Open AccessTransarterial Chemoembolization Of Hepatocellular Carcinoma: Can Early Diffusion Weighted Imaging Predict Response?
Author(s) -
Asma Gulzar,
Tahleel Altaf Shera,
Omair Ashraf Shah,
Naseer A. Choh,
Tariq Gojwari,
Mohammad Akbar Bhat,
Shadab Maqsood
Publication year - 2022
Publication title -
basic and clinical cancer research
Language(s) - English
Resource type - Journals
eISSN - 2228-6527
pISSN - 2228-5466
DOI - 10.18502/bccr.v13i1.8834
Subject(s) - medicine , hepatocellular carcinoma , magnetic resonance imaging , diffusion mri , effective diffusion coefficient , nuclear medicine , predictive value , gold standard (test) , lesion , complete response , radiology , response evaluation criteria in solid tumors , clinical trial , pathology , chemotherapy , phases of clinical research
PURPOSE: We evaluated the role of early diffusion weighted imaging (DWI) in predicting response to TACE in patients with HCC and compare the results with contrast enhanced magnetic resonance imaging.
Methods: 24 patients with documented HCC were taken up for TACE after a pre-procedural contrast CT and MRI. Post procedural DWI was taken on day 5-7 and the mean ADC values were documented and compared to pre procedural values. The change in ADC values was grouped into 4 categories: group 1- 75%. The increase in ADC values signifying response was correlated with 5 week CEMRI scan (which has been the traditional gold standard for response evaluation) and a threshold ADC increase signifying response in majority of the cases was calculated.
Results: The mean ADC of the lesions changed from 1.21× 10-3 (pre TACE) to 2.02× 10-3 mm2/sec (post TACE) [p<0.001]. Taking CE MRI as gold standard, DWI imaging had a sensitivity of 80%, specificity of 94.7% with a positive predictive value of 80%, negative predictive value of 94.7% and overall accuracy of 91.7%. Complete response was seen in19 (79%) and incomplete in 5 (21%) patients in our study. The change in ADC was significantly higher in responders (884.15 ± 161.60) as compared to non responders (564.80 ± 221.05) [p =0.001].
Conclusion: Early DWI after TACE can predict response of a HCC lesion to chemoembolization. The change in ADC values can earmark responders from non-responders. Early DWI results are concordant with CEMRI results in most of the cases. DWI can act as a substitute to CEMRI when contrast administration is not advised.