Transarterielle Chemoembolisation bei hepatozellulären Karzinomen: Technik, Indikationsstellung, Ergebnisse

BACKGROUND: At time of diagnosis 80% of the patients with hepatocellular carcinoma (HCC) could not be treated with surgical treatments, so that transarterial chemoembolization (TACE) was used as an neoadjuvant or palliative treatment modality. MATERIAL AND METHODS: 60 patients were treated with 217 TACE courses, in the mean 3.6 TACE treatments per patient with an 4 week interval. TACE was performed with a dispersion of lipiodol, mitomycin C and spherex. 11 patients (18.3%) were treated in a neoadjuvant protocol with successful ablation. Lipiodol retention and size of the tumors were evaluated by CT and MRI. RESULTS: 60 patients were successful treated with TACE. After treatment a primary high lipiodol retention was displayed and in 68 (63.3%) patients a reduction of the tumor size and in 11 (20%) patients a reduction of tumor growth rate was noted. The 1 year survival rate was 59%. After response to TACE and reducing the tumor size 11 patients could be treated with MR-guided LITT 4 to 6 weeks post embolization. CONCLUSION: Chemoembolization is a minimal invasive and outpatient treatment protocol for HCC. TACE might be indicated as a palliative treatment to control the diseased liver. If repeated TACE alters the size and structure of primary unresectable HCC TACE expands the indication for MR-guided LITT.     

Transcatheter Arterial Chemoembolization (TACE) with Lipiodol to Treat Hepatocellular Carcinoma: Survey Results from the TACE Study Group of Japan

The purpose of this study was to retrospectively clarify the current status in Japan of TACE using Lipiodol together with anticancer agents to treat hepatocellular carcinoma (HCC). We retrospectively surveyed 4,659 (average annual total) procedures for HCC over the years 2002–2004 at 17 institutions included in the TACE Study Group of Japan. The survey included six questions that were related mainly to TACE and Lipiodol for HCC treatment. The most frequently applied among the 4,659 procedures at the 17 institutions were TACE (2,310; 50%) and local ablation (1,395; 30%). Five of the institutions applied 201–300 procedures and 4 applied 101–200. Lipiodol was used in “all procedures” and in “90% or more” at seven and nine institutions, respectively. Almost all institutions applied 4–6 (mean, 5) ml of Lipiodol during TACE to treat tumors 5 cm in diameter. In conclusion, this survey clarified that TACE using Lipiodol and anticancer agents is a popular option for HCC treatment in Japan.     

Oligonoduläres hepatozelluläres Karzinom (HCC): MR-gesteuerte laserinduzierte Thermotherapie (LITT)

PURPOSE: To prospectively evaluate the therapeutic potential of MR-guided laser-induced thermotherapy (LITT) in patients with oligonodular hepatocellular carcinoma. MATERIAL AND METHODS: 39 patients with 61 intrahepatic lesions were treated with LITT. The Nd:YAG laser fiber was introduced with a percutaneously positioned irrigated laser application system. Qualitative and quantitative MR parameters and clinical data were evaluated. RESULTS: All patients tolerated the procedure well under local anesthesia. All observed complications were minor and no further treatment was necessary. Online MR thermometry allowed exact visualization. Lesions up to 2 cm in diameter could be efficiently treated with a single laser application, larger lesions were treated simultaneous multiapplication. In 97.5% we achieved a complete necrosis of the tumor and a 5 mm safety margin, resulting in a complete destruction of the tumor without local recurrences. Mean survival was 4.4 years (95% CI: 3.6-5.2 years) after the time of diagnoses of the HCC (Kaplan-Meier-method). CONCLUSION: In intrahepatic oligonodular involvement of hepatocellular carcinoma LITT appears to be an effective therapeutic procedure with a high tumor control rate and better survival data.     

