Abstract
The purpose of the present study was to evaluate whether diffusion-weighted imaging (DWI) can be used to assess hepatocellular carcinoma (HCC) viability following transarterial chemoembolization (TACE). A total of 41 consecutive patients were treated according to chemoembolization protocols. The follow-up was performed between six and eight weeks post-chemoembolization by multidetector computed tomography [or enhanced magnetic resonance imaging (MRI)] and DW-MRI on the same day. The presence of any residual tumor and the extent of tumor necrosis were evaluated according to the European Association for the Study of the Liver. The apparent diffusion coefficient (ADC) values of the entire area of the treated mass and the vital and necrotic tumor tissues were recorded. Correlation coefficients were also calculated to compare the percentage of necrosis with ADC values. The mean ADC values of the necrotic and vital tumor tissues were 2.22±0.31×10−3 mm2/sec and 1.42±0.25×10−3 mm2/sec, respectively (Mann-Whitney U test, P<0.001). The results from the receiver operating characteristic analysis showed that the threshold ADC value was 1.84×10−3 mm2/sec with 92.3% sensitivity and 100% specificity for identifying the necrotic tumor tissues. A significant linear regression correlation was identified between the ADC value of the entire area of the treated mass and the extent of tumor necrosis (r=0.58; P<0.001). In conclusion, DWI can be used to assess HCC viability following TACE.
Highlights
Liver cancer is one of the most frequently diagnosed cancers worldwide, with figures for 2008 estimating 748,300 new liver cancer cases and 695,900 cancer mortalities [1]
Computed tomography (CT) is commonly used as the standard imaging technique to evaluate the therapeutic response in patients with Hepatocellular carcinoma (HCC) following Transarterial chemoembolization (TACE)
The purpose of the current study was to investigate the ability of diffusion‐weighted imaging (DWI) to evaluate treatment results with respect to the extent of tumor necrosis and viable tumor tissue following TACE, with a special focus on the feasibility of DWI for the short‐term follow‐up of HCC following chemoembolization
Summary
Liver cancer is one of the most frequently diagnosed cancers worldwide, with figures for 2008 estimating 748,300 new liver cancer cases and 695,900 cancer mortalities [1]. Since histological evaluation of each nodule is not feasible or reasonable for patients, the daily practice of monitoring treatment is restricted to the use of radiological imaging to evaluate tumor viability and to reach a conclusion [3]. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are widely used for treatment monitoring. Computed tomography (CT) is commonly used as the standard imaging technique to evaluate the therapeutic response in patients with HCC following TACE. MRI is more efficient than MDCT in the detection of viable residual tumor elements following lipiodol‐based TACE. With regard to the decision making process following lipiodol‐based TACE protocols, the use of MRI is compulsory during the follow‐up [4]
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