Journal
WORLD JOURNAL OF GASTROENTEROLOGY
Volume 16, Issue 25, Pages 3161-3167Publisher
BAISHIDENG PUBLISHING GROUP INC
DOI: 10.3748/wjg.v16.i25.3161
Keywords
Hepatocellular carcinoma; Transcatheter arterial chemoembolization; Diffusion-weighted imaging; Apparent diffusion coefficient; Functional imaging biomarker
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Funding
- National Institutes of Health [R01 CA126809]
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AIM: To investigate whether intra-procedural diffusion-weighted magnetic resonance imaging can predict response of hepatocellular carcinoma (HCC) during transcatheter arterial chemoembolization (TACE). METHODS: Sixteen patients (15 male), aged 59 +/- 11 years (range: 42-81 years) underwent a total of 21 separate treatments for unresectable HCC in a hybrid magnetic resonance/interventional radiology suite. Anatomical imaging and diffusion-weighted imaging (b = 0, 500 s/mm(2)) were performed on a 1.5-T unit. Tumor enhancement and apparent diffusion coefficient (ADC, mm(2)/S) values were assessed immediately before and at 1 and 3 mo after TACE. We calculated the percent change (PC) in ADC values at all time points. We compared follow-up ADC values to baseline values using a paired t test (alpha = 0.05). RESULTS: The intra-procedural sensitivity, specificity, and positive and negative predictive values (%) for detecting a complete or partial 1-mo tumor response using ADC PC thresholds of +/- 5%, +/- 10%, and +/- 15% were 77, 67, 91, and 40; 54, 67, 88, and 25; and 46, 100, 100, and 30, respectively. There was no clear predictive value for the 3-mo follow-up. Compared to baseline, the immediate post-procedure and 1-mo mean ADC values both increased; the latter obtaining statistical significance (1.48 +/- 0.29 mm(2)/s vs 1.65 +/- 0.35 x 10(-3) mm(2)/s, P < 0.014). CONCLUSION: Intra-procedural ADC changes of > 15% predicted 1-mo anatomical HCC response with the greatest accuracy, and can provide valuable feedback at the time of TACE. (C) 2010 Baishideng. All rights reserved.
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