Role of diffusion-weighted magnetic resonance imaging in the evaluation of hepatocellular carcinoma response to transcatheter arterial chemoembolization using drug eluting beads; correlation with dynamic MRI

Yousef, Mohamed I.; Refaat, Medhat; Faheem, Mohamed H.

doi:10.1016/j.ejrnm.2017.05.004

Cited by 7 publications

(9 citation statements)

References 23 publications

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“…Yousef et al [18] and our study agreed that DWI has some privileges in comparison to dynamic MRI study. For instance, contrast agent administration is contraindicated, and for a relatively shorter time examination.…”

Section: Discussionsupporting

confidence: 80%

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Value of dynamic and DWI MRI in evaluation of HCC viability after TACE via LI-RADS v2018 diagnostic algorithm

Saleh

Bahig

Shebrya

et al. 2019

Egypt J Radiol Nucl Med

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Background: Detection of the value of DCE (dynamic contrast enhanced) MRI and DWI (diffusion-weighted imaging) in follow-up of treatment response for HCC (hepatocellular carcinoma) lesions post TACE (trans-arterial chemo-embolization) through LI-RADS v2018 algorithmic approach. Results: A prospective study was performed on 30 patients with 41 treated hepatic focal lesions. The patients underwent DCE MRI with DWI in less than 1-month duration following TACE procedure and were radiologically assessed to observe tumoral post treatment response; then, another follow-up after another 3 months later was done for non-viable, equivocal, and non-evaluable post treatment response categories. Statistical analysis showed that DCE MRI had 100% level of sensitivity, specificity of 95.24%, PPV of 95.00%, and NPV of 100% with an overall agreement of 97.50%. While on the other hand, statistics showed that DWI has 52.63% level of sensitivity, specificity of 90.48%, PPV of 83.33%, PPV of 67.86%, and NPV of 72.50%. The difference between non-viable and viable groups' ADC variables was found statistically significant at P value < 0.001, and best cut off value that augments sensitivity and specificity is 1.35. At this ADC value, sensitivity reaches 78.9% and specificity is 85.7%. Conclusions:Our study showed that DCE MRI has 100% level of sensitivity via application of LI-RADS v2018 diagnostic algorithmic approach while DWI alone has 52.63% level of sensitivity, yet it can enhance the diagnostic confidence of DCE MRI for post treatment response viability detection.

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Section: Discussionsupporting

confidence: 80%

“…Furthermore, less time is consumed in post-processing for DWI images in comparison to DCE MR imaging. Finally, DWI is beneficial in cases of in-homogeneity that may occur within tumors, where it permits easy evaluation of the whole tumor [18].…”

Section: Discussionmentioning

confidence: 99%

Value of dynamic and DWI MRI in evaluation of HCC viability after TACE via LI-RADS v2018 diagnostic algorithm

Saleh

Bahig

Shebrya

et al. 2019

Egypt J Radiol Nucl Med

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“…For DWI, reader 1 found that it had sensitivity of 80%, specificity of 80%, PPV of 75%, and NPV of 78% Compared to sensitivity of 80%, specificity of 96%, PPV of 95.2%, and NPV of 82.7% for reader 2 and sensitivity of 80%, specificity of 80%, PPV of 81.8%, and NPV of 75% for reader 3. Our results were comparable with previous study [9] who found that the DWI imaging had an overall sensitivity of 83.9%, a specificity of 64.3%, PPV of 72.2%, and a NPV of 78.3% and accuracy of 74.5% and with another study [2] who found that reader 1 evaluation of DWI yielded sensitivity of 70.59%, specificity of 75%, PPV of 82.76%, and a NPV of 60% compared to 76.47%, 90%, 92.86%, and 69.23% respectively with reader 2.…”

Section: Discussionsupporting

confidence: 93%

“…HCC is considered as the fifth most common cancer worldwide and the most common liver malignancy [1]. It is one of the leading causes of morbidity and mortality, with an estimated incidence of more than 500,000 new cases per year [9]. In Egypt, almost two and half fold increase in the HCC incidence was noticed between 1993 and 2009 among the hepatic patients.…”

Section: Discussionmentioning

confidence: 99%

The value of dynamic subtraction MRI technique in the assessment of treatment response of hepatocellular carcinoma to transcatheter arterial chemoembolization