Neoadjuvant TACE before laser induced thermotherapy (LITT) in the treatment of non-colorectal non-breast cancer liver metastases: Feasibility and survival rates

Purpose

To evaluate safety, feasibility and overall survival rates for transarterial chemoembolization (TACE) alone or combined with MR-guided laser-induced-thermotherapy (LITT) in liver metastases of non-colorectal and non-breast cancer origin.

Methods and materials

Included were patients with unresectable non-colorectal non-breast cancer liver metastases with progression under systemic chemotherapy. Excluded were patients with Karnofsky score ≤70, respiratory, renal and cardiovascular failure, and general TACE contraindications. TACE using Mitomycin alone, Mitomycin–Gemcitabine or Mitomycin–Gemcitabine–Cisplatin was performed to all patients. After TACE 146 metastases were ablated with MR-guided LITT. To be eligible for LITT metastases should be <5 cm in size and ≤5 in number. Tumor response was evaluated using MRI according to RECIST. Survival was evaluated using Kaplan–Meier analysis.

Results

A total of 110 patients (mean age 59.2 years) with 371 metastases received TACE (mean 5.4 sessions/patient, n = 110) with 76 (69%) receiving LITT (mean 1.6 session/patient) afterwards. TACE resulted in a mean decrease of mean maximum diameter of 52% ± 26.6 and volume change of −68.5% ± 22.9 in the 25 patients (23%) with partial response. Stable disease (n = 59, 54%). Progressive disease (n = 26, 23%). The RECIST outcome after LITT showed complete response (n = 13, 17%), partial response (n = 1, 1%), stable situation (n = 41, 54%) and progressive disease (n = 21, 28%). The mean time to progression (TTP) was 8.6 months. Median survival of all patients was 21.1 months.

Conclusion

TACE with different protocols alone and in combination with LITT is a feasible palliative treatment option resulting in a median survival of 21.1 months for unresectable liver metastases of non-colorectal and non-breast cancer origin.     

Treatment of Liver Tumors with Lipiodol TACE: Technical Recommendations from Experts Opinion

Transarterial chemoembolization with Lipiodol (Lipiodol TACE), also called conventional TACE, was developed in the early 1980s and widely adopted worldwide after randomized control trials and meta-analysis demonstrated superiority of Lipiodol TACE to best supportive care. Presently, there is no level one evidence that other TACE techniques are superior to Lipiodol TACE for intermediate stage hepatocellular carcinoma (HCC), which includes patients with preserved liver function and nonsurgical large or multinodular HCC without distant metastases. In addition, TACE is part of the treatment for progressive or symptomatic liver metastases from gastroenteropancreatic neuroendocrine tumors. When injected into the hepatic artery, Lipiodol has the unique property of selective uptake and retention in hyperarterialyzed liver tumors. Lipiodol/drug emulsion followed by particle embolization has been demonstrated to improve the pharmacokinetic of the drug and tumor response. Radio opacity of Lipiodol helps to monitor treatment delivery, with retention of Lipiodol serving as an imaging biomarker for tumor response. For 30 years, Lipiodol TACE has been inconsistently referenced in many publications with various levels of details for the method of preparation and administration, with reported progressive outcomes following improvements in the technique and the devices used to deliver the treatment and better patient selection. Consequently, there is no consensus on the standard method of TACE regarding the use of anticancer agents, embolic material, technical details, and the treatment schedule. In order to develop an internationally validated technical recommendation to standardize the Lipiodol TACE procedure, a worldwide panel of experts participated in a consensus meeting held on May 10, 2014 .     

