The Role of Diffusion-Weighted Imaging (DWI) in Locoregional Therapy Outcome Prediction and Response Assessment for Hepatocellular Carcinoma (HCC): The New Era of Functional Imaging Biomarkers

Ludwig, Johannes; Camacho, Juan C.; Kokabi, Nima; Xing, Minzhi

doi:10.3390/diagnostics5040546

Cited by 27 publications

(20 citation statements)

References 62 publications

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“…While low ADC was found to correlate with poorer outcomes in this study, this observation has not been seen consistently in previously published reports [ 12 ]. Multiple studies have investigated the evaluation of pre-treatment ADC values to accurately predict response to chemoembolization with varying results [ 13 , 14 , 15 , 16 ].…”

Section: Discussioncontrasting

confidence: 54%

Baseline Apparent Diffusion Coefficient as a Predictor of Response to Liver-Directed Therapies in Hepatocellular Carcinoma

Niekamp

Abdel-Wahab

Kuban

et al. 2018

JCM

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Predicting outcomes in patients with hepatocellular carcinoma (HCC) who undergo locoregional therapies remains a substantial clinical challenge. The purpose of this study was to investigate pre-procedure diffusion weighted magnetic resonance imaging (DW-MRI) as an imaging biomarker for tumoral response to therapy for patients with HCC undergoing drug eluting embolic (DEE) chemoembolization and radioembolization. A retrospective review of HCC patients who underwent DEE chemoembolization or radioembolization was performed. Of the 58 patients who comprised the study population, 32 underwent DEE chemoembolization and 26 underwent radioembolization. There was no significant difference in median apparent diffusion coefficient (ADC) values across the two treatment groups (1.01 × 10−3 mm2/s, P = 0.25). The immediate objective response (OR) rate was 71% (40/56). Tumors with high ADC values were found to have a higher probability of OR within 90 days (odds ratio 4.4, P = 0.03). Moreover, index lesion specific progression free survival (PFS) was greater for high ADC tumors, independent of conventional predictors of treatment response (hazard ratio 0.44, P = 0.01). Low ADC was associated with poorer PFS (P = 0.02). Pre-procedure ADC < 1.01 × 10−3 mm2/s is an independent predictor of poorer immediate OR and index lesion specific PFS in patients with HCC undergoing DEE chemoembolization or radioembolization.

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Section: Discussioncontrasting

confidence: 54%

Baseline Apparent Diffusion Coefficient as a Predictor of Response to Liver-Directed Therapies in Hepatocellular Carcinoma

Niekamp

Abdel-Wahab

Kuban

et al. 2018

JCM

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“…We could not correlate MRI findings with histopathological changes as performing repeat biopsies solely for the purposes of research is not ethical. We did not examine DWI sequence data and ADC values, which have been proven a reliable for the diagnosis of pulmonary nodules [ 2 , 27 ], and evaluation of therapeutic response [ 21 , 28 ]. These examinations were not performed because there were artifacts on DWI images at 1 day and 1 week post-cryoablation, and putting the ROI in the correct place was difficult due to cavity formation.…”

Section: Discussionmentioning

confidence: 99%

3.0T MRI for long-term observation of lung nodules post cryoablation: a pilot study

Zhang

et al. 2017

Cancer Imaging

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BackgroundThe purpose of this study was to use serial magnetic resonance imaging (MRI) examinations to observe changes in malignant lung tumors over time post-cryoablation.MethodsThe study protocol was approved by Institutional Review Board, and written informed consent was obtained from each participant in accordance with the Declaration of Helsinki. Patients with primary or metastatic lung tumors eligible for cryoablation were included in this prospective study. Cryoablation was performed according to standard procedures. Unenhanced and dynamic contrast-enhanced MRI scans were performed pre-cryoablation and at 1 day, 1 week, and 3-, 6-, and 12 months after cryoablation. At each time point, the signal intensity of the ablated zone on both T1WI and T2WI images, and volume and characteristics of the ablation zone were examined, and changes over time analyzed.ResultsA total of 26 nodules in 23 patients were included in the study. The mean patient age was 53.7 ± 13.6 years, and 57.7% were males. Ablation zone volume increased to 1 week after the procedure, and then returned to baseline by 3 months. Cavitation post-cryoablation was found in 34.6% (9/26) of the nodules 1 month after treatment. Two types of time-signal intensity curves post-cryoablation were found: a straight line representing no definite enhancement from 1-day to 1-month, and an inflow curve representing mild delayed enhancement from month 3 to month 12. Local progression was associated with an incomplete hypointense rim around the ablation zone and absence of cavitation post-treatment.ConclusionsCharacteristic changes are present on MRI after cryoablation of lung tumors. A complete hypointense rim and cavitation may be signs of adequate treatment and that local tumor progression is less likely.Electronic supplementary materialThe online version of this article (doi:10.1186/s40644-017-0131-7) contains supplementary material, which is available to authorized users.

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“…Dynamic contrast-enhanced (DCE)-MRI and its volume transfer coefficient (K trans ) have been demonstrated to correlate with MVD, and may quantitatively reflect tumor angiogenesis ( 5 , 14 ). Furthermore, studies have demonstrated that diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) are useful in evaluating cellularity and monitoring the tumor response to therapy ( 15 , 16 ).…”

Section: Introductionmentioning

confidence: 99%

Dynamics of angiogenesis and cellularity in rabbit VX2 tumors using contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging

Wang

et al. 2017

Oncol Lett

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A number of studies have demonstrated that dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) may be used to evaluate microvessel density (MVD), and may quantitatively reflect tumor angiogenesis. To investigate the dynamics, including angiogenesis and tumor cellularity, of rabbit VX2 tumors during the 4 weeks following tumor implantation, the present study used DCE-MRI combined with diffusion-weighted imaging (DWI) to scan the tumors at 3 days, and then at 1, 2, 3 and 4-week intervals, following tumor implantation. The dynamics, volume transfer coefficient (Ktrans) and apparent diffusion coefficient (ADC) of the tumor parenchyma were analyzed. Furthermore, the associations between Ktrans and MVD at 4 weeks after tumor implantation were analyzed. Tumor Ktrans was positively correlated with MVD at 4 weeks (r=0.674, P<0.001). Following tumor implantation, the tumor Ktrans level rose for 2 weeks and then began to decline, reaching its lowest point at 4 weeks (P<0.001). ADC values at 1 week were higher than at 3 days, but declined thereafter (P<0.001). Tumor necrosis appeared by 1 week after tumor implantation. The necrosis degree of tumor was gradually increased from the occurrence of necrosis within the 4-week time span of the present study (1 vs. 2 weeks, P=0.008; 2 vs. 3 weeks, P<0.001; 3 vs. 4 weeks, P<0.001). The present study identified that tumor angiogenesis is a dynamic process that serves a function in tumor growth, and that DCE-MRI may reflect tumor parenchymal MVD and be useful in evaluating angiogenesis.

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The Role of Diffusion-Weighted Imaging (DWI) in Locoregional Therapy Outcome Prediction and Response Assessment for Hepatocellular Carcinoma (HCC): The New Era of Functional Imaging Biomarkers

Cited by 27 publications

References 62 publications

Baseline Apparent Diffusion Coefficient as a Predictor of Response to Liver-Directed Therapies in Hepatocellular Carcinoma

Baseline Apparent Diffusion Coefficient as a Predictor of Response to Liver-Directed Therapies in Hepatocellular Carcinoma

3.0T MRI for long-term observation of lung nodules post cryoablation: a pilot study

Dynamics of angiogenesis and cellularity in rabbit VX2 tumors using contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging

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