Abstract
Reliable response criteria are critical for the evaluation of therapeutic response in hepatocellular carcinoma (HCC). Current response assessment is mainly based on: (1) changes in size, which is at times unreliable and lag behind the result of therapy; and (2) contrast enhancement, which can be difficult to quantify in the presence of benign post-procedural changes and in tumors presenting with a heterogeneous pattern of enhancement. Given these challenges, functional magnetic resonance imaging (MRI) techniques, such as diffusion-weighted imaging (DWI) have been recently investigated, aiding specificity to locoregional therapy response assessment and outcome prediction. Briefly, DWI quantifies diffusion of water occurring naturally at a cellular level (Brownian movement), which is restricted in multiple neoplasms because of high cellularity. Disruption of cellular integrity secondary to therapy results in increased water diffusion across the injured membranes. This review will provide an overview of the current literature on DWI therapy response assessment and outcome prediction in HCC following treatment with locoregional therapies.
Highlights
Hepatocellular carcinoma (HCC) is the 3rd deadliest cancer worldwide [1] with a 3-4-fold incidence increase within the past decades in the United States [2]
Liver (EASL) criteria were developed with the aim of achieving reliable and early response assessment not solely based on tumor size changes
Apparent Diffusion Coefficient (ADC) value increase or decrease of ≥15% of individual lesions was associated with a 100% positive predictive value, a specificity of 100%, and a sensitivity of 46% for tumor response after 1 month (EASL) following conventional TACE (cTACE)
Summary
Hepatocellular carcinoma (HCC) is the 3rd deadliest cancer worldwide [1] with a 3-4-fold incidence increase within the past decades in the United States [2]. Liver (EASL) criteria were developed with the aim of achieving reliable and early response assessment not solely based on tumor size changes These criteria determine changes in tumor viability by detection of perfusion changes, using contrast enhanced cross sectional imaging [6,8]. In cases of infiltrative lesions or heterogeneous necrosis, anatomical response criteria may be difficult or even impossible to apply appropriately [16,17,18] To overcome these shortcomings, technological advancements in functional MR imaging, such as diffusion-weighted imaging (DWI), are increasingly being used and evaluated for both post-treatment response assessment and outcome prediction prior to therapy. Provide an overview of the technical aspects of DWI in the liver; Review the current literature investigating the role of DWI for response assessment and outcome prediction in HCC following treatment with locoregional therapies; and Discuss potential limitations of DWI imaging. At least two b-value measurements are needed for ADC value determination [23]
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