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. 2019 Apr-Jun;29(2):195-200.
doi: 10.4103/ijri.IJRI_383_18.

Diagnostic accuracy of intermediate b-value diffusion-weighted imaging for detection of residual hepatocellular carcinoma following transarterial chemoembolization with drug-eluting beads

Ahmed E Hassan  1 , Radwa E Mostafa  1 , Ayman Nada  2 , Mohamed S Elazab  1 , Ahmed Sayed Awad  3 , Ikram M Hamed  1
Affiliations

Diagnostic accuracy of intermediate b-value diffusion-weighted imaging for detection of residual hepatocellular carcinoma following transarterial chemoembolization with drug-eluting beads

Ahmed E Hassan et al. Indian J Radiol Imaging. 2019 Apr-Jun.

Abstract

Purpose: To evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of residual malignant tumor of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) with drug-eluting beads (DEBs).

Subjects and methods: Pre-contrast T1, T2, dynamic contrast-enhanced, and respiratory-triggered DW-MRI (b factor 0, 400, and 800 s/mm2) were obtained in 60 patients with HCC who underwent tran-sarterial hepatic chemoembolization with DEBs. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the DW imaging images. Apparent diffusion coefficients (ADCs) were calculated searching for the optimal cut-off value using the receiver operating characteristic (ROC) curve.

Results: DW-MRI had a sensitivity of 77.1%, a specificity of 60.7%, a PPV of 71.05%, and a NPV of 68%. The difference between the malignant and benign groups' ADC variables was statistically significant (P < 0.003). The ROC curve showed that the area under the curve is C = 0.718 with SE = 0.069 and 95% confidence interval from 0.548 to 0.852.

Conclusion: In our study, we demonstrated that diffusion MRI has limited diagnostic value in the assessment of viable tumor tissue after TACE with DEBs in cases of HCC.

Keywords: Drug-eluting beads; diffusion-weighted magnetic resonance imaging; hepatic; hepatocellular carcinoma-transcatheter arterial chemoembolization; malignant.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
A 71-year-old male treated with DEB-TACE for HCC. DWIs of the lesion showed peripheral bright areas that became brighter with increasing the b value (0, 400, 800) in successive images from the top two rows with dark signal in the ADC map denoting restricted diffusion “arrows.” Dynamic thrive images showed necrosis of the lesion with thin smooth rim of reactive enhancement “arrows.” The bright T1 signal in the precontrast image represents coagulative necrosis
Figure 2
Figure 2
A 65-year-old female treated with DEB-TACE for HCC. DWIs showed central bright areas that became brighter with increasing the b value (0, 400, 800) in successive images from the top images with dark signal in the ADC map denoting restricted diffusion. Dynamic thrive images showed marginal reactive enhancement with no evidence of early pathological enhancement or washout of contrast “arrows” denoting good therapeutic response with no residual tumoral activity. The bright T1 signal in the precontrast image represents coagulative necrosis
Figure 3
Figure 3
A 68-year-old male treated with DEB-TACE for HCC. DWIs of the lesion showed peripheral bright areas that became brighter with increasing the b value (0, 400, 800) in successive images from the top images with dark signal in the ADC map denoting restricted diffusion. Dynamic thrive images also showed heterogeneous enhancement with nodular vivid enhancement in the arterial and portal phases with delayed contrast washout matching the nodules of restricted diffusion pattern “arrows” denoting residual viable tumoral activity. The precontrast images show hyperintense T1 signal, suggestive of hemorrhagic foci
Figure 4
Figure 4
Results of receiver operating curves for ADC values in distinguishing benign and malignant groups
See this image and copyright information in PMC

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