Immediate post-doxorubicin drug-eluting beads chemoembolization Mr Apparent diffusion coefficient quantification predicts response in unresectable hepatocellular carcinoma: A pilot study

• Published in: Journal of magnetic resonance imaging 2015-10, Vol.42 (4), p.981-989
• Main Authors: Kokabi, Nima, Camacho, Juan C., Xing, Minzhi, Edalat, Faramarz, Mittal, Pardeep K., Kim, Hyun S.
• Format: Article
• Language: English
• Subjects: ADC; Aged; Aged, 80 and over; Antibiotics, Antineoplastic - administration & dosage; Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - pathology; Chemoembolization, Therapeutic - methods; DEB-TACE; Delayed-Action Preparations - administration & dosage; Diffusion; Diffusion Magnetic Resonance Imaging - methods; Doxorubicin - administration & dosage; Drug Monitoring - methods; Early Detection of Cancer - methods; Female; HCC; Hemostatics - administration & dosage; Humans; Image Interpretation, Computer-Assisted - methods; imaging biomarker; immediate; Liver cancer; Liver Neoplasms - drug therapy; Liver Neoplasms - pathology; Magnetic resonance imaging; Male; Middle Aged; NMR; Nuclear magnetic resonance; Pilot Projects; Reproducibility of Results; response; Sensitivity and Specificity; survival; Treatment Outcome
• ISSN: 1053-1807; 1522-2586
• DOI: 10.1002/jmri.24845

Purpose To investigate magnetic resonance imaging (MRI) diffusion‐weighted imaging (DWI) of hepatocellular carcinoma (HCC) immediately post‐doxorubicin drug‐eluting beads transcatheter arterial chemoembolization (DEB‐TACE) therapy as an early imaging biomarker of therapy response. Materials and Methods In a single‐center prospective correlative study, 12 consecutive patients, median age 64 years, underwent DEB‐TACE and dynamic contrast‐enhanced (DCE) and DWI (b = 50,400,800 s/mm2) MRI at baseline with respect to first DEB‐TACE, within 3 hours, and at 1 and 3 months posttherapy. DCE imaging response was evaluated according to target mRECIST and EASL. Relative change (RC) in apparent diffusion coefficient (ADC) of treated lesions was measured on follow‐ups. Correlation between ADC RC in tumors and anatomical response were evaluated with paired t‐test and receiver operator characteristic (ROC) curve. Survival from first DEB‐TACE was estimated using Kaplan–Meier and log‐rank analysis. Results Compared to baseline, mean ADC increased significantly for responders within 3 hours post‐DEB‐TACE (0.73 ± 0.20 mm2/s vs. 0.99 ± 0.28 mm2/s × 10−3 (P = 0.001)). There was no significant change in ADC within 3 hours for nonresponders. ADC RC threshold of 20% immediately post‐DEB‐TACE showed 100% sensitivity and specificity in predicting anatomical response at 1 and 3 months with patients with ≥20% ADC increase demonstrated significantly prolonged mean overall survival compared to others (25.4 vs. 13.3 months (P = 0.017)). Conclusion ADC relative change of ≥20% immediately post‐DEB‐TACE is an accurate predictor of objective and quantitative treatment response and prolonged survival in unresectable HCC. J. Magn. Reson. Imaging 2015;42:981–989.