Review on transarterial chemoembolization in hepatocellular carcinoma: palliative, combined, neoadjuvant, bridging, and symptomatic indications

The current review provides an overview on the palliative, combined, neoadjuvant, bridging, and symptomatic indications of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). It is based on an analysis of the current literature and the experience of the authors on the topic. Chemoembolization combines the infusion of chemotherapeutic drugs with particle embolization. Tumor ischemia raises the drug concentration compared to infusion alone, extends the retention of the chemotherapeutic agent and reduces systemic toxicity. Palliatively, TACE is performed to control symptoms and prolong survival in HCC patients; in some indications TACE allows a local tumor control of 18-63%. For combined indications, excellent results were achieved by combined therapies, such as percutaneous ethanol injection (PEI)/TACE, radiofrequency ablation (RF)/TACE, and laser-induced thermotherapy (LITT)/TACE. As a neoadjuvant therapy prior to liver resection TACE showed 70% tumor control. Though debatable, TACE still plays a role as a bridging tool before liver transplantation. Symptomatic indication of TACE in ruptured HCC showed 83-100% control of bleeding but survival was poor. Thus, TACE represents an important therapeutic tool against HCC in general in addition to its special role in cases of unresectable HCC.     

Review on transarterial chemoembolization in hepatocellular carcinoma: Palliative,combined, neoadjuvant,bridging, and symptomatic indications

The current review provides an overview on the palliative, combined, neoadjuvant, bridging, and symptomatic indications of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). It is based on an analysis of the current literature and the experience of the authors on the topic. Chemoembolization combines the infusion of chemotherapeutic drugs with particle embolization. Tumor ischemia raises the drug concentration compared to infusion alone, extends the retention of the chemotherapeutic agent and reduces systemic toxicity. Palliatively, TACE is performed to control symptoms and prolong survival in HCC patients; in some indications TACE allows a local tumor control of 18–63%. For combined indications, excellent results were achieved by combined therapies, such as percutaneous ethanol injection (PEI)/TACE, radiofrequency ablation (RF)/TACE, and laser-induced thermotherapy (LITT)/TACE. As a neoadjuvant therapy prior to liver resection TACE showed 70% tumor control. Though debatable, TACE still plays a role as a bridging tool before liver transplantation. Symptomatic indication of TACE in ruptured HCC showed 83–100% control of bleeding but survival was poor. Thus, TACE represents an important therapeutic tool against HCC in general in addition to its special role in cases of unresectable HCC.     

Correlation of Multislice CT and Histomorphology in HCC Following TACE: Predictors of Outcome

The purpose of this study was to correlate histopathological with CT findings in patients suffering from hepatocellular carcinoma (HCC) eligible for orthotopic liver transplantation (OLT), with a special focus on the antitumoral effect of transarterial chemoembolization (TACE) therapy. A total of 42 consecutive patients suffering from HCC had been treated prior to OLT by means of TACE. TACE was carried out with a mixture of Lipiodol (10-20 ml) and mitomycin C (max. dosage, 10 mg). TACE was performed at 6- to 8-week intervals. Follow-up investigation included contrast-enhanced multislice CT controls and laboratory control. Liver explants were evaluated macroscopically and microscopically to determine the number and size of the tumor lesions as well as the degree of tumor necrosis. Necrosis was investigated in H&E-stained sections. The degree of necrosis was classified as follows: 0-25%, 26-50%, 51-75%, 75-99%, and complete necrosis. Two hundred thirty-one TACE procedures (5.5 +/- 2.9; range, 1-14) were performed. Mean tumor size in CT before and after TACE was 4.1 +/- 2.4 (range, 1.0-12.0 cm) and 2.7 +/- 1.2 (range, 1.0-6.0 cm; p < 0.001). Mean tumor number before and after TACE in CT was 2.5 +/- 1.5 (n = 105; range, 1-8) and 2.4 +/- 2.0 (n = 103; range, 1-6; p = 0.99). In the surgical specimen tumor size and tumor number were 2.8 +/- 1.6 (range, 1.0-7.0 cm; p = 0.78) and 1.9 +/- 1.2 (range, 1-7; p = 0.003). Mean tumor necrosis was 67.8% +/- 28.1%. Tumor necrosis was subtotal or complete in 17 of 42 (40.5%) patients. Tumor necrosis correlated significantly with the degree of arterial devascularization in CT (p = 0.001), the amount of Lipiodol washout (p = 0.002), and the number of tumor lesions (i.e., unifocal vs. multifocal). Furthermore, elevated serum levels of bilirubin (p = 0.005) and decreased albumin (p = 0.004) affected the local antitumoral effect. A poor necrosis rate (< 25%) significantly correlated with the number of TACE procedures accomplished (p = 0.023). In conclusion, TACE provided an acceptable local antitumoral effect in patients scheduled for liver transplantation. Tumor necrosis depended significantly on the degree of arterial devascularization and the accumulation of Lipiodol within the HCC lesions. Unifocal tumors and preserved liver function were positive predictors for a more favorable local antitumoral effect. Poor necrosis rates were found in patients with significant Lipiodol washout and who received a limited number of TACE procedures.     

