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ADC total ratio and D ratio derived from intravoxel incoherent motion early after TACE are independent predictors for survival in hepatocellular carcinoma
Author(s) -
Wu Lifang,
Xu Pengju,
Rao Shengxiang,
Yang Li,
Chen Caizhong,
Liu Hao,
Fu Caixia,
Zeng Mengsu
Publication year - 2017
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.25617
Subject(s) - intravoxel incoherent motion , medicine , effective diffusion coefficient , hazard ratio , hepatocellular carcinoma , nuclear medicine , receiver operating characteristic , mann–whitney u test , magnetic resonance imaging , proportional hazards model , diffusion mri , confidence interval , radiology
Purpose To explore the threshold of intravoxel incoherent motion (IVIM) parameters, apparent diffusion coefficient [ADC total and ADC (0,500) ] ratios 24–48 hours after transarterial chemoembolization (TACE) to assess early response in patients with unresectable hepatocellular carcinoma (HCC) and to compare the association between diffusion‐weighted imaging with the intravoxel incoherent motion (IVIM‐DWI) and mRECIST with survival. Materials and Methods Institutional Review Board approval and informed consent were obtained for this prospective study. There were 30 patients undergoing 1.5T magnetic resonance imaging (MRI) with IVIM‐DWI of 12 b values (0, 10, 20, 30, 40, 50, 70, 100, 200, 300, 500, 800 s/mm 2 ) 1 week before and 24–48 hours after TACE. Response was assessed with the change of true diffusion coefficient (D), pseudo‐diffusion coefficient (D*), perfusion fraction (PF), ADC total , and ADC (0,500) values relative to baseline and with mRECIST. Receiver operating characteristic (ROC) curve analysis was used to explore the threshold of these parameters ratios. Kaplan–Meier, log‐rank tests, and the Cox hazard model were used to correlate the response variables with progression‐free survival (PFS) and to assess the incidence and potential clinical risk factors for PFS. Mann–Whitney U ‐test was used to compare the difference in parameters between different groups with progression within and beyond median PFS prior to TACE. Results Median PFS was 99 days, within which 16 patients progressed. The threshold of ADC total ratio, D ratio, and ADC (0,500) ratio were 13.1% ( P = 0.001), 7.0% ( P = 0.011), and 3.6% ( P = 0.018) with sensitivity and specificity of 78.6% and 87.5%, 85.7% and 62.5%, 78.6% and 75%, respectively. The predictive utility of ADC total ratio, D ratio, and ADC (0,500) ratio for PFS were 0.848, 0.772, and 0.754, respectively. Survival analyses showed ADC total ratio, D ratio, ADC (0,500) ratio, liver cirrhosis, and mRECIST had a significant effect on PFS ( P < 0.05). ADC total ratio and D ratio were independent predictors for 99‐day PFS ( P = 0.025, P = 0.036). There were no significant differences in pretreatment IVIM‐DWI parameters between PFS > 99‐day group and PFS ≤ 99‐day group with P values of 0.547 for D, 0.394 for D*, 0.575 for PF, 0.901 for ADC (0,500) , and 0.506 for ADC total , respectively. Conclusion The ADC total ratio and D ratio 24–48 hours after TACE were independent predictors for response to TACE for HCC, and showed stronger association with PFS than mRECIST. Level of Evidence : 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:820–830