeks
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