Thermische Ablation von Lebermetastasen: Aktueller Stand und Perspektiven

Purpose. To present thermal ablation of liver metastases via laser induced thermotherapy. Material and methods. Different technical procedures of thermal ablation and online monitoring are used, as there are the MR-guided laser induced thermotherapy (LITT) and the radiofrequency ablaton thermotherapy (RF). Results. In a prospective non randomized study 606 patients with liver metastases were treated via MR-guided laserinduced thermotherapy. Inclusion criteria were the exclusion of extrahepatic tumor spread and a number of metastases lower than 5 and a size lower than 50 mm in diameter. The local tumor control rate in the 3 month and 6 month control study was 98.3%, the complication rate 3,5% (clinically relevant: 1,2%). The mean survival rate was 40,9 months for all patients with liver metastases without statistically relevant differences for various primaries, like colorectal carcinoma, breast cancer and various other tumors. Results for radiofrequency are so far limited with incidence of a higher local tumor recurrence rate versus LITT. Conclusion. MR-guided LITT results in a high local tumor control rate with improved survival.     

Breast cancer metastases in liver: laser-induced interstitial thermotherapy--local tumor control rate and survival data

PURPOSE: To evaluate the local tumor control rate and survival data for magnetic resonance (MR) imaging-guided laser ablation of breast cancer liver metastases by using laser-induced interstitial thermotherapy (LITT). MATERIALS AND METHODS: MR-guided LITT was performed in 232 female patients with 578 liver metastases from breast cancer. Survival rates were calculated with the Kaplan-Meier method. Indications for the procedure were defined for patients with no more than five metastases, none of which were larger than 5 cm in diameter, as follows: recurrent liver metastases after partial liver resection (8.2%), metastases in both liver lobes (45.2%), locally nonresectable tumors (19%), general contraindications for surgery (2.6%), or refusal to undergo surgical resection (25%). RESULTS: Local recurrence rate at 6-month follow-up after LITT was 2.3% (five of 213) for metastases up to 2 cm in diameter, 4.3% (seven of 162) for metastases 2-3 cm in diameter, 3.2% (two of 63) for metastases 3-4 cm in diameter, and 1.9% (one of 52) for metastases larger than 4 cm in diameter. No additional local tumor progression was observed beyond 6 months. The mean survival rate for all treated patients, with calculation started on the date of diagnosis of the metastases treated with LITT, was 4.9 years (95% confidence interval: 4.3, 5.4). The median survival was 4.3 years; 1-year survival, 96%; 2-year survival, 80%; 3-year survival, 63%; and 5-year survival, 41%. The mean survival after the first LITT treatment was 4.2 years (95% confidence interval: 3.6, 4.8). CONCLUSION: MR-guided LITT yields high local tumor control and survival rates in patients with liver metastases from breast cancer.     

