Division of Interventional Radiology & Image Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Division of Abdominal Imaging, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
J Magn Reson Imaging. 2015 Oct;42(4):981-9. doi: 10.1002/jmri.24845. Epub 2015 Feb 12.
To investigate magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) of hepatocellular carcinoma (HCC) immediately post-doxorubicin drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) therapy as an early imaging biomarker of therapy response.
In a single-center prospective correlative study, 12 consecutive patients, median age 64 years, underwent DEB-TACE and dynamic contrast-enhanced (DCE) and DWI (b = 50,400,800 s/mm(2)) MRI at baseline with respect to first DEB-TACE, within 3 hours, and at 1 and 3 months posttherapy. DCE imaging response was evaluated according to target mRECIST and EASL. Relative change (RC) in apparent diffusion coefficient (ADC) of treated lesions was measured on follow-ups. Correlation between ADC RC in tumors and anatomical response were evaluated with paired t-test and receiver operator characteristic (ROC) curve. Survival from first DEB-TACE was estimated using Kaplan-Meier and log-rank analysis.
Compared to baseline, mean ADC increased significantly for responders within 3 hours post-DEB-TACE (0.73 ± 0.20 mm(2) /s vs. 0.99 ± 0.28 mm(2) /s × 10(-3) (P = 0.001)). There was no significant change in ADC within 3 hours for nonresponders. ADC RC threshold of 20% immediately post-DEB-TACE showed 100% sensitivity and specificity in predicting anatomical response at 1 and 3 months with patients with ≥20% ADC increase demonstrated significantly prolonged mean overall survival compared to others (25.4 vs. 13.3 months (P = 0.017)).
ADC relative change of ≥20% immediately post-DEB-TACE is an accurate predictor of objective and quantitative treatment response and prolonged survival in unresectable HCC.
探讨多柔比星载药微球动脉化疗栓塞术（DEB-TACE）后即刻磁共振扩散加权成像（DWI）在预测治疗反应中的作用，作为一种早期治疗反应的影像学生物标志物。
在一项单中心前瞻性相关性研究中，连续 12 例患者，中位年龄 64 岁，在首次 DEB-TACE 治疗前、治疗后 3 小时内、1 个月和 3 个月进行了 DWI（b 值=50、400、800 s/mm²）和动态对比增强（DCE）MRI 检查。根据靶标 mRECIST 和 EASL 标准评估 DCE 成像反应。在随访时测量治疗后病变的表观扩散系数（ADC）的相对变化（RC）。采用配对 t 检验和受试者工作特征（ROC）曲线评估 ADC RC 与解剖学反应的相关性。采用 Kaplan-Meier 和对数秩检验分析首次 DEB-TACE 后的生存情况。
与基线相比，在 3 小时内，反应者的平均 ADC 显著增加（0.73±0.20 mm²/s 与 0.99±0.28 mm²/s×10（-3）（P=0.001））。而无反应者在 3 小时内 ADC 没有明显变化。DEB-TACE 后即刻 ADC 增加≥20%的患者在 1 个月和 3 个月时预测解剖学反应的敏感性和特异性均为 100%，与其他患者相比，ADC 增加≥20%的患者具有显著延长的总生存期（25.4 个月与 13.3 个月（P=0.017））。
DEB-TACE 后即刻 ADC 增加≥20%是不可切除 HCC 患者客观和定量治疗反应及延长生存的准确预测指标。
