Abstract
Aim: The study goal is to detect if apparent diffusion coefficient (ADC), a quantitative parameter of diffusion-weighted imaging (DWI), can recognize HCC post TACE residuals. Results were obtained by using MRI_DWI & ADC and were compared with those of Tri phasic-computed tomography (CT). patient and Methods MRI-DWI was performed to 20 patients with 24 HCC focal lesions before and 1month after TACE to calculate the ADC value of HCC. Patients were also evaluated with Tri phasic-CT after TACE. CT was performed within 1 month after TACE. Results: All patients under the study shows pretreatment restricted Diffusion weighted images with low ADC value. Mean ADC value before treatment was 1.14× 10¯³ ±0.29× 10¯³ and ranged from 0.819× 10¯³ to 2.48× 10¯³. 9 cases (45%) cases show post-TACE good therapeutic response with facilitated diffusion & mean ADC value 1.32×10¯³ with significant increase compared to pre-treatment values. 11 cases (55%) shows post-TACE partial or no therapeutic response with restricted diffusion & mean ADC value 1.18×10¯³. However, there was no statistical significant difference between ADC value of resolved and that of residual cases (P-value=0.067), DWI could predict the response of treatment as CT by 100%. All cases of Good therapeutic response had a facilitated diffusion, all cases of partial therapeutic response had a restricted diffusion but less than pretreatment and all cases with no therapeutic response had a restricted diffusion but more than pretreatment. Conclusion DWI could evaluate HCC necrosis of tumor after chemoembolization, and the ADC importance might be its ability to detect viable necrotic tumor tissues. Furthermore, DWI-MRI determines improved liver lesion location. So, DWI can be used as an option for HCC patients short term follow up after chemoembolization and may direct patient control for decreasing radiation CT examination exposure and the danger of contrast material-induced nephropathy.
Highlights
The most widely recognized primary hepatic malignant cancer is Hepatocellular carcinoma (HCC) which is the fifth most prevalent malignant disease and the third most basic worldwide reason for deaths due to cancer
Categorical data was presented as number and percent Scale data presented as mean and standard deviation (SD) Table (2) demonstrated that 11(55%) cases of HCC had post-treatment restricted diffusion and 9 (45%) had facilitated diffusion with mean post-treatment apparent diffusion coefficient (ADC) value 1.24×10 ̄3±0.25×10 ̄3 ranged from 0.858×10 ̄3 to1.777×10 ̄3 7
TriphasicCT widely used for post-transarterial chemoembolization (TACE) HCC assessment depending on presence or absence of contrast enhancement; high-attenuation lipidol can cause beamhardening artifact that may hind intralesional viable tumor tissue. (10)
Summary
The most widely recognized primary hepatic malignant cancer is Hepatocellular carcinoma (HCC) which is the fifth most prevalent malignant disease and the third most basic worldwide reason for deaths due to cancer. In 2000, there were 564,000 new cases and 549,000 mortality rates from HCC around the world, demonstrating the overwhelming evaluation of this tumour (1). Using IFN as example in controlling chronic hepatitis C can reduce risk of hepatocellular carcinoma (2), HCV still one of major causes of hepatocellular carcinoma (3). In contrast to different types of malignant cancers, the HCC evaluation doesn’t generally require histological affirmation and HCC is normally estimated by tumour marker and radiology like ultrasonography, C.T and X-ray (4). Transplantation, trans-arterial treatments, different local ablative and liver resection are considered current efficacious therapy for HCC. Liver transplantation and liver resection are the primary therapeutic treatment.
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