Treatment of hepatocellular carcinoma (HCC) with radiolabeled Lipiodol: a preliminary report

Fatty acid esters such as Lipiodol or Ethiodol (Savage Laboratories, Melville, New York) are known to selectively localize in vascular hepatocellular carcinomas (HCC), following intra-arterial hepatic administration. Lipiodol was labeled with radioactive 131I and administered in 47 patients with HCC for both imaging and therapy. The short term preliminary results suggest radiolabeled Lipiodol is effective in eliminating ascites, shrinking the tumor by a high internal radiation dose, and in improving symptomatology of these tumors. In the future, 90Y, which is a stronger pure beta-emitter (maximum beta energy of 2.27 MeV, a half life of 64 h, and a maximum penetration or beta range of 11mm), than 131I will be used for more effective treatment of HCC.     

Preliminary clinical experience with laser-induced interstitial thermotherapy in patients with hepatocellular carcinoma

The purpose of this preliminary study was to evaluate whether laser-induced interstitial thermotherapy (LITT) may be used for palliative treatment of localized hepatocellular carcinomas (HCC). We applied LITT to two patients suffering from unresectable localized hepatocellular carcinomas of different sizes (2.5 and 4 cm). LITT was performed with an Nd:YAG laser (1,064 nm) at 5 W laser power (15–20 minutes). Thermometry during LITT was performed by MRI using a temperature-sensitive T1-weighted fast low-angle shot (FLASH) sequence. Follow-up for local tumor control was performed by MRI and ultrasound. LITT was well tolerated and no adverse events occurred during or after LITT; no secondary liver lesions were seen in the follow-up (11 or 12 months, respectively). Only minimal tumor growth was observed in the larger HCC (from 4 to 5 cm), whereas the smaller HCC remained unchanged in size during 11 months of follow-up. We conclude that LITT might be an effective minimally invasive palliative treatment option for patients with small unresectable HCC.     

Nitroglycerine use in transcatheter arterial (chemo)embolization in patients with hepatocellular carcinoma and dual-energy CT assessment of Lipiodol retention

Objectives

To investigate whether the addition of nitroglycerine to transcatheter arterial (chemo)embolization (TAE/TACE) can increase the delivery and effectiveness of TAE/TACE in patients with hepatocellular carcinoma (HCC) by dual-energy CT.

Methods

HCC patients (BCLC stage A or B) were randomized to (n?=?51) or not to (n?=?50) receive nitroglycerine and an emulsion of Lipiodol with or without doxorubicin, followed by embolization with Gelfoam pledgets. Dual-energy CT was performed pre- and 1 to 3?months post-embolization to assess changes in tumour diameter and Lipiodol levels in tumours.

Results

Median tumour diameter decreased from baseline in both groups with and without nitroglycerine (7.11?% vs. 12.5?%, respectively), and was statistically significant in the group receiving nitroglycerine (P?=?0.023). There was no difference between the two groups in disease response (P?=?0.237). The concentration and percentage of Lipiodol retained in tumours were significantly greater in patients treated with nitroglycerine compared to those without (median concentration 15.05?mg/mL vs. 4.40?mg/mL, respectively, P?P?Conclusions Nitroglycerine increased delivery of the Lipiodol emulsion via TAE/TACE to HCC tumours with significant tumour reduction. Dual-energy CT can accurately quantify the amount of Lipiodol deposited in tumours.

Key Points

? Nitroglycerine improves delivery of tumour-targeted therapy via enhanced permeability and retention. ? In hepatocellular carcinoma, nitroglycerine added to TAE/TACE showed greater tumour reduction. ? Dual-energy CT can reliably quantify the amount of Lipiodol in TAE/TACE.     

