Biomedical Engineering and Imaging Institute (S.J.H., S.L., P.K., O.B., D.S., M. Segall, B.T.), Department of Diagnostic, Molecular and Interventional Radiology (S.J.H., S.L., P.K., O.B., D.S., M. Segall, E.K., B.T.), and Department of Liver Surgery, Recanati/Miller Transplantation Institute (M. Schwartz), Icahn School of Medicine at Mount Sinai, 1460 Madison Ave, New York, NY 10029; and Department of Radiology, Weill Cornell Medicine, New York, NY (S.J.H.).
Radiol Imaging Cancer. 2020 Jul 24;2(4):e190094. doi: 10.1148/rycan.2020190094.
To quantify diffusion and perfusion changes in hepatocellular carcinoma (HCC) induced by yttrium 90 (Y) radioembolization and to assess the value of dynamic contrast material-enhanced (DCE) MRI and intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) for predicting HCC response.
Institutional review board approval was obtained for this prospective study (clinical trial registry NCT01871545). Twenty-four participants with HCC (mean age, 69 years ± 9 [standard deviation], 18 men) underwent multiparametric MRI, including IVIM DWI and gadoxetic acid DCE MRI before ( = 24) and 6 weeks ( = 21) after radioembolization. IVIM DWI and DCE MRI histogram parameters were quantified in HCCs and liver parenchyma. HCC response was assessed by using modified Response Evaluation Criteria in Solid Tumors at 6 weeks and 6-12 months after radioembolization. Logistic regression analysis was used to evaluate the diagnostic performance of baseline MRI and clinical parameters for prediction of response.
Twenty-five HCCs were analyzed (mean size, 3.6 cm ± 1.9). Radioembolization resulted in significantly decreased perfusion (DCE MRI arterial flow, = .002; IVIM pseudodiffusion coefficient [], = .014). Multivariate logistic regression selected combined serum α-fetoprotein and portal flow ( ) skewness (area under the curve [AUC] = 0.924) and combined standard deviation and kurtosis (AUC = 0.916) for prediction of objective and complete response at 6 weeks, respectively. Standard deviation of DCE MRI parameter arterial fraction was selected as the optimal predictor for complete response at 6-12 months (AUC = 0.857).
Diffusion and perfusion MRI can be used to evaluate the response of HCC to radioembolization. Pretreatment DCE MRI histogram parameters may be useful for radioembolization treatment stratification. © RSNA, 2020.
定量研究钇 90（Y）放射性栓塞诱导的肝细胞癌（HCC）的弥散和灌注变化，并评估动态对比增强（DCE）MRI 和体素内不相干运动（IVIM）弥散加权成像（DWI）在预测 HCC 反应中的价值。
本前瞻性研究获得了机构审查委员会的批准（临床试验注册 NCT01871545）。24 例 HCC 患者（平均年龄 69 岁±9[标准差]，18 例男性）在放射性栓塞前（ = 24）和后 6 周（ = 21）进行了多参数 MRI 检查，包括 IVIM DWI 和钆塞酸二钠 DCE MRI。在 HCC 和肝实质中定量分析 IVIM DWI 和 DCE MRI 直方图参数。在放射性栓塞后 6 周和 6~12 个月时，采用改良实体瘤反应评估标准评价 HCC 反应。采用逻辑回归分析评估基线 MRI 和临床参数对预测反应的诊断性能。
共分析了 25 个 HCC（平均大小为 3.6 cm±1.9）。放射性栓塞导致灌注明显降低（DCE MRI 动脉血流， =.002；IVIM 假性扩散系数， =.014）。多变量逻辑回归选择血清甲胎蛋白和门静脉血流（ ）偏度（曲线下面积[AUC] = 0.924）和 标准差和 峰度（AUC = 0.916）联合用于预测 6 周时的客观和完全反应，分别。DCE MRI 参数动脉分数的标准差被选为预测 6~12 个月完全反应的最佳预测因子（AUC = 0.857）。
弥散和灌注 MRI 可用于评估 HCC 对放射性栓塞的反应。治疗前 DCE MRI 直方图参数可能对放射性栓塞治疗分层有用。
