Evolving Role of MRI in Assessment of Response of Hepatocellular Carcinoma Patients Post Trans-Arterial Chemoembolization: What Does the Physician Want to Know?

Abstract

Background: In clinical practice, Transarterial Chemoembolization (TACE) has been widely used for the treatment of Hepatocellular Carcinoma (HCC) beyond as well as within guideline recommendations. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) play critical roles for assessing treatment response of Hepatocellular Carcinoma (HCC) after locoregional therapy. Interpretation is challenging because post-treatment imaging findings depend on the type of treatment, magnitude of treatment response, time interval after treatment, and other factors. Aim of Study:To illustrate the prime role of MRI in accurate assessment and early monitoring of hepatocellular carcinoma response to treatment after transarterial chemoembolization.Patients and Methods: This study included 80 patients, 52 males and 28 females, patients ages ranged from 45 to 81 years with the mean age of 60 years underwent transarterial chemoembolization over a period of 23 months (Jan. 2019-Dec. 2020). All patients had liver cirrhosis related to chronic viral hepatitis. MRI was conducted at MRI unit in a private radiology centre.Results: Showed superior diagnostic performance of dynamic MRI compared to diffusion studies as dynamic MRI had a sensitivity of 90.9%, a specificity of 95.7%, PPV of 93.7%, NPV of 93.7% and overall agreement of 94% compared to 100%, 65.2%, 68%, 100% and 80% respectively of diffusion weighted imaging. The difference between the malignant residual and well-ablated groups ADC variables was statistically significant p-value 0.006. Conclusion:MRI is a robust tool in detection of tumour viability after TACE of hepatocellular carcinoma and should be performed at regular time intervals. Imaging protocol should include dynamic study combined with diffusion imaging. DW MR imaging is a rapid promising technique for the non-invasive evaluation of tumor response after TACE particularly when contrast medium administration is contraindi-