Trans-catheter arterial chemoembolization as first-line treatment for hepatic metastases from endocrine tumors

Our objective was to report the outcome in patients with liver metastasis from endocrine tumors who underwent transarterial chemoembolization (TACE) as first-line non-surgical treatment. From January 1990 to December 2000, 14 patients with progressive unresectable liver metastases from digestive neuroendocrine tumor were treated with TACE (mean of 3.6 sessions) before any non-surgical treatment (somatostatin analogue, chemotherapy or interferon). Liver involvement was less than 50% in 11 patients. Size of the largest lesion ranged from 1.5 to 10 cm. Ten patients presented with carcinoid symptoms. The TACE was performed with Doxorubicin emulsified in Lipiodol and gelatin sponge particles. Symptomatic response upon flushes and/or diarrhea was complete in 7 of 10 cases and partial in 2 of 10 cases. An objective morphologic response was noted in 12 of 14 cases. The 5- and 10-year survival rate from diagnosis was 83 and 56%, respectively. Six patients were alive at the end of the study after 27–100 months from first TACE and 38–142 months from diagnosis. Three of them were successfully palliated for 55, 69, and 100 months with only TACE as treatment. Long-term palliation is possible in unresectable liver metastases from digestive neuroendocrine tumors with a few sessions of TACE as first-line and eventually exclusive treatment. Electronic Publication     

经肝动脉化疗栓塞术联合激光热疗治疗大鼠肝转移癌

目的:评价经肝动脉化疗栓塞术(TACE)联合激光热疗(LITT)治疗大鼠肝转移癌的疗效.方法:30只雄性WAG大鼠肝包膜下注入CC531结直肠癌肝转移癌细胞混悬液,种植术后13天行MRI检查,测量肿瘤体积V1,然后采取介入治疗措施:①第14天时采取单纯TACE治疗(丝裂霉素(碘油(降解淀粉);②第14天时采取单纯LITT治疗(Nd:YAG激光);③联合TACE(第14 天时)和LITT治疗(第21 天时).第28天时再次行MRI检查以确定肿瘤体积V2变化,比较肝肿瘤体积生长率V2/V1.结果:介入治疗后肿瘤体积与治疗前肿瘤体积之比分别为A组5.42、B组6.14、C组3.15.与对照组A组和B组相比,采取C组即TACE联合LITT的治疗方案明显抑制肝肿瘤的生长(Bonferroui检验,P＜0.01).结论:联合TACE和LITT的综合介入治疗方法与单纯TACE以及LITT相比,能明显抑制大鼠肝转移癌的生长.     

Chemoembolisation of hepatocellular carcinomas: personal experience

Transcatheter arterial chemoembolisation (TACE) using antiblastic agents in association with occlusion of tumour-feeding arteries seems currently to be the most suitable treatment for unresectable hepatocellular carcinomas (HCC) larger than 3 cm in diameter. From July 1989 to January 1991, 21 patients with HCC and a previous history of liver cirrhosis were treated by TACE. The drugs used were doxorubicin and mitomycin C mixed with Lipiodol UF. The arterial occlusion was obtained using Gelfoam or Spongostan particles; in 16 patients it was limited to tumour-feeding arteries to avoid diffuse parenchymal liver damage, while in 5 patients either the main right or left hepatic artery was embolised. Three patients were excluded from the study after TACE because of too short a follow-up; 4/18 died within 3–9 months and 14/18 are still alive with follow-up ranging from 3 to 19 months. A tumour size reduction of more than 50% was observed in 9 patients (50%), with a median survival of 9.8 months. Transient and well-controlled side effects (fever, abdominal pain, nausea and vomiting) were related to the post-embolisation syndrome and could be reduced by using a superselective occlusion procedure. Correspondence to: G. C. Ettorre     

Embolization of liver tumors: Past, present and future

Curative therapies for hepatocellular carcinoma(HCC),such as resection and liver transplantation,can only be applied in selected patients with early tumors.More advanced stages require local or systemic therapies.Resection of HCC offers the only hope for cure.Even in patients undergoing resection,recurrences are common.Chemoembolization,a technique combining intraarterial chemotherapy with selective tumor ischemia,has been shown by randomized controlled trials to be efficacious in the palliative setting.There is now renewed interest in transarterial embolization/transarterial chemoembolization(TACE) with regards to its use as a palliative tool in a combined modality approach,as a neoadjuvant therapy,in bridging therapy before transplantation,for symptomatic indications,and even as an alternative to resection.There have also been rapid advances in the agents being embolized trans-arterially(genes,biological response modifiers,etc.).The current review provides an evidence-based overview of the past,present and future trends of TACE in patients with HCC.     

The combined effect of radiofrequency and ethanol ablation in the management of large hepatocellular carcinoma

Only a small percentage of patients with large hepatocellular carcinoma (HCC) may benefit out of surgical resection. Thus, most of these patients are in need of a form of local control, such as ethanol ablation, transarterial chemoembolization (TACE), radiofrequency thermal ablation (RF), or laser induced thermotherapy (LITT). The purpose of this study was to assess the short-term effect of sequential RF and ethanol ablation in the management of large HCC (>5 cm). Our series included 40 patients with large HCC tumors (>5 cm in diameter). We adopted a protocol of overlapping RF applications, followed by repeated ethanol ablation sessions. Our results showed that the volume of tumor coagulative necrosis initially induced by RF has significantly risen after adjuvant ethanol ablation sessions (P < 0.001). Patients who achieved complete tumor necrosis after RF ablation were 52.5% of the series. This percent has jumped to 80% of the series at the end of the protocol. This indicates that such combined protocol is more effective than RF alone. Besides, it is valuable in reducing the number of RF sessions.     

Dense parenchymal accumulation of Lipiodol after transarterial chemoembolization.

Dense accumulation of Lipiodol in hepatic segmental parenchyma was studied by computed tomography (CT) after transarterial chemoembolization (TACE) for hepatic tumor. Six patients showed dense accumulation of Lipiodol in hepatic segmental parenchyma on CT two weeks after TACE. Four of the six showed parenchymal accumulation of Lipiodol as dense as that in a tumor at three weeks after TACE. Therefore, it was considered that evaluation with CT should be performed after one month or more in order to differentiate between Lipiodol accumulation in tumors and that in non-neoplastic liver parenchyma.     

The role of functional MR imaging in the assessment of tumor response after chemoembolization in patients with hepatocellular carcinoma

PURPOSE: To assess treatment response of hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) with use of diffusion and dynamic contrast medium-enhanced magnetic resonance (MR) imaging. MATERIALS AND METHODS: MR imaging studies before and after TACE in 38 patients with HCC (33 male patients and five female patients) were evaluated. Diffusion and dynamic contrast medium-enhanced MR imaging was performed on a 1.5-T unit. The imaging protocol included T2-weighted fast spin-echo, breath-hold diffusion-weighted echoplanar, and breath-hold unenhanced and contrast medium-enhanced T1-weighted three-dimensional fat-saturation gradient-recalled echo imaging in the arterial and portal venous phases. Tumor size, percent enhancement, and apparent diffusion coefficient (ADC) values were recorded before and after treatment. Survival analysis was also performed. RESULTS: The study included 38 lesions with a mean diameter of 8.0 cm. Mean reduction in tumor diameter was 8 mm after treatment (t test; P = .0005), which did not fulfill Response Evaluation Criteria in Solid Tumors for complete or partial response. Reduction in tumor enhancement in the arterial (30%) and venous (47%) phases was statistically significant (signed-rank test; P = .0003 and P < 0.00005, respectively). Tumor ADC value increased from 0.0015 mm(2)/sec to 0.0018 mm(2)/sec after treatment (t test; P = .026), whereas the ADC values for the liver, spleen, and muscle remained unchanged. Median patient survival was 19 months. CONCLUSIONS: After TACE, tumors demonstrated decreased size and enhancement with increases in ADC values. In this cohort, diffusion and dynamic contrast medium-enhanced MR imaging parameters were significantly altered after TACE, and these could be useful tools in the assessment of tumor response.