Diffusion Kurtosis Imaging for Assessing the Therapeutic Response of Transcatheter Arterial Chemoembolization in Hepatocellular Carcinoma

Abstract

Objective: This study aimed to evaluate the therapeutic response of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) with diffusion kurtosis imaging (DKI). Methods: Forty-three patients with fifty-nine hepatic cancer nodules were recruited for this study. All patients were treated by TACE. Magnetic resonance imaging (MRI) and DKI (b=0, 800, 1,500, 2,000mm 2 /s) were performed before and one month after initiating TACE. Patients were classified as either progressing groups or non-progressing groups. Mean kurtosis (MK), mean diffusion (MD), and apparent diffusion coefficient (ADC) values of the tumor tissue were analyzed. Results: Twenty-three HCCs were classified as progressing groups, and thirty-six HCCs were non-progressing groups. After TACE, the values of MD and ADC in non-progressing groups (1.92±0.36×10 − 3 mm 2 /s, 1.36±0.23×10 − 3 mm 2 /s) were greater than progressing groups (1.44±0.32× 10 − 3 mm 2 /s, 1.10±0.23×10 − 3 mm 2 /s), however, the MK values in non-progressing groups (0.47±0.12) were lower than progressing groups (0.72±0.14). The MK values of tumor among non-progressing patients decreased one month after TACE (0.47±0.12) relative to the preoperative values (0.71±0.12) (P<0.05). In the non-progressing groups, the MD and ADC values of tumor after TACE (1.92±0.36×10 − 3 mm 2 /s, 1.36±0.23×10 − 3 mm 2 /s) became higher than their preoperative values (1.44±0.35×10 − 3 mm 2 /s, 1.09±0.22×10 − 3 mm 2 /s) (P<0.05). In the progressing groups, the MK, MD, and ADC values of tumor after TACE remained similar before TACE (P>0.05). The sensitivity, specificity, and AUC of the ROC curve for the assessment of HCC progress after TACE by MK (85.2%, 97.5%, and 0.95, respectively) were greater than by ADC (78.6%, 66.5%, and 0.75, respectively) and MD (76.2%, 64.3%, and 0.71, respectively). Conclusions: DKI for assessing the therapeutic response of TACE in HCC shows great promise. MK is more advantageous in the assessment of HCC progress after TACE.

Radiomics Analysis Based on Contrast-Enhanced MRI for Prediction of Therapeutic Response to Transarterial Chemoembolization in Hepatocellular Carcinoma

“…Although radiologists had attempt to standardize interpretation of liver imaging, the assessment of therapeutic response using such qualitative imaging characteristics remains subjective and variable. In recent years, functional MRI technologies such as diffusion-weighted imaging (DWI), diffusion kurtosis imaging (DKI), and dynamic contrast enhanced MRI (DCE-MRI) have made it possible to effectively and quantitatively evaluate the response of tumors to TACE ( 13 , 16 , 17 ). However, these function imaging techniques require additional acquisitions and stricter scanning conditions and are more affected by respiratory motion, the MR device, scan parameters, etc, which may limit the clinical application and promotion ( 18 ).…”

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

“…Kokabi et al [67] reported an ADC value threshold of 0.83 × 10 −3 mm 2 /s, below which an objective response can be predicted (91% sensitivity and 96% specificity) at 1 and 3 months after DEB chemoembolization. In contrast, different threshold were reported by Mannelli et al [29], 0.695 × 10 −3 mm 2 /s; Yuan et al [31], 1.618 × 10 −3 mm 2 /s; and Dong et al [64], 1.3 × 10 −3 mm 2 /s.…”

“…Lin et al [28] as well as Yuan et al [31] included only histopathologically confirmed HCC. A maximum tumor diameter >2 cm and no large necrosis were inclusion criteria for Lin et al [28].…”

“…The timeframe of MRI acquisition pre- and post-TACE was heterogenous across included studies: Kokabi et al [26] (pre: no data, post: 3 h, 1 and 3 months), Kubota et al [27] (pre: 1–2 days, post: 5–7 days), Lin et al [28] (pre: 1–3 days, post: 1 month), Mannelli et al [29] (within 3 months before and after TACE), Ou et al [30] (pre: 0–2 days, post: 1, 2 and 4 weeks), and Yuan et al [31] (pre: no data, post: 1 month, every 3 months). The TACE drugs, which were administered to the patients, were also different (Table 1).…”

Diagnostic evaluation and ablation treatments assessment in hepatocellular carcinoma

“…The traditional DWI data analysis approach is founded on the hypothesis that voxel water diffusion has a single component and follows a normal Gaussian distribution, and that water molecules diffuse without any constraint. However, water molecule diffusion within biologic tissue exhibits non-Gaussian behavior [123][124][125][126][127][128][129][130][131][132]. Jensen et al in 2005 reported a non-Gaussian diffusion model called Diffusion Kurtosis imaging (DKI) [123] used to analyze DWI data.…”