Liver Transplantation Program and Departments of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan.
Liver Transplantation Program and Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan.
Dig Dis Sci. 2020 Aug;65(8):2433-2441. doi: 10.1007/s10620-019-05951-6. Epub 2019 Nov 15.
The purpose of this study was to assess the value of functional MRI (fMRI) of post-doxorubicin drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) for hepatocellular carcinoma (HCC) as an early imaging biomarker of response to therapy.
This prospective analysis included 21 consecutive patients undergoing fMRI before and after DEB-TACE at a single medical center from January 2013 to December 2014. Functional MRI, including relative changes in apparent diffusion coefficient (ADC) and choline levels measured at hydrogen-1 magnetic resonance spectroscopy (MRS) of treated lesions, was recorded at baseline before DEB-TACE, and at 1, 2, and 4 weeks after DEB-TACE therapy. Assessment of tumor response was based on dynamic contrast-enhanced computer tomography imaging response according to modified response evaluation criteria in solid tumors.
At post-therapy, 76% (n = 16) of patients demonstrated objective tumor response, 10% (n = 2) had stable disease, and 3 (14%) had progressive disease. Stable disease and progressive disease were designated as non-response. At week 2, the mean change in ADC value of responsive tumors was 0.35 ± 0.24 mm/s, which was greater than that of non-response tumors (mean 0.01 ± 0.13 × 10 mm/s) (P = 0.006). Significant differences were found in mean choline/water ratio between responsive (7.8 ± 4.9 × 10) and non-responsive (17.2 ± 4.9 × 10) tumors (P = 0.005). Composite scores of choline/water ratio and relative change of ADC showed significantly better diagnostic accuracy in non-responsive tumors than responsive tumors (area under the curve = 1.0; P < 0.001).
Combined DWI and MRS may be used as an early imaging biomarker of therapy response in HCC patients after chemoembolization therapy.
本研究旨在评估阿霉素载药微球经导管动脉化疗栓塞术（DEB-TACE）后功能磁共振成像（fMRI）在肝癌（HCC）中的价值，作为治疗反应的早期影像学生物标志物。
本前瞻性分析纳入 2013 年 1 月至 2014 年 12 月在单一医疗中心接受 DEB-TACE 治疗的 21 例连续患者。在 DEB-TACE 前和治疗后，对接受治疗的病变进行功能磁共振成像（包括氢-1 磁共振波谱（MRS）测量的表观扩散系数（ADC）和胆碱水平的相对变化），并在 DEB-TACE 治疗前、治疗后 1、2 和 4 周进行记录。根据实体瘤改良反应评价标准，根据动态对比增强计算机断层扫描成像反应评估肿瘤反应。
治疗后，76%（n=16）的患者显示出客观的肿瘤反应，10%（n=2）的患者疾病稳定，3 例（14%）的患者疾病进展。疾病稳定和疾病进展被指定为无反应。在第 2 周，有反应肿瘤的 ADC 值平均变化为 0.35±0.24mm/s，大于无反应肿瘤（平均 0.01±0.13×10mm/s）（P=0.006）。在有反应（7.8±4.9×10）和无反应（17.2±4.9×10）肿瘤之间，胆碱/水比值的平均差异有统计学意义（P=0.005）。胆碱/水比值和 ADC 相对变化的综合评分在无反应肿瘤中的诊断准确性明显优于有反应肿瘤（曲线下面积=1.0；P<0.001）。
联合 DWI 和 MRS 可作为 HCC 患者栓塞治疗后治疗反应的早期影像学生物标志物。
