CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S18
DOI: 10.1055/s-0041-1730693

Hepatocellular Carcinoma Post-Transarterial Chemoembolization and Diffusion-Weighted Imaging: Therapy Outcome Prediction and Tumor Response Assessment

Hesham Abdelmonem Elsayed Temraz
National Liver Institute, Shebin Elkom, Egypt
Mohamed Mohame Houseni
National Liver Institute, Shebin Elkom, Egypt
› Author Affiliations

Background: The current established therapeutic response criteria for hepatocellular carcinoma (HCC) postconventional transarterial chemoembolization (cTACE) is based on tumor enhancement. This can be difficult to quantify in some cases presented by benign conditions of enhancement and in tumor areas show heterogeneous pattern of enhancement. Furthermore, reliable response prediction before cTACE can help to identify patients with potential treatment benefit. Diffusion-weighted imaging (DWI) was investigated as an aiding tool for response assessment and outcome prediction. Methods: From February 2015 to February 2017, 60 patients/70 lesions with average lesions size 4.14 cm (range: 1.0–10 cm) diagnosed as HCC had performed DWI 2 weeks before and 3 weeks after cTACE. The b values used in the diffusion sequence were 50, 200, and 800 s/mm2. The corresponding apparent diffusion coefficient (ADC) maps were generated. The results were correlated with 3 months modified response evaluation criteria in solid tumors (mRECIST) objective response. Results: There was an absolute increase in ADC values in responding lesions compared to nonresponding lesions by mRECIST criteria (35.4% vs. 5.2%; P < 0.001). The increase in volumetric ADC values posttrans-arterial chemoembolization (TACE) to 1.65 × 103 mm2/s in at least >42% of the tumor volume correlates with objective response by mRECIST with a sensitivity of 90.4% and specificity of 80.1% (P = 0.001). The pretreatment ADC value above the threshold 1.31 × 103 mm2/s predicts tumor response by mRECIST with a sensitivity of 81% and specificity of 60%. Conclusion: ADC value differences before and after TACE may provide valuable information for lesions response post-TACE and may play a role in predicting the HCC response.

Publication History

Article published online:
11 May 2021

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