Role of diffusion-weighted magnetic resonance imaging in the evaluation of hepatocellular carcinoma response to transcatheter arterial chemoembolization using drug eluting beads; correlation with dynamic MRI

Role of DWI in evaluation of HCC after radiofrequency ablation compared to dynamic MRI using MRI (3 T)

Background

The purpose of this study was to investigate the diagnostic performance of diffusion weight imaging (DWI), apparent diffusion coefficient (ADC) map, normalized ADC liver, and normalized ADC spleen compared to the dynamic contrast-enhanced MRI (DCE-MRI) in the evaluation of residual hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) using 3 T (T) magnetic resonance imaging (MRI).

Results

A prospective study was performed on 40 patients with radiofrequency-ablated HCC, and 15 (37.5%) patients had viable lesion post-RFA, while 25 (62.5%) had non-viable lesions. DCE-MRI had a sensitivity, specificity, and accuracy of 100%, 100%, and 100%, respectively, compared to DWI which had a sensitivity, specificity, and accuracy of 80%, 88%, and 85%, respectively, for identifying post-RFA viable HCC. The sensitivity, specificity, and accuracy of ADC at a cutoff value of 1.01 × 10−3 mm2/s were 80%, 100%, and 97.1%, respectively. The optimal cutoff value of normalized ADC liver was 0.81 with a sensitivity of 73.3%, specificity of 96%, and accuracy of 92.8%. The sensitivity, specificity, and accuracy of normalized ADC spleen at a cutoff value of 1.22 were 80%, 92%, and 91.1%, respectively.

Conclusions

DWI-MRI is a reliable technique for assessing HCC after radiofrequency ablation. DWI-MRI with ADC may be used as an alternate sequence for assessing radiofrequency-ablated lesions in individuals who have a contraindication to the contrast media, and the normalized ADC value may be of additional benefit.

Utility of diffusion weighted imaging with the quantitative apparent diffusion coefficient in diagnosing residual or recurrent hepatocellular carcinoma after transarterial chemoembolization: a meta-analysis

Background

Accurate and early diagnosis of residual tumors or intrahepatic recurrences after TACE is critically needed for determining the success of treatments and for guiding subsequent therapeutic planning. This meta-analysis was performed to assess the efficacy of diffusion weighted imaging (DWI) with the quantitative apparent diffusion coefficient (ADC) value in diagnosing residual or recurrent hepatocellular carcinoma after transarterial chemoembolization (TACE).

Materials and methods

A comprehensive literature search of PubMed, Embase, Web of Science, Scopus and the Cochrane Library database, from inception to July 2019, was conducted to select original studies on diagnosing residual or recurrent HCCs after TACE using DWI sequence with its ADC value. Two researchers independently chose study, extracted data, conducted meta-analysis, and evaluated methodological quality according to Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.

Results

Twelve studies comprising 624 patients and 712 tumors were finally included. The pooled sensitivity, specificity and AUC value of DWI in diagnosing residual or recurrent HCCs after TACE were 85% (95%CI: 74–92%), 83% (95%CI: 75–88%) and 0.90 (95%CI: 0.87–0.92), respectively. Residual or recurrent HCCs have significantly lower ADC value than necrotic tumors (MD = -0.48, 95%CI: − 0.69~ − 0.27, P < 0.01).

Conclusion

This study demonstrated that DWI performed better in diagnosing residual or recurrent HCCs after TACE, and ADC value may serve as alternatives for further evaluation of residual or recurrent leisions in HCC patients after TACE.

Diagnostic accuracy of intermediate b-value diffusion-weighted imaging for detection of residual hepatocellular carcinoma following transarterial chemoembolization with drug-eluting beads

Purpose:

To evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of residual malignant tumor of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) with drug-eluting beads (DEBs).

Subjects and Methods:

Pre-contrast T1, T2, dynamic contrast–enhanced, and respiratory-triggered DW-MRI (b factor 0, 400, and 800 s/mm²) were obtained in 60 patients with HCC who underwent tran-sarterial hepatic chemoembolization with DEBs. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the DW imaging images. Apparent diffusion coefficients (ADCs) were calculated searching for the optimal cut-off value using the receiver operating characteristic (ROC) curve.

Results:

DW-MRI had a sensitivity of 77.1%, a specificity of 60.7%, a PPV of 71.05%, and a NPV of 68%. The difference between the malignant and benign groups’ ADC variables was statistically significant (P < 0.003). The ROC curve showed that the area under the curve is C = 0.718 with SE = 0.069 and 95% confidence interval from 0.548 to 0.852.

Conclusion:

In our study, we demonstrated that diffusion MRI has limited diagnostic value in the assessment of viable tumor tissue after TACE with DEBs in cases of HCC.