Abstract
BackgroundDetection of the value of DCE (dynamic contrast enhanced) MRI and DWI (diffusion-weighted imaging) in follow-up of treatment response for HCC (hepatocellular carcinoma) lesions post TACE (trans-arterial chemo-embolization) through LI-RADS v2018 algorithmic approach.ResultsA prospective study was performed on 30 patients with 41 treated hepatic focal lesions. The patients underwent DCE MRI with DWI in less than 1-month duration following TACE procedure and were radiologically assessed to observe tumoral post treatment response; then, another follow-up after another 3 months later was done for non-viable, equivocal, and non-evaluable post treatment response categories. Statistical analysis showed that DCE MRI had 100% level of sensitivity, specificity of 95.24%, PPV of 95.00%, and NPV of 100% with an overall agreement of 97.50%. While on the other hand, statistics showed that DWI has 52.63% level of sensitivity, specificity of 90.48%, PPV of 83.33%, PPV of 67.86%, and NPV of 72.50%.The difference between non-viable and viable groups’ ADC variables was found statistically significant at P value < 0.001, and best cut off value that augments sensitivity and specificity is 1.35. At this ADC value, sensitivity reaches 78.9% and specificity is 85.7%.ConclusionsOur study showed that DCE MRI has 100% level of sensitivity via application of LI-RADS v2018 diagnostic algorithmic approach while DWI alone has 52.63% level of sensitivity, yet it can enhance the diagnostic confidence of DCE MRI for post treatment response viability detection.
Highlights
Detection of the value of Dynamic contrast enhanced (DCE) MRI and Diffusionweighted images (DWI) in follow-up of treatment response for Hepatocellular carcinoma (HCC) lesions post trans-arterial chemoembolization (TACE) through Liver Imaging Reporting and Data Systems (LI-RADS) v2018 algorithmic approach
Among 40 treated lesions in our study, 45% of lesions showed heterogeneous T2 signal intensity and 61% of the treated hepatic lesions showed heterogeneous T1 signal intensity making the evaluation of HCC post
Final diagnosis: LR-TR viable 27 mm Statistical analysis showed that DCE MRI had 100% level of sensitivity, specificity of 95.24%, positive predictive value (PPV) of 95.00%, and negative predictive value (NPV) of 100% with an overall agreement of 97.50%
Summary
Detection of the value of DCE (dynamic contrast enhanced) MRI and DWI (diffusion-weighted imaging) in follow-up of treatment response for HCC (hepatocellular carcinoma) lesions post TACE (trans-arterial chemo-embolization) through LI-RADS v2018 algorithmic approach. Guided by the Barcelona Clinic Liver Cancer (BCLC) classification system, trans-arterial chemoembolization (TACE) is the first line of treatment for HCC patients with intermediate stage and those with sizable or multicentric HCC [4]. It was found that MRI signals are not degraded by lipidol droplets; a residual/newly developed lesion is better detected by DCE MRI. In this manner, DCE MRI study for the hepatic lesions is viewed as the chosen radiological modality [5]
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