TY - JOUR
T1 - Diffusion-weighted imaging of hepatocellular carcinoma before and after transarterial chemoembolization: role in survival prediction and response evaluation
AU - Labeur, Tim A.
AU - Runge, Jurgen H.
AU - Klompenhouwer, Elisabeth G.
AU - Klümpen, Heinz-Josef
AU - Takkenberg, R. Bart
AU - van Delden, Otto M.
PY - 2019/8
Y1 - 2019/8
N2 - Background: Survival outcomes of patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) are heterogeneous. Measuring the apparent diffusion coefficient (ADC) using diffusion-weighted imaging (DWI) may improve overall survival prediction. Aim: To assess the value of measuring the ADC before and after TACE in predicting overall survival. Methods: A retrospective analysis was performed in HCC patients treated with TACE at a tertiary referral center between 2008 and 2017. The ADC values and changes in ADC value (ΔADC) of HCC lesions (≥ 1 cm) and liver parenchyma were assessed by DWI ≤ 3 months before and after first TACE. Pre- and post-TACE ADC values were compared with tumor response according to mRECIST and correlated with overall survival (OS) in a univariable and multivariable Cox-regression analysis. Results: A total of 89 patients were included, mostly Child–Pugh A (85%) and BCLC stage B (53%) with a median OS of 21.7 months (95% CI 17.6–25.9). Tumor ADC increased from 1081 mm 2 /s before (IQR 964–1225) to 1328 mm 2 /s (IQR 1197–1560) after TACE (p < 0.001). Responders according to mRECIST showed a higher ΔADC after first TACE than non-responders (26 vs. 14%, p = 0.048). Pre-TACE ADC and ΔADC were not significantly associated with OS in both univariable and multivariable analysis, whereas response according to mRECIST remained an independent predictor of OS. Conclusion: mRECIST was confirmed as an independent prognostic factor of OS, but pre- or post-TACE ADC measurements were not. Response according to mRECIST was associated with a higher increase in ADC than non-response.
AB - Background: Survival outcomes of patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) are heterogeneous. Measuring the apparent diffusion coefficient (ADC) using diffusion-weighted imaging (DWI) may improve overall survival prediction. Aim: To assess the value of measuring the ADC before and after TACE in predicting overall survival. Methods: A retrospective analysis was performed in HCC patients treated with TACE at a tertiary referral center between 2008 and 2017. The ADC values and changes in ADC value (ΔADC) of HCC lesions (≥ 1 cm) and liver parenchyma were assessed by DWI ≤ 3 months before and after first TACE. Pre- and post-TACE ADC values were compared with tumor response according to mRECIST and correlated with overall survival (OS) in a univariable and multivariable Cox-regression analysis. Results: A total of 89 patients were included, mostly Child–Pugh A (85%) and BCLC stage B (53%) with a median OS of 21.7 months (95% CI 17.6–25.9). Tumor ADC increased from 1081 mm 2 /s before (IQR 964–1225) to 1328 mm 2 /s (IQR 1197–1560) after TACE (p < 0.001). Responders according to mRECIST showed a higher ΔADC after first TACE than non-responders (26 vs. 14%, p = 0.048). Pre-TACE ADC and ΔADC were not significantly associated with OS in both univariable and multivariable analysis, whereas response according to mRECIST remained an independent predictor of OS. Conclusion: mRECIST was confirmed as an independent prognostic factor of OS, but pre- or post-TACE ADC measurements were not. Response according to mRECIST was associated with a higher increase in ADC than non-response.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85065669567&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31069479
U2 - https://doi.org/10.1007/s00261-019-02030-2
DO - https://doi.org/10.1007/s00261-019-02030-2
M3 - Article
C2 - 31069479
SN - 2366-004X
VL - 44
SP - 2740
EP - 2750
JO - Abdominal Radiology
JF - Abdominal Radiology
IS - 8
ER -