Diffusion-weighted MR Imaging for Determination of Hepatocellular Carcinoma Response to Yttrium-90 Radioembolization

Deng, Jie; Miller, Frank H.; Rhee, Thomas K.; Sato, Kent T.; Mulcahy, Mary F.; Kulik, Laura; Salem, Riad; Omary, Reed A.; Larson, Andrew C.

doi:10.1097/01.rvi.0000227234.81718.eb

Cited by 104 publications

(66 citation statements)

References 19 publications

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“…After locoregional therapies including TACE, radiofrequency ablation, or cryoablation, the necrotic areas are distinguished by increased water diffusion on DWIs from the viable tumor portion (12)(13)(14)(15). Through increased ADC, DWI can potentially distinguish necrotic tissue with increased permeability from viable tumor cells with intact cell membranes that restrict the motion of water molecules (14).…”

Section: Discussionmentioning

confidence: 99%

“…There have been several studies on the decrease of signal intensity on DWI and increase of ADC after TACE procedure, according to the increased molecular motions in the HCC after TACE (12)(13)(14)(15). By the way, one recent report by Goshima et al (16) suggested that DWI is not a reliable predictor of local recurrence of HCC after TACE as compared to dynamic MRI.…”

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confidence: 95%

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Added value of diffusion‐weighted imaging in the MRI assessment of perilesional tumor recurrence after chemoembolization of hepatocellular carcinomas

Kim

Chung

et al. 2009

Magnetic Resonance Imaging

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Purpose: To investigate the additional value of diffusionweighted imaging (DWI) in the MRI assessment of perilesionally recurrent hepatocellular carcinomas (HCCs) after transcatheter arterial chemoembolization (TACE). Materials and Methods:For gadopentetate dimeglumineenhanced multