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©2010 Baishideng. All rights reserved.
Diffusion-weighted magnetic resonance imaging to predict response of hepatocellular carcinoma to chemoembolization
Johnathan C Chung, Neel K Naik, Robert J Lewandowski, Jie Deng, Mary F Mulcahy, Laura M Kulik, Kent T Sato, Robert K Ryu, Riad Salem, Andrew C Larson, Reed A Omary
Johnathan C Chung, Neel K Naik, Robert J Lewandowski, Jie Deng, Kent T Sato, Robert K Ryu, Riad Salem, Andrew C Larson, Reed A Omary, Department of Radiology, Northwestern University, Chicago, IL 60611, United States
Robert J Lewandowski, Mary F Mulcahy, Riad Salem, Andrew C Larson, Reed A Omary, Clinical Sciences Research Division, Gastrointestinal Oncology Program, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL 60611, United States
Mary F Mulcahy, Department of Medicine, Division of Hematology and Oncology, Northwestern Memorial Hospital, Chicago, IL 60611, United States
Laura M Kulik, Department of Hepatology, Northwestern University, Chicago, IL 60611, United States
Andrew C Larson, Reed A Omary, Department of Biomedical Engineering, Northwestern University, Chicago, IL 60611, United States
Author contributions: Omary RA, Larson AC and Deng J designed the research; Lewandowski RJ, Deng J, Mulcahy MF, Kulik LM, Sato KT, Ryu RK, Salem R and Omary RA performed the research; Chung JC, Lewandowski RJ, Naik NK, Deng J and Omary RA analyzed the data; Chung JC and Omary RA wrote the paper.
Supported by National Institutes of Health R01 CA126809
Correspondence to: Reed A Omary, MD, MS, Professor of Radiology and Biomedical Engineering, Vice Chair of Research, Department of Radiology, Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave., Suite 1600, Chicago, IL 60611, United States. reed@northwestern.edu
Telephone: +1-312-6953774 Fax: +1-312-9265991
Received: February 17, 2010
Revised: March 27, 2010
Accepted: April 3, 2010
Published online: July 7, 2010
AIM: To investigate whether intra-procedural diffusion-weighted magnetic resonance imaging can predict response of hepatocellular carcinoma (HCC) during transcatheter arterial chemoembolization (TACE).
METHODS: Sixteen patients (15 male), aged 59 ± 11 years (range: 42-81 years) underwent a total of 21 separate treatments for unresectable HCC in a hybrid magnetic resonance/interventional radiology suite. Anatomical imaging and diffusion-weighted imaging (b = 0, 500 s/mm2) were performed on a 1.5-T unit. Tumor enhancement and apparent diffusion coefficient (ADC, mm2/s) values were assessed immediately before and at 1 and 3 mo after TACE. We calculated the percent change (PC) in ADC values at all time points. We compared follow-up ADC values to baseline values using a paired t test (α = 0.05).
RESULTS: The intra-procedural sensitivity, specificity, and positive and negative predictive values (%) for detecting a complete or partial 1-mo tumor response using ADC PC thresholds of ±5%, ±10%, and ±15% were 77, 67, 91, and 40; 54, 67, 88, and 25; and 46, 100, 100, and 30, respectively. There was no clear predictive value for the 3-mo follow-up. Compared to baseline, the immediate post-procedure and 1-mo mean ADC values both increased; the latter obtaining statistical significance (1.48 ± 0.29 mm2/s vs 1.65 ± 0.35 × 10-3 mm2/s, P < 0.014).
CONCLUSION: Intra-procedural ADC changes of > 15% predicted 1-mo anatomical HCC response with the greatest accuracy, and can provide valuable feedback at the time of TACE.
