Role of Dynamic Subtraction MRI in Assessment of Reactivity of Hepatic Focal Lesions post Trance arterial chemoembolization

Abstract

Abstract The aim of this work was to assess HCC cases after trans-arterial chemoembolization by subtraction dynamic contrast enhanced MRI to detect its accuracy, sensitivity and specifity in detecting residual tumor and assess the need for further treatment. Patients and methods: This was a retrospective comparative study will be conducted on 35 patients hepatocellular carcinoma (HCC); to assess HCC cases after trans-arterial chemoembolization (TACE) by subtraction dynamic contrast enhanced MRI to detect its accuracy, sensitivity and specificity in detecting residual tumor and assess the need for further treatment. We found that; the mean age of all patients was (62.31 ± 7.14) years. Regarding gender of the patients, the majority (88.6%) of patients were males; while only (11.4%) were females. Regarding residence, the majority (77.1%) of patients live in rural areas, while only (22.9%) live in urban areas. Comparative study between D-MRI and DS-MRI assessments revealed; highly significant increase in disease detection rate, sensitivity, and NPV in favor of DS-MRI in HCC patients; with highly significant difference (p < 0.01 respectively). Comparative study between D-MRI and DS-MRI assessments revealed; non-significant difference in specificity and PPV in HCC patients; with non-significant difference (p > 0.05). We found a moderate agreement between D-MRI and DS-MRI assessments of reactivity among HCC patients (kappa =0.44). Conclusion: Dynamic MRI is valuable in detecting recurrent lesions however, this value is augmented by the addition of subtraction technique especially in lesions having high signal before administration of contrast medium. So we recommend adding the subtraction technique in the protocol of MRI in the follow up after transarterial chemoembolization as it increases the diagnostic confidence. This may help to facilitate the appropriate clinical management of patients including the need for re-treatment sessions.