The Value Of IVIM And DCE-MR In Patients With Hepatocellular Carcinoma Treat With Transcatheter Arterial Chemoembolization

Part1 Intra-voxel Incoherent Motion Diffusion-weighted Imaging on 3.0T MRI in Predicting Transcatheter Arterial Chemoembolization Response in Hepatocellular CarcinomaPurpose:The aim of this study was to predict response to transcatheter arterial chemoembolization(TACE)in patients with HCC by IVIM values.Material and Methods:Ninety patients with HCC underwent IVIM studies using twelve different b values(b=0,10,20,50,100,150,200,400,600,800,1000 and 1200 s/mm2).All patients underwent two MRI studies:a baseline exam before any treatment and a mid-treatment exam 4-6 weeks after TACE.ADC map were extracted from a mono-exponential fit and,D,D*and f were extracted from a bi-exponential fit in IVIM approach for comparison.At the end of TACE,patients were classified as progress or non-progress group according to the modified Response Evaluation Criteria in Solid Tumors criteria(mRECIST),based on their MRI measurement.The predictive value of IVIM parameters were examined with Student's t-test,analysis of variance(ANOVA),multivariate Logistic regression and receiver operating characteristic(ROC)curves.Results:After one treatment of TACE,48 patients were categorized into the non-progress group whereas the other 42 patients were considered progress group.Compared with the pretreatment value,the posttreatment ADC value and D value was higher and the posttreatment D*value and f parameter were lower.The pretreatment D*,f,posttreatment D*and D were four independent factors in the prediction of TACE.The area under curve(AUC)of the four above values were decreased as following:0.694,0.502,0.499 and 0.398,respectively(P=0.002,0.968,0.987 and 0.097,respectively).The ROC curve analysis indicated that,the cutoff of pretreatment D*value in 'best predicting tumor's TACE response.When pretreatment Da*value>12.319×10-3 mm/s,the prediction of response is poor,and the sensitivity,specificity and accuracy were 76.2%,64.6%,and 70%,respectively.Conclusion:IVIM-DWI can potentially predict the treatment response to TACE for HCC especially for pretreatment D*.Part 2 The value of Intra-voxel incoherent motion diffusion-weighted imaging(IVIM-DWI)in the prognosis of transcatheter arterial chemoembolization response in hepatocellular carcinomaPurpose:To predict the value of Intra-voxel incoherent motion diffusion-weighted imaging(IVIM-DWI)in progression-free survival(PFS)of hepatocellular carcinoma(HCC)after trascatheter arterial chemoembolization(TACE).Material and Methods:Ninety patients were enrolled in this study from Sep 2014 to Sep 2017.A total of 12 parameters including 6 clinical indexes:gender,age,size of lesion,tumor thrombus,AFP and ALT values;and 8 functional MRI indexes:pretreatment ADC,D,D*,F,posttreatment ADC,D,D*and f were analyzed by multivariate analysis.Using independent sample t test,ANOVA,the Kaplan-Meier survival curve,Log-Rank test and Cox regression analysis to determinate the prognostic value of IVIM parameters and clinical indicators.Results:Gender,age,pretreatment D*,fand posttreatment D*were 5 indicators in the prognosis of HCC after TACE(Pgender=0.030;Page =0.005,PpretreatmentD*<0.001,Ppretreatmentmnt f=0.007,PposttreatmentD*<0.001).Using median(age=53 yrs,pretreatment D*=14.1×10-3mm2/s,pretreatment f=23.63%,posttreatment D*=11.9×10-3mm2/s)as cut-off value,found that age and pretreatment D*showed statistical significance in predicting the prognosis of HCC(Page =0.027,PpretreatmentD*=0.003).Conclusion:Age and pretreatment D*value can predict the prognosis of TACE treatment for HCC.Part 3 Quantitative Perfusion weighted imaging(PWI)on 3.0T MRI in Predicting sensitivity of hepatocellular carcinoma received transcatheter arterial chemoembolizationPurpose:To evaluate the value of perfusion weighted imaging(PWI)performed before treatment in predicting the sensitivity of hepatocellular carcinoma(HCC)to transcatheter arterial chemoembolization(TACE).Material and Methods:Ninety patients with HCC received TACE.All patients underwent pretreatment PWI to obtain the quantitative parameters of the tumors,including volume transfer constant(Ktrans),exchange rate constant(Kep),and extravascular extracellular space volume ratio(V,)were measured.After receiving one TACE,the patients were re-examined with DCE-MR imaging.According to the tumor response,the patients were divided into progress and non-progress 'group.Results:48 cases after TACE were divided into non-progress group,and other 42 cases were progress group.The pretreatment values of Ktrans,Kep and Ve were(1.28±0.19)/min,(2.40±0.94)/min,and 0.44±0.20 in non-progress group.The pretreatment values of Ktrans,Kep and Ve were(1.03±0.21)/min,(1.86±0.98)/min,and 0.56±0.22 in progress group.There were no significant difference of Ve observed among non-progress and progress group(P>0.05).however Ktrans and Kep were significantly different among the two group(all P<0.05).ROC curve analysis revealed that the corresponding AUC of Ktrans Ve and Kep were 0.807,0.666 and 0.650,respectively.When Ktrans>1.028/min to predicting progress group,sensitivity and specificity were 59.5%and 93.8%.respectively.When Kep>2.36/min to predicting progress group,the sensitivity and specificity were 69.0%and 60.4%,respectively.Conclusion:Pretreatment PWI parameters were helpful to predict the early response of HCC received TACE.Part 4 Perfusion MRI Prediction of Progrossion-Free Survival in Patients with Hepatocellular Carcinoma Treat with Transcatheter Arterial ChemoembolizationPurpose:To predict the value of perfusion wieighted imaging(PWI)in progression-free survival(PFS)of hepatocellular carcinoma(HCC)after trascatheter arterial chemoembolization(TACE).Material and Methods:Ninety patients were enrolled in this study from Sep 2014 to Sep 2017.A total of 10 parameters including 4 clinical indexes:gender,age,size of lesion,tumor thrombus;and 6 functional MRI indexes:pretreatment and posttreatment volume transfer constant(Ktrans),exchange rate constant(Kep),and extravascular extracellular space volume ratio(V,)were analyzed by multivariate analysis.Using independent sample t test,ANOVA,the Kaplan-Meier survival curve,Log-Rank test and Cox regression analysis to determinate the prognostic value of DCE-MR parameters and clinical indicators.Results:Age,pretreatmentKtrans and posttreatment Ktrans were 3 indicators in the prognosis of HCC after TACE(Page =0.027,PpreKtrans<0.001,-PpostKtrans<0.001).Using median as cut-off value,found that age>53 yrs,pretreatmentKtrans>1.165/min and posttreatment Ktrans>1.077/min predicts poor prognosis of HCC.Others(gender,thrombus,size,preKep,postKep,preVe and postVP)showed no statistical significance.Conclusion:Age,pretreatment Ktrans and posttreatment Ktrans value can predict the prognosis of TACE treatment for HCC.