Metwally

Mahmoud

Yehia

2019

Egypt J Radiol Nucl Med

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Background: Hepatocellular carcinoma is considered to be the fifth most common cancer worldwide. Resection and liver transplantation have a high survival in the correct clinical scenarios; however, locoregional therapy has many advantages over tumor resection like preservation of hepatic parenchyma and overall less morbidity and mortality. Our aim was to present the role of dynamic subtraction MRI technique in the assessment of treatment response of hepatocellular carcinoma to transarterial chemoembolization. Methods: The study consisted of 43 patients with 55 hepatocellular carcinoma lesions who underwent transarterial chemoembolization procedure and followed up by dynamic MRI of the liver with post processing to obtain subtraction images 1-1.5 months after the procedure. If no signs of disease activity, another follow up study was preformed 2-4 months later. Five patients were excluded due to misregistration artifact at the subtraction images. The final cohort is 38 patients having 50 lesions. Precontrast T1, T2, dynamic contrast enhanced, and diffusion-weighted images were acquired. Subtracted dynamic images were created on the workstation. Sequences were assessed by three experienced readers in hepatic imaging. The sensitivity, specificity, positive predictive value, negative predictive value, 95% confidence interval, and overall agreement were calculated for the dynamic and subtracted dynamic images.Results: The subtraction images have sensitivity of 96%, specificity of 100%, PPV of 100%, and NPV of 100% Compared to 96%, 100%, 100%, 96%, and 96%, 100%, 100% 96% for the three readers respectively. On the other hand, the dynamic images has sensitivity of 92%, specificity of 96%, PPV of 95%, and NPV of 92.3% compared to 92%, 96%, 95%, 92.3% and 80%, 68%, 71.4%, and 77.2% for the three readers respectively.Conclusion: Subtraction technique is a useful confirmative tool as it had higher sensitivity, specificity, PPV, and NPV values compared to the dynamic and diffusion images with high level of agreement between the readers and also associated with significantly higher reader confidence levels.

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“…Hepatocellular carcinoma (HCC) is the most common primary liver malignancy, (1)  Out of the 40 locally treated lesions (25) lesions showed free diffusion (62%) while (15) lesions showed restricted diffusion (38%) .…”

Section: Introductionmentioning

confidence: 99%

The Role of Diffusion Weighted MRI in The Assessment of Post Ablation HCC Viability

Elmorsy

Refaat

Galal

2020

Benha Medical Journal

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Background: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Local ablative therapies include chemical (ethanol, acetic acid) or thermal ablation [radiofrequency ablation (RFA), microwave, laser, cryoablation] are curative treatment options that treat HCC. The apparent diffusion coefficient (ADC) calculated in diffusion-weighted MRI has become a favorable biomarker of tumor. The ADC is a measure of the mobility of water in tissues Methods: 30 cases of patients having HCC to radiology department of Damietta Cancer Center who underwent locoregional therapies (radio frequency ablation, microwave ablation percutaneous ethanol injection and trans-arterial hepatic chemoembolization) over a period of 18 months (APR.2017-OCT.2018). Patient are scheduled for dynamic contrast enhanced (DCE) MRI and diffusion weighted images (DWI) either in the routine follow up or after inconclusive triphasic CT study to assess tumor response to treatment and detect residual or recurrent lesions. Results: The ADC variable was found to be a fair indicator to differentiate marginal recurrence of HCC from benign or pseudo-lesions the sensitivity of DWI was 80%, its Specificity was 76.7%, positive predictive value was 53.3% and negative predictive value was 92%. Conclusion: we concluded that DWI together with conventional imaging is a promising tool in the evaluation of HCC post ablation. DWI can provide information about molecular tissue characteristics; it can help to distinguish between viable and necrotic tumor areas thus facilitating the diagnosis of residual or recurrent tumor. We could recommend a cutoff value 1.024 x 10-3mm 2 /sec, with t values below this level, express viability of the malignancy.

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Role of diffusion-weighted magnetic resonance imaging in the evaluation of hepatocellular carcinoma response to transcatheter arterial chemoembolization using drug eluting beads; correlation with dynamic MRI

Cited by 7 publications

References 23 publications

Value of dynamic and DWI MRI in evaluation of HCC viability after TACE via LI-RADS v2018 diagnostic algorithm

Value of dynamic and DWI MRI in evaluation of HCC viability after TACE via LI-RADS v2018 diagnostic algorithm

The value of dynamic subtraction MRI technique in the assessment of treatment response of hepatocellular carcinoma to transcatheter arterial chemoembolization

The Role of Diffusion Weighted MRI in The Assessment of Post Ablation HCC Viability

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