Original Articles

Transarterial Chemoembolization Of Hepatocellular Carcinoma: Can Early Diffusion Weighted Imaging Predict Response?


Background: We evaluated the role of early diffusion weighted imaging (DWI) in predicting response to TACE in patients with HCC and compare the results with contrast enhanced magnetic resonance imaging. METHODS: 24 patients with documented HCC were taken up for TACE after a pre-procedural contrast CT and MRI. Post procedural DWI was taken on day 5-7 and the mean ADC values were documented and compared to pre procedural values. The change in ADC values was grouped into 4 categories: group 1- <25%, group 2 26-50%, group 3- 51-75% and group 4- >75%. The increase in ADC values signifying response was correlated with 5 week CEMRI scan and a threshold ADC increase signifying response in majority of the cases was calculated. RESULTS: The mean ADC of the lesions changed from 1.21× 10-3 (pre TACE) to 2.02× 10-3 mm2/sec (post TACE) [p<0.001]. Taking CE MRI as gold standard, DWI imaging had a sensitivity of 80%, specificity of 94.7% with a positive predictive value of 80%, negative predictive value of 94.7% and overall accuracy of 91.7%. Complete response was seen in19 (79%) and incomplete in 5 (21%) patients in our study. The change in ADC was significantly higher in responders (884.15 ± 161.60) as compared to non responders (564.80 ± 221.05) [p =0.001]. CONCLUSION: Early DWI after TACE can predict response of a HCC lesion to chemoembolization. The change in ADC values can earmark responders from non-responders. Early DWI results are concordant with CEMRI results in most of the cases. DWI can act as a substitute to CEMRI when contrast administration is not advised.
1. El-Serag HB, Davila JA, Petersen NJ, et al. The continuing increase in the incidence of hepatocellular carcinoma in the United States: an update. Ann Intern Med 2003;139(10):817–823.
2. McGlynn KA, London WT. Epidemiology and natural history of hepatocellular carcinoma. Best Pract Res Clin Gastroenterol 2005;19(1):3–23.
3. Trevisani F, Cantarini MC, Wands JR, et al. Recent advances in the natural history of hepatocellular carcinoma. Carcinogenesis 2008;29(7):1299–1305.
4. Bruix J, Sherman M; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011;53(3):1020–1022.
5. European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer. EASL- EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56(4):908–943.
6. Krinsky GA, Nguyen MT, Lee VS, et al. Dysplastic nodules and hepatocellular carcinoma: sensitivity of digital subtraction hepatic arteriography with whole liver explant correlation. J Comput Assist Tomogr 2000;24;628-634.
7. Hepatocellular carcinoma - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Barcelona-Clinic-Liver-Cancer-BCLC-staging-and-treatment-strategy-The-BCLC-system_fig2_322267682.
8. Bruix J, Sherman M; Practice Guidelines Committee, American Association For The Study Of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005; 42: 1208-1236.
9. Baffy G, Brunt EM, Caldwell SH. Hepatocellular carcinoma in non- alcoholic fatty liver disease: an emerging menace. J Hepatol 2012;56(6):1384–1391.
10. Ito K, Honjo K, Fujita T, et al. therapeutic efficacy of transcatheter arterial chemoembolization for hepatocellular carcinoma: MRI and pathology. J Comput Assist Tomogr 1995; 19:198-203.
11. Semelka RC, Worawattanakul S, Mauro MA, et al. Malignant hepatic tumours: changes on MRI after hepatic arterial chemoembolization – preliminary findings. J Magn Reson Imaging 1998; 8:48-56.
12. Kubota K, Hisa N, Nishikawa T, et al. Evaluation of hepatocellular carcinoma after treatment with transcatheter arterial chemoembolization: comparison of lipoidol-CT, power Doppler sonography, and dynamic MRI. Abdom Imaging 2001; 26; 184-190.
13. Kamel IR, Liapi E, Reyes DK. Unresectable hepatocellular carcinoma: serial early vascular and cellular changes after transarterial chemoembolization as detected with MR imaging. Radiology 2009;250:466-473.
14. Ibrahim YA, ElGharib M, Sheha DM. Chemoembolization follow- up of hepatocellular carcinoma with diffusion-weighted MR imaging. The Egyptian Journal of Radiology and Nuclear Medicine (2015) 46, 871-878.
15. Afifi AH, Naguib AM, Seragaldin F. Diffusion weighted magnetic resonance imaging in assessment of hepatocellular carcinoma after chemoembolization. The Egyptian Journal of Radiology and Nuclear Medicine (2010) 47, 61-71.
16. Tantawy HI, Mohamed FF (2016) Diagnostic value of apparent diffusion coefficient (ADC) in evaluating hepatocellular carcinomas post trans-catheter arterial chemoembolization and radiofrequency ablation. Egypt J Radiol Nucl Med 47(3):699–706.
17. Ebraheem Ebeed A, Abd El-hamied Romeih M, Mohamed Refat M et al (2017) Role of dynamic contrast-enhanced and diffusion weighted MRI in evaluation of hepatocellular carcinoma after chemoembolization. Egypt J Radiol Nucl Med 48:807–815
18. Ozkavukcu E, Halilog lu N, Erden A. Post-treatment MRI findings of hepatocellular carcinoma. Cardiovasc Intervent Radiol 2010; 33(3):532-40.
19. Kubota K, Yamanishi T, Itoh S, et al. Role of diffusion weighted imaging in evaluating therapeutic efficacy after transcatheter arterial chemoembolization for hepatocellular carcinoma. Oncology Reports 24: 727-732, 2010.
20. Lu T-L, Becce F, Bize P, et al. Assessment of liver tumor response by high-field (3 T) MRI after radiofrequency ablation: short- and mid-term evolution of diffusion parameters within the ablation zone. Eur. J. Radiol.2012;81:944–50.
21. Holtås S, Geijer B, Strömblad LG, et al. A ring enhancing metastasis with central high signal on diffusion-weighted imaging and low apparent diffusion coefficients. Neuroradiology 2000; 42(11):824–7.
22. Tung GA, Evangelista P, Rogg JM, et al. Diffusion-weighted MR imaging of rim-enhancing brain masses: is markedly decreased water diffusion specific for brain abscess? AJR Am J Roentgenol 2001;177(3):709–12. doi:https://doi. org/10.2214/ajr.177.3.17 70709.
23. Goshima S, Kanematsu M, Kondo H, et al. Evaluating local hepatocellular carcinoma recurrence post-transcatheter arterial chemoembolization: is diffusion-weighted MRI reliable as an indicator? J Magn Reson Imaging 2008;27:834-839
24. Mohamed IY, Medhat MR, Mohamed HF. Role of diffusion-weighted magnetic resonance imaging in the evaluation of hepatocellular carcinoma response to transcatheter arterial chemoembolization using drug eluting beads; correlation with dynamic MRI. Egypt J Radiol Nucl Med 2017; 48: 817-24.
IssueVol 13 No 1 (2021) QRcode
SectionOriginal Articles
Transarterial Chemoembolization Magnetic Resonance Imaging. Hepatocellular Carcinoma Diffusion Weighted Imaging Apparent Diffusion Coefficient.

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Gulzar A, Shera T, Shah O, Choh N, Gojwari T, Bhat M, Maqsood S. Transarterial Chemoembolization Of Hepatocellular Carcinoma: Can Early Diffusion Weighted Imaging Predict Response?. Basic Clin Cancer Res. 2021;13(1):9-20.