Abstract
BackgroundTumor recurrence is the major risk factor affecting post-transplant survival. In this retrospective study, we evaluate the prognostic values of magnetic resonance (MR) diffusion-weighted imaging (DWI) in liver transplantation for hepatocellular carcinoma (HCC).MethodsFrom April 2014 to September 2016, 106 HCC patients receiving living donor liver transplantation (LDLT) were enrolled. Nine patients were excluded due to postoperative death within 3 months and incomplete imaging data. The association between tumor recurrence, explant pathologic findings, and DWI parameters was analyzed (tumor-to-liver diffusion weighted imaging ratio, DWIT/L; apparent diffusion coefficients, ADC). The survival probability was calculated using the Kaplan–Meier method.ResultsSixteen of 97 patients (16%) developed tumor recurrence during the follow-up period (median of 40.9 months; range 5.2–56.5). In those with no viable tumor (n = 65) on pretransplant imaging, recurrence occurred only in 5 (7.6%) patients. Low minimum ADC values (p = 0.001), unfavorable tumor histopathology (p < 0.001) and the presence of microvascular invasion (p < 0.001) were risk factors for tumor recurrence, while ADCmean (p = 0.111) and DWIT/L (p = 0.093) showed no significant difference between the groups. An ADCmin ≤ 0.88 × 10− 3 mm2/s was an independent factor associated with worse three-year recurrence-free survival (94.4% vs. 23.8%) and overall survival rates (100% vs. 38.6%).ConclusionsQuantitative measurement of ADCmin is a promising prognostic indicator for predicting tumor recurrence after liver transplantation.
Highlights
Tumor recurrence is the major risk factor affecting post-transplant survival
The apparent diffusion coefficient (ADC) values calculated from diffusion-weighted imaging (DWI) data reflect the tumor microenvironment and have the potential to predict tumor histopathology
Based on the magnetic resonance (MR) imaging performed in 2 months prior to transplantation, all patients met the University of California San Francisco (UCSF) criteria [9]
Summary
Tumor recurrence is the major risk factor affecting post-transplant survival. In this retrospective study, we evaluate the prognostic values of magnetic resonance (MR) diffusion-weighted imaging (DWI) in liver transplantation for hepatocellular carcinoma (HCC). Liver transplantation (LT) is the preferred treatment for selected patients with hepatocellular carcinoma (HCC) and end-stage liver disease, given that it removes the tumor as well as the diseased liver. The Milan criteria [1], which considers the size and number of the tumors, was used for decades as the standard to determine transplant eligibility. Diffusion-weighted imaging (DWI) is a distinct functional imaging technique, allowing qualitative and quantitative assessment of the diffusion properties of various types of tissue. The apparent diffusion coefficient (ADC) values calculated from DWI data reflect the tumor microenvironment and have the potential to predict tumor histopathology
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