Study Of Functional MRI At 3.0T On Hepatocellular Carcinoma Treated By Internal Therapy

Part Ⅰ:The value of functional MRI on predicting therapeutic outcome of TACE on hepatocellular carcinomaObjective:To explore the efficacy of functional MRI quantitative analysis in predicting therapeutic outcome of transcatheter arterial chemoembolization (TACE) on hepatocellular carcinoma (HCC).Materials and methods:Sixty-five patients with biopsy-proven or clinical diagnostic HCC underwent diffusion-weighted imaging (DWI), IntraVoxel incoherent motion (IVTM) and perfusion-weighted imaging (PWI) on a 3.0T MR scanner before TACE treatment, and forty-three HCC patients took the same MR scan after TACE treatment. The quantitative parameters were measured on the maximal tumor region, including MTD, ADC, Dslow, Dfast, f, Ktrans,Kep and Ve value before and after TACE treatment. All data were statistically analyzed.Results:In the preoperative, Univariate Cox regression analysis indicated that ADC, Dslow, Dfast, f, Ktrans, Kep and Ve values of the tumor were significantly associated with progression-free survival (PFS) (P<0.05, respectively). In multivariate analysis, both Dfast and Ktrans values of tumors were significant predictors for tumor progressive (χ2=6.77 and 7.66, P= 0.01 and 0.00) before the preoperative. When ROC of was used for finding the cut-off value, the cut-off value of Dfast and Ktrans were 26.40 ×10"3mm2/s and1.46 /min.Conclusion:The Dfast and Ktrans values of HCC acquired before TACE obviously correlated with PFS and was valuable in the prediction of the clinical outcome of HCC treated with TACE.Part Ⅱ:Functional MRI evaluation on short-term therapeutic effect and prognosis of TACE on hepatocellular carcinomaObjective:To investigate the postoperative early response and short-term prognosis value of functional MR quantitative parameters for the patients with hepatocellular carcinoma treated by TACE.Materials and methods:Sixty-five patients with biopsy-proven or clinical diagnostic HCC underwent diffusion-weighted imaging (DWI), IntraVoxel incoherent motion (IVIM) and perfusion-weighted imaging (PWI) on a 3.0T MR scanner before TACE, and forty-three HCC patients took the same MR scan one month after TACE. The quantitative parameters were measured on the maximal tumor region, including MTD, ADC, Dslow, Dfast, f, Ktrans, Kep and Ve value before and after TACE. The patients were divided into progressive group and stable group based on mRECIST as criterion. All data were statistically analyzed.Results:There were significant differences between progressive group and the stable group in MTD, ADC, Dslow, Dfast, Ktrans, Kep values of the tumor before TACE (P<0.05, respectively). One month after TACE, the MTD, Ktrans, Kep, △ MTD, △ ADC, △ Dslow, △Dfast, △ Ktrans and △ Kep values of the tumor had significant differences between progressive group and the stable group (P<0.05, respectively). The MTD, AFP, ADC, Dslow, Dfast, Ktrans and Kep values of tumors had significant differences before and after TACE (P<0.05, respectively).Conclusion:When mRECIST as criterion, the parameters of the functional MR could predict the efficacy before TACE in HCC patients. Furthermore, the functional MR as a noninvasive method might evaluate the early response after TACE in HCC patients.Part Ⅲ:Predictive Value of Apparent Diffusion Coefficient Histogram in Evaluation of Hepatocellular Carcinoma’Response to Radiofrequency AblationObjective:To evaluate the value of apparent diffusion coefficient (ADC) histogram analysis for predicting tumor progressive in patients with hepatocellular carcinoma treated with radiofrequency ablation (RFA).Materials and methods:In a retrospective study, both 38 progressive patients and 35 stable patients with biopsy-proven HCC underwent breath-hold diffusion-weighted imaging (DWI) on a 3.0T magnetic resonance (MR) scanner before RFA treatment. The pre-treatment ADC value was averaged from the lowest to 10th,30th,50th, and 100th percentile of histogram respectively, called ADC10, ADC30, ADC50 and ADC100.The ratio of ADC10, ADC30, ADC50 and ADC100 to mean ADC of non-lesion area were calculated, called RADC10, RADC30, RADC50 and RADC100. All the ADC and RADC values were statistically analyzed.Results:The ADC30, ADC50, ADC100, RADC30, RADC50 and RADC100 values of tumors in the progressive group were significantly higher than those of the stable group (P< 0.05, respectively). Univariate Cox regression analysis indicated that RADC10, RADC30, RADC50 values of the tumor were significantly associated with progression-free survival (PFS) (RR=104.63、114.69 and 117.77; P< 0.05, respectively). In multivariate analysis, the RADC50 value of tumors was a significant predictor for tumor progressive (χ2= 6.61, P=0.01). When the cut-off value of RADC50 (0.71) was used, the PFS of above the cut-off value group was significantly lower than that of below the cut-off value group (χ2=6.95, P=0.01).Conclusion:Pre-RFA ADC histogram analysis may serve as a biomarker for predicting tumor progressive in patients with HCC treated with RFA.