Role of dynamic contrast-enhanced and diffusion weighted MRI in evaluation of hepatocellular carcinoma after chemoembolization

Ebeed, Ahmed; Romeih, Marwa; Refat, Medhat; Yossef, Mohamed Hamdy

doi:10.1016/j.ejrnm.2017.06.006

Cited by 12 publications

(9 citation statements)

References 23 publications

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“…with its higher accuracy in lesion characterization, was used. (14) In our study, the difference between ADC variables between the malignant and benign groups was statistically significant P value…”

Section: (Fig3 G)supporting

confidence: 46%

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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Section: (Fig3 G)supporting

confidence: 46%

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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“…In this meta‐analysis, all included studies were not of case–control design and enrolled consecutive patients who were suspected of residual or recurrent HCCs after TACE, thus leading to a low risk of bias in patient selection for all included studies. In this study, four studies showed unclear blinding application, and one study presented a nonblinded application of the blinding method, which results in an unclear risk of bias concerning the index test in two studies and a high risk of bias in one study. Modified response evaluation criteria in solid tumors (mRECIST) and European association for the study of liver (ELSA) guidelines state that pathology, digital subtraction angiography (DSA), and clinical follow‐up results are reliable reference standards in diagnosing residual or recurrent HCCs after TACE, so the reference standard domain showed a low risk of bias in all studies.…”

Section: Resultsmentioning

confidence: 84%

“…Upon reading the titles and abstracts, 793 references were excluded, and the remaining 85 references were then retrieved for further inspection. After full text review, a total of 13 studies with 721 nodules evaluated by CEMRI were finally included in this meta‐analysis. The baseline information extracted from each study is presented in Tables and .…”

Section: Resultsmentioning

confidence: 99%

“…Persistent postcontrast arterial enhancement in the lesion presumably represents residual or recurrent tumors on CEMRI images, whereas the absence of enhancement is the hallmark of necrosis from successful TACE treatment. However, the clinical value of CEMRI in detecting residual or recurrent HCCs remains unclear, partly because different diagnostic accuracies have been reported in various studies . Therefore, the purpose of this study was to perform a meta‐analysis based on the currently available published articles on CEMRI in detecting residual or recurrent HCCs after TACE in order to provide scientific evidence‐based data for clinical and imaging diagnostics.…”

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confidence: 99%

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Diagnostic Efficacy of Contrast‐Enhanced MRI in Detecting Residual or Recurrent Hepatocellular Carcinoma After Transarterial Chemoembolization: A Systematic Review and Meta‐analysis

Liu

Liqiu

et al. 2019

Magnetic Resonance Imaging

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Background The diagnostic efficacy of contrast‐enhanced magnetic resonance imaging (CEMRI) in diagnosing residual or recurrent hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) is currently not completely clear. Purpose To investigate the diagnostic efficacy of CEMRI in detecting residual or recurrent HCCs after TACE by meta‐analysis. Study Type Systematic review and meta‐analysis. Population A systematic literature search was performed in PubMed, Embase, Web of Science, Ovid, and the Cochrane Library database up to June 2019 to find original studies on diagnosing patients suspected of residual or recurrent HCCs after TACE with CEMRI. Thirteen studies comprising 721 nodules were finally included. Field Strength/Sequence 1.5T or 3.0T, CEMRI. Assessment Quality assessment of the included studies was performed by applying the Quality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2) tool. Statistical Tests Sensitivity and specificity were pooled with a bivariate random‐effects model. Heterogeneity was assessed by the chi‐square test. The potential sources of heterogeneity were explored by subgroup and publication bias analyses. Results The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operating characteristic (ROC) curve (AUC) of CEMRI in diagnosing residual or recurrent HCCs after TACE were 91% (95% confidence interval [CI]: 87%–96%), 93% (95% CI: 85%–97%), 12.22 (95% CI: 5.62–26.57), 0.09 (95% CI: 0.05–0.18), 126.99 (95% CI: 34.76–436.99) and 0.97 (95% CI: 0.95–0.98), respectively. Subgroup analysis revealed that CEMRI performed significantly better in prospective studies than in retrospective studies: 0.99 (95% CI: 0.96–1.00) vs. 0.95 (95% CI: 0.92–0.96) with P < 0.05. Data Conclusion Our meta‐analysis suggested that CEMRI had high diagnostic efficacy in detecting residual or recurrent HCCs after TACE and may serve as an alternative method for further evaluation after TACE. Level of Evidence: 5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;52:1019–1028.

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“…Barcelona Clinic Liver Cancer (BCLC) classification system showed that Trans-Arterial Chemoembolization (TACE) should be the first-line for HCC treatment in case intermediate stage, also in case of with sizable or multi-centric HCC as well as in case of patients with intact hepatic function with no radiological evidence of either vascular infiltration nor extra-hepatic metastatic spread [6] . Effectiveness of TACE is followed-up via imaging modalities is crucial in assessing its outcome and planning the next steps in the patient future treatment strategy plan [7] .…”

Section: Introductionmentioning

confidence: 99%

Role of Dynamic Contrast Enhanced MRI and Diffusion Weighted Imaging in Evaluation of H.C.C after Chemo-Embolization

Yousef¹,

Bahig

Shebrya³

et al. 2019

The Medical Journal of Cairo University

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Background: Hepatocellular Carcinoma (HCC) is the most common primary malignant disease of the liver and is the third leading cause of death from cancer worldwide. Dynamic Contrast-Enhanced MRI (DCE MRI) can play a significant role as an imaging of H.C.C, especially in the detection of viable tumor foci, the differentiation between necrosis and viable tumor after TACE and early prediction of response. Diffusion-weighted MRI shall be more frequently used for tumor response evaluation to TACE because they provide detailed anatomic and functional or metabolic change information during tumor treatment, particularly during targeted chemotherapy. Aim of Study: Detection of the value of DCE (Dynamic contrast enhanced) MRI and DWI (Diffusion Weighted Imaging) in evaluation of HCC (Hepatocellular Carcinoma) necrosis after TACE (Trans-Arterial Chemo-Embolization).Material and Methods: Pre-contrast T1 and T2 WIs followed by diffusion weighted MR images (several b factors 20, 500, 800s/mm 2 ) then DCE MRI study using a 3 Telsa scanner followed by measuring different ADC values obtained in 30 patients underwent TACE for treatment of 40 HCC lesions for assessment of tumoral necrosis. ADC cut-off number was estimated using the ROC curve after measuring ADC values for all cases.Results: Statistical analysis demonstrated that Dynamic MRI had sensitivity of about 100% and 95.24% for specificity, While DWI has level of sensitivity of about 52.63% and 90.5% as a degree of specificity.The difference between well-ablated and residual/newly developed groups'. ADC values was found to be significant statistically ( pvalue <0.001) and best cut-off variable that maximize specificity and sensitivity is 1.35, where sensitivity level reaches about 78.9% and specificity level reaches about 85.7%.Conclusions: Depending on our study, dynamic MRI showed very high sensitivity while DWI with ADC mapping series alone have low level of sensitivity so it promotes reader confidence and might be used in case of gadolinium contraindications or in case of incapability of breath holding adequately.

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Role of dynamic contrast-enhanced and diffusion weighted MRI in evaluation of hepatocellular carcinoma after chemoembolization

Cited by 12 publications

References 23 publications

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

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

Diagnostic Efficacy of Contrast‐Enhanced MRI in Detecting Residual or Recurrent Hepatocellular Carcinoma After Transarterial Chemoembolization: A Systematic Review and Meta‐analysis

Role of Dynamic Contrast Enhanced MRI and Diffusion Weighted Imaging in Evaluation of H.C.C after Chemo-Embolization

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