The Clinical Value Of MR Diffusion-weighted Imaging In Hepatocellular Carcinoma After Transcatheter Arterial Chemoembolization

Objective :There are many ways for follow-up of TACE,such as CT, ultrasonography, PET/CT, DSA ,MR and so on,but which is most beneficial for evaluating the effort of TACE is controversial. In our study, CT,DSA or PET/CT were performed to compare with DWI so as to assess the advantage and clicical value of diffusion-weighted imaging (DWI) in primary hepatic carcinoma (PHC) after transcatheter arterial chemoembolization (TACE).Methods:DWIs were performed in 21 patients with PHC who were treated by TACE,The DWI iamges were analyzed in liver lesions and correlated with DSA or CT, 18F-FDG-PET/CT was performed in 3 patients .Results:Five patients were excluded from the study because of dead,lack of money and aggravation ,and they did not finish the follow-up.Therefore,16 patients were completely followed.The follow-up period was 2-10 months , and 3 patients died,the other remained alive.Fifteen hepatic cysts were found,and the ADC values and signal intensity of PHC were lower than hepatic cysts.Most tumors were large PHC,two lesions enlarged,no significant difference was found for the other lesions.Eighteen lesions were found in DSA and eleven with satisfactory iodinated oil accumulation,and seven lesions with poor accumulation, the mean ADC value of the two group were different, the latter group was significantly lower than that of the first group(P<0.01),the mean ADC value increased in the first group which with satisfactory iodinated oil accumulation(P<0.01),however,no significant difference in the latter group (slightly decreased in four lesions) .The mean ADC value of normal liver parenchyma had no difference pre-and post treatment(P>0.05). DWI detected 12 metastatic lesions , the mean ADC values of which was different with those primary tumors (P<0.01).Abnormal 18F-FDG was found in PET/CT in one patient pre-treatment, residue of tumor was found in two patients after treatment(a metastase was found in one of the two patients).Conclusion:DWI can distinguish hepatic cysts easily,the ADC values and signal intensity of PHC are lower than hepatic cysts(P<0.05). The signal of PHC, mean ADC values and ADC map are characteristic post-treatment,DWI is sensitive for detecting hepatic lesions,and can identify viable and necrotic tumor tissue in PHC after TACE and detect metastatic lesions and recurrence of tumor sensitively. Generally, ADC values will increase if satisfactory iodinated oil accumulation is found, and ADC values may decrease if recurrence is found. The serum AFP values and ADC values of tumor are beneficial for us to evaluate effect of TACE. PET/CT may detect metastases and residue of PHC, which will be beneficial for evaluating the effort of TACE and for clinical staging.