Apparent Diffusion Coefficient Can Predict Therapy Response of Hepatocellular Carcinoma to Transcatheter Arterial Chemoembolization

Abstract

Aim: The goal of this meta-analysis was to assess the apparent diffusion coefficient (ADC) as a pre- and posttreatment (ΔADC) predictive imaging biomarker of response to transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Methods: SCOPUS database, EMBASE database and MEDLINE library were scanned for connections between pre- and posttreatment ADC values of HCC and response to TACE. Six studies qualified for inclusion. The following parameters were collected: authors, publication year, study design, number of patients, drugs for TACE, mean ADC value, standard deviation, measure method, b-values and Tesla-strength. The QUADAS-2 instrument was employed to check the methodological quality of each study. The meta-analysis was performed by utilizing RevMan 5.3 software. DerSimonian and Laird random-effects models with inverse-variance were used to regard heterogeneity. Mean ADC values and 95% confidence intervals were computed. Results: Six studies (n=271 patients with 293 HCC nodules) were included. The pretreatment mean ADC in the responder group was 1.20 x 10-3 mm2/s (0.98, 1.42) and 1.14 x 10-3 mm2/s (0.89, 1.39) in the non-responder group. The analysis of post TACE ADC value changes (ΔADC) revealed a threshold of ≥ 20% to identify treatment responders. No suitable pretreatment ADC threshold to predict therapy response or discriminate between responders and non-responders before therapy could be discovered. Conclusion: ΔADC can facilitate early objective response evaluation through post-therapeutic ADC alterations ≥ 20%. Pretreatment ADC cannot predict response to TACE.

The Diagnostic Performance of Maximum Uptake Value and Apparent Diffusion Coefficient in Differentiating Benign and Malignant Ovarian or Adnexal Masses: A Meta-Analysis

“…ADC has been proven to have good diagnostic performance in the identification of benign and malignant lesions such as the brain, thyroid, pancreas, and uterus (38)(39)(40)(41)(42). In addition, ADC has also been confirmed in other studies to better predict the response evaluation of liver cancer, nasopharyngeal cancer, colon cancer with liver metastasis after treatment (43)(44)(45). Whether the ADC value can better distinguish benign and malignant ovarian or appendages is different in some previous studies (46,47).…”

Local ablation of hepatocellular carcinoma by interstitial brachytherapy: prediction of outcome by diffusion-weighted imaging

“…Both minimum and mean ADC values predicted treatment response in patients with locally advanced rectal cancer before neoadjuvant chemoradiation treatment (41). A recent meta-analysis showed that alterations between pre-and post-treatment ADC can identify responders to TACE in HCC (42).…”

Recent Advances in Locoregional Therapy of Hepatocellular Carcinoma

“…There are no established imaging markers used for the prediction of TACE response. However, the delta of ADC values on MRI imaging higher than 20% facilitates early objective response to treatment [ 86 , 87 ]. To assess the presence of residual tumours, contrast-enhanced ultrasound can also be used.…”