Role of ADC Mapping in the Assessment of Therapeutic Response of Hepatocellular Carcinoma in Patients with Post-trans-catheter Arterial Chemoembolization

Abstract

Background: Hepatocellular carcinoma (HCC) is more common in persons with chronic liver disease and cirrhosis. The apparent diffusion coefficient (ADC) has the ability to detect tumour response to treatment weeks before morphological alterations are evident. Aim of The Work:To compare the response to therapy of HCC cases after trans-arterial chemoembolization using the ADC mapping MRI approach to the dynamic contrast study (DCE MRI). Patients and Methods:The current study involved 30 patients who underwent dynamic MRI with ADC mapping technique before and after TACE. All patients had been subjected to clinical assessment, laboratory investigations (AFP, liver functions, serum albumin bilirubin, coagulation profile, CBC) and ultrasound to exclude ascites.All cases underwent baseline and follow-up MR imaging. Results: DCE-MRI and DWI/ADC assessments regarding active lesions showed; comparable sensitivity, specificity, PPV, NPV and accuracy in HCC patients; without significance (p >0.05) (Table 3). Table ( 4) shows a good agreement between dynamic-MRI and DWI/ADC evaluation of reactivity between HCC cases. DWI/ADC value at a cutoff point (≤2.17) can identify cases with remnant active pathology, with good (83.3%) accuracy, sensitivity= 87.5% and specificity= 81.8% (p< 0.001). Conclusion:We conclude that dynamic MRI is useful and the standard in identifying relapsed pathology but, this value is enhanced by DWI/ ADC protocol which will significantly be of great value in increasing the confidence in our diagnosis.