Server Sadık, Sabet Soheil, Bilgin Refik, Inan Nagihan, Yuzer Yıldıray, Tokat Yaman
Department of Radiology, Istanbul Bilim University, Sisli Florence Nightingale Hospital, Istanbul, Turkey.
Department of Radiology, Istanbul Bilim University, Sisli Florence Nightingale Hospital, Istanbul, Turkey.
Transplant Proc. 2019 Sep;51(7):2391-2396. doi: 10.1016/j.transproceed.2019.01.161.
To evaluate the diagnostic accuracy of Intravoxel Incoherent Motion (IVIM) parameters for assessment of tumor response after locoregional treatment (LRT) of hepatocellular carcinoma (HCC).
Fifteen patients with HCC who had undergone LRTs (11 transarterial radioembolization, 4 transarterial chemoembolization) were included. In addition to routine upper abdominal magnetic resonance imaging sequences, IVIM with 16 different b values and conventional diffusion weighted imaging with 3 different b factors were obtained immediately before and 8 weeks after LRTs. Magnetic resonance imaging response was evaluated according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) and HCCs were categorized into 2 subgroups, responders and nonresponders. Quantitatively, the number of diffusion-changes were calculated with apparent diffusion coefficient (ADC) and IVIM parameters, including mean D (true diffusion coefficient), pseudo-diffusion coefficient associated with blood flow, and f (perfusion fraction) values. Subsequently, the pre- and post-treatment parameters were compared using the Mann-Whitney U test.
Considering all HCCs, a significant decrease was observed according to mRECIST criteria (-38.43 ± 16.49). The ADC and D values after LRTs were significantly higher than those of the preceding ones. The f values after LRTs were significantly lower than those of pre-treatment. In the responders group, ADC and D values were significantly increased and f values were significantly decreased after LRTs. No difference of statistical significance was achieved in the nonresponders group.
ADC values and IVIM parameters appear to reflect the response of LRTs as effectively as those of mRECIST. This promises new horizons in the management of pretransplant patients, especially in renal insufficiency clinical settings, owing to the elimination of contrast media administration.
评估体素内不相干运动（IVIM）参数对肝细胞癌（HCC）局部区域治疗（LRT）后肿瘤反应的诊断准确性。
纳入15例接受过LRT的HCC患者（11例行经动脉放射性栓塞，4例行经动脉化疗栓塞）。除常规上腹部磁共振成像序列外，在LRT前及LRT后8周即刻分别进行具有16个不同b值的IVIM检查以及具有3个不同b因子的传统扩散加权成像检查。根据改良实体瘤疗效评价标准（mRECIST）评估磁共振成像反应，并将HCC分为2个亚组，即反应者和无反应者。定量计算表观扩散系数（ADC）和IVIM参数（包括平均D值（真实扩散系数）、与血流相关的伪扩散系数以及f值（灌注分数））的扩散变化数量。随后，使用Mann-Whitney U检验比较治疗前后的参数。
根据mRECIST标准，所有HCC患者均有显著下降（-38.43±16.49）。LRT后的ADC和D值显著高于之前的值。LRT后的f值显著低于治疗前。在反应者组中，LRT后ADC和D值显著升高，f值显著降低。在无反应者组中未观察到统计学差异。
ADC值和IVIM参数似乎与mRECIST一样能有效反映LRT的反应。由于无需使用造影剂，这为移植前患者的管理带来了新的前景，尤其是在肾功能不全的临床环境中。
