Evaluation Of Treatment Reponse After TACE In Hepatocellular Carcinoma Using GD-EOB-DTPA Enhanced MRI And Diffusion Weighted Imaging

Objective To investigate the value of Gadolinium Ethoxybenzyl Diethylene-triaminepentaacetic-acid(Gd-EOB-DTPA)enhanced magnetic resonance imaging(MRI)and diffusion weighted imaging(DWI)in evaluating teatment response after transarterial chemoembolization(TACE)in hepatocellular carcinoma(HCC),in order to provide scientific imaging evidences for clinical precise diagnosis and treatment.Material and Methods Nighty-six patients with 115 HCCs who had undergone TACE firstly in the first affiliated hospital of lanzhou university from September 2016 to December 2018 were prospectivelly and consecutively included in our study.The aim of this study was to investigate the diagnostic accuracy of Gd-EOB-DTPA enhanced MRI and DWI,as well as receiver operator characteristics(ROC)curve was used to evaluate the differential diagnosis value of apparent diffusion coefficient(ADC)in detecting residual or recurrent tumors after 1-2 months based on the reference standard of CT and/or MRI follow up,surgery pathology.Morever,imaging symptoms including T1 WI signal,T2 WI signal,morphology,capsule,DWI signal,arterial-phase enhancement performance and hepatobiliary phsase signal were explored in analyzing postoperative residual or recurrent lesions by Chi-square test.Last but not east,regional liver fuction after TACE in HCC were evaluated comparely by measuring the signal-to-noise ratio(SNR)of peritumoral region(surrounded with 3cm)and non-peritumoral tissue region using Mann-Whitney U test.Results(1)Twenty-nine residual tumors,18 hepatic recurrent tumors and 82 necrotic lesion were proved by reference standrad.(2)The residual or recurrent tumors were characteristic with hypointense on T1-weighted image(T1WI),hyperintense on T2 WI and DWI,hyperintense in arterial phase and hypointense on hepatobiliary phsase.(3)The sensitivity and specificity of Gd-EOB-DTPA enhanced MRI and DWI in diagnosing residual or recurrent tumors after TACE in HCC patients were 93.62% and 91.49%,96.34% and 95.12% respectively,as well as the combined sensitivity and specificity were 95.74% and 100%.(4)Lesion capsule,DWI signal,and enhanced performance of arterial phsase signal were important factors in predicting residual orrecurrent tumors(P<0.05).(5)On hepatobiliary phsase of Gd-EOB-DTPA enhanced MRI,the SNR of peritumoral region and non-peritumoral region were 73.22±26.48 vs.83.15±29.31 with P<0.05.Conclusions1)The manifestation of residual or recurrent tumors after TACE in HCC are characteristic with hypointense on T1 WI,hyperintense on T2 WI and DWI,hyperintense in arterial phase and hypointense on hepatobiliary phsase.2)Gd-EOB-DTPA enhanced MRI perform better in diagnosing residual or recurrent tumors in comparasion with DWI,but the combination of both detective methods can improve the diagnostic accuracy.3)Arterial-phase enhancement performance,high DWI signal and capsule are help of diagnosing residual or recurrent tumors after TACE.4)In addition,Gd-EOB-DTPA enhanced MRI can be used in evaluating regional liver fuction after TACE.