Assessment of hepatocellular carcinoma response to 90Y radioembolization using dynamic contrast material– enhanced MRI and intravoxel incoherent motion diffusion-weighted imaging

Stefanie J. Hectors, Sara Lewis, Paul Kennedy, Octavia Bane, Daniela Said, Maxwell Segall, Myron Schwartz, Edward Kim, Bachir Taouli

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Purpose: To quantify diffusion and perfusion changes in hepatocellular carcinoma (HCC) induced by yttrium 90 (90Y) radioemboliza-tion 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. Materials and Methods: 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, includ-ing IVIM DWI and gadoxetic acid DCE MRI before (n = 24) and 6 weeks (n = 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. Results: Twenty-five HCCs were analyzed (mean size, 3.6 cm ± 1.9). Radioembolization resulted in significantly decreased perfusion (DCE MRI arterial flow, P = .002; IVIM pseudodiffusion coefficient [D*], P = .014). Multivariate logistic regression selected combined serum α-fetoprotein and portal flow (Fp) skewness (area under the curve [AUC] = 0.924) and combined D* standard deviation and Fp 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). Conclusion: 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.

Original languageEnglish
Article numbere190094
JournalRadiology: Imaging Cancer
Volume2
Issue number4
DOIs
StatePublished - Jul 2020

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