Plain and gadolinium-DTPA-enhanced MR imaging of hepatocellular carcinoma treated with transarterial chemoembolization |
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Authors: | M Castrucci S Sironi F De Cobelli M Salvioni A Del Maschio |
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Institution: | (1) Department of Radiology, Scientific Institute S. Raffaele, University Hospital, Olgettina 60, 20132 Milan, Italy, IT |
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Abstract: | Background: To assess unenhanced and gadolinium-enhanced magnetic resonance (MR) imaging patterns of hepatocellular carcinoma (HCC) treated
with transarterial chemoembolization (TACE).
Methods: Thirty-two patients with 48 HCC lesions underwent MR imaging before and 15 days after TACE. Fifteen lesions were then surgically
resected. The remaining 33 lesions were not removed and were followed up with MR imaging at 3, 6, 12, and 18 months after
treatment. Spin echo (SE) T1- and T2-weighted and gadolinium-enhanced SE T1-weighted sequences were employed. Qualitative
evaluation of signal intensity pattern of the treated lesions was performed in all cases. Histological evaluation and selective
hepatic arteriography were considered the gold standard of the study for the 15 resected lesions and the 33 unresected lesions,
respectively.
Results: On follow-up enhanced T1-weighted images of the 15 resected lesions, seven showed no area of enhancement corresponding to
complete necrosis at histologic examination. The remaining eight resected lesions showed areas of enhancement; in six of these
cases, viable tumor tissue was found at histology; in the other two lesions, histologic examination revealed the presence
of complete tumor necrosis. In the group of resected lesions, T2-weighted images showed no pattern characteristic of necrosis.
In 24 of 33 unresected lesions, loss of enhancement on follow-up enhanced T1-weighted images was a characteristic finding,
which correlated to devascularization at arteriography. Of these 24 lesions, 17 were completely hypointense on follow-up T2-weighted
images; the remaining seven showed small foci of hyperintensity. The other nine unresected lesions showed enhanced portions
on follow-up enhanced T1-weighted images, which corresponded to hyperintense areas on T2-weighted images. These findings correlated
to persistence of hypervascular areas at arteriography.
Conclusion: Gadolinium-enhanced T1-weighted MR imaging is a reliable method for evaluating the outcome of TACE treatment and is more
accurate than unenhanced T2-weighted MR imaging.
Received: 2 June 1995/Accepted: 18 July 1995 |
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Keywords: | : Liver neoplasm chemotherapeutic infusion— Liver neoplasm MR— Liver neoplasm therapy |
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