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Role of dynamic contrast-enhanced and diffusion weighted MRI in evaluation of hepatocellular carcinoma after chemoembolization
Authors:Ahmed Ebraheem Ebeed  Marwa Abd El-hamied Romeih  Medhat Mohamed Refat  Mohamed Hamdy Yossef
Affiliation:1. Radio-diagnosis Department, Faculty of Medicine, Aswan University, Egypt;2. Radio-diagnosis Department, Faculty of Medicine, Helwan University, Egypt;3. Radio-diagnosis Department, Faculty of Medicine, Banha University, Egypt
Abstract:

Purpose

To assess the role of dynamic contrast- enhanced and diffusion-weighted (DWI) MRI in the evaluation of the response of hepatocellular carcinoma (HCC) after chemoembolization.

Patient & method

30 patients having 40 HCC lesions underwent transcatheter arterial chemoembolization (TACE). Ages ranged between 41 and 76?years. All examinations were performed using Philips 1.5 Tesla MRI (Achieva). Precontrast T1, T2, Dynamic contrast enhanced and respiratory triggered DWI MR images with (b?=?50, 400, 800?mm/s). DWI MRI images and Contrast-enhanced MRI images after TACE are assessed to evaluate post treatment response. DWI was used to create ADC maps and ADC values were calculated looking for a cut off value using the ROC curve.

Results

Dynamic MRI had a sensitivity of 94.1%, a specificity of 95.6%, PPV value of 94.1%, NPV of 95.6% and an overall agreement of 95% compared to 82%, 73.9%, 70%, 85% and 77.5% respectively of DWI MRI. The difference between the malignant residual and well ablated groups' ADC variables was statistically significant P value 0.009.

Conclusion

Dynamic and diffusion MRI complete each other in assessment of HCC response to therapy, especially in those who cannot properly hold their breath that cause degradation of the dynamic MR quality.
Keywords:CT  computed tomography  MRI  magnetic resonance imaging  TACE  transarterial chemoembolization  DWI  diffusion weighted imaging  RECIST  response evaluation criteria in solid tumors  ADC  apparent diffusion coefficient  ROI  region of interest  TN  true negative  TP  true positive  FN  false negative  FP  false positive  NPV  negative predictive value  PPV  positive predictive value  SE  standard error  CI  confidence interval  THRIVE  T1 high resolution isotropic volume examination  SPAIR  SPectral Attenuated Inversion Recovery  Dynamic contrast-enhanced and diffusion weighted MRI  Hepatocellular  Carcinoma  Chemoembolization
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