Role of diffusion weighted MRI in patients with hepatocellular carcinoma: prediction and assessment of response to trans-arterial chemoembolization

Document Type : Original Article

Authors

Radiology department, Faculty of Medicine, Baniseuf University, Egypt

Abstract

Aim: The study goal is to detect if apparent diffusion coefficient (ADC), a quantitative parameter of diffusion-weighted imaging (DWI), can recognize HCC post TACE residuals. Results were obtained by using MRI_DWI & ADC and were compared with those of Tri phasic-computed tomography (CT).  patient and Methods MRI-DWI was performed to 20 patients with 24 HCC focal lesions before and 1month after TACE to calculate the ADC value of HCC. Patients were also evaluated with Tri phasic-CT after TACE. CT was performed within 1 month after TACE. Results: All patients under the study shows pretreatment restricted Diffusion weighted images with low ADC value. Mean ADC value before treatment was 1.14× 10¯³ ±0.29× 10¯³ and ranged from 0.819× 10¯³ to 2.48× 10¯³.  9 cases (45%) cases show post-TACE good therapeutic response with facilitated diffusion & mean ADC value 1.32×10¯³ with significant increase compared to pre-treatment values. 11 cases (55%) shows post-TACE partial or no therapeutic response with restricted diffusion & mean ADC value 1.18×10¯³. However, there was no statistical significant difference between ADC value of resolved and that of residual cases (P-value=0.067), DWI could predict the response of treatment as CT by 100%. All cases of Good therapeutic response had a facilitated diffusion, all cases of partial therapeutic response had a restricted diffusion but less than pretreatment and all cases with no therapeutic response had a restricted diffusion but more than pretreatment. Conclusion DWI could evaluate HCC necrosis of tumor after chemoembolization, and the ADC importance might be its ability to detect viable necrotic tumor tissues. Furthermore, DWI-MRI determines improved liver lesion location. So, DWI can be used as an option for HCC patients short term follow up after chemoembolization and may direct patient control for decreasing radiation CT examination exposure and the danger of contrast material-induced nephropathy.

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References

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