<p>Pretreatment Apparent Diffusion Coefficient as a Predictor of Response to Transcatheter Arterial Chemoembolization Immediately Combined with Radiofrequency Ablation for Treatment of Solitary Large Hepatocellular Carcinoma</p>

Abstract

Purpose: To evaluate whether the pretreatment apparent diffusion coefficient (ADC) measured with diffusion weighted imaging (DWI) of tumor can be used as an imaging biomarker for predicting prognosis in solitary large hepatocellular carcinomas (HCCs) treated with transcatheter arterial chemoembolization (TACE) immediately combined with radiofrequency ablation (RFA). Patients and Methods: In this single institution retrospective study, 40 solitary large HCCs that underwent treatment with TACE immediately combined with RFA were analyzed. All patients underwent abdominal dynamic contrast-enhanced magnetic resonance imaging within one month before treatment with DWI, and ADC values in the lesions were measured by two independent radiologists. Associations among patients' preoperative ADC values and objective response (OR), progression-free survival (PFS) and overall survival (OS) were examined. Survival curves were drawn with the Kaplan-Meier method, and differences were determined with the Log rank test. The Cox proportional-hazards model was used for univariate and multivariate analyses of PFS and OS. Results: Forty solitary large HCCs (mean 9.54 cm, range 5.04-16.06 cm) were successfully treated with TACE in immediate combination with RFA (OR 75%). The ADC values were significantly higher in the response group than the non-response group (1.51±0.32×10 −3 mm 2 /s vs 1.09±0.17×10 −3 mm 2 /s; P<0.001). As predicted on the basis of the ADC values, the optimal cutoff value for the efficacy of TACE combined with RFA was 1.32×10 −3 mm 2 /s, with a predictive sensitivity of 0.63 and a specificity of 1.00. Patients with high ADC had longer PFS than those with low ADC (14.9 months vs 5.3 months; P<0.001) and had significantly longer survival rates (22.6 months vs 12.1 months; P=0.004). Conclusion: Preoperative ADC values <1.32×10 −3 mm 2 /s are an independent predictor of poorer prognosis in patients with solitary large HCCs who have undergone TACE immediately combined with RFA.

The Value of CT Perfusion Parameters and Apparent Diffusion Coefficient Value of Magnetic Resonance Diffusion Weighted Imaging in Diagnosis of Hepatocellular Carcinoma

“…DWI provides a variety of analytical methods, such as DWI images, ADC maps, and ADC values, which can reflect the internal changes of malignant tumors at the cellular and molecular levels, and has unparalleled advantages in noninvasive evaluation of early tumor efficacy [ 11 , 12 ]. DWI is the best method for quantitative study of microvascular perfusion and diffusion in vivo and has been successfully applied to the central nervous system [ 13 , 14 ]. DWI has been gradually used for the diagnosis of abdominal disease.…”

Local ablation of hepatocellular carcinoma by interstitial brachytherapy: prediction of outcome by diffusion-weighted imaging

“…Preliminary results in smaller series indicate that pre-treatment baseline ADC may be a predictor of tumor response and survival in patients treated with TACE, with lower ADC values indicating worse outcome (26,27). Tang et al found similar results for patients treated with TACE and RFA (47). Higher pre-treatment ADC values were associated with higher local tumor progression-free survival in patients with HCC treated with RFA (48).…”

Apparent diffusion coefficient correlates with different histopathological features in several intrahepatic tumors

“…Some previous reports indicated that ADC can predict tumor behavior in several liver malignancies. So far, in HCC, pretreatment low ADC, namely values under 1.32 × 10 -3 mm 2 /s, independently predicted poorer prognosis in patients with solitary large HCCs who have undergone transcatheter arterial chemoembolization (TACE) immediately combined with radiofrequency ablation [19]. Furthermore, low minimum ADC has been reported as a risk factor for HCC recurrence following liver transplantation (20).…”