Can volumetric ADC measurement help predict response to Y90 radioembolization in HCC?

Abstract

As soon as 1 month post-treatment, mRECIST and volumetric ADC performed better than traditional size RECIST or volumetric parameters in detecting imaging response to Y90; however, CPN cannot be predicted by any criteria. Improvements in methodologies to assess response and identification of better surrogates are awaited.

Pitfalls in liver MRI: Technical approach to avoiding misdiagnosis and improving image quality

“…ADC values are a potential biomarker of response assessment after locoregional liver therapy . However, in clinical practice the use of DWI is primarily based on qualitative assessment of the high b value DWI sequences, and comparing these to low b value images and the ADC map.…”

“…ADC values are a potential biomarker of response assessment after locoregional liver therapy. [72][73][74] However, in clinical practice the use of DWI is primarily based on qualitative assessment of the high b value DWI sequences, and comparing these to low b value images and the ADC map. Posttreatment intralesional hemorrhage often has restricted diffusion, and therefore can confound the appearance of a treated tumor on DWI and on ADC maps.…”

Quantitative volumetric functional MR imaging: an imaging biomarker of early treatment response in hypo-vascular liver metastasis patients after yttrium-90 transarterial radioembolization

“…90 Y microspheres obliterate tumor vascular flow and result in cellular death and tumor necrosis, affecting the functional and physiologic behavior of the lesion more than the tumor size. Traditional anatomic criteria based on decrease in tumor size in the axial plane show significant limitation in detecting early tumor response to TARE therapy [18,20]. While tumor shrinkage may not be initially apparent, there were changes in tumor ADC and enhancement that could be valuable in assessing early therapeutic efficacy [21][22][23].…”

“…According to individual patient clinical demand, the elective segmental or lobar TARE was injected into the hepatic artery feeding the tumor. Patients were monitored for 2 h after the procedure and were subsequently discharged [17,18].…”

PET/MRI of hepatic 90Y microsphere deposition determines individual tumor response

“…While generally well tolerated, the main complications of radioembolization are liver toxicity from radiation exposure and non-target embolization [8][9][10][11][12][13][14][15]. Response is generally heterogeneous between patients, even those with the same tumor types [16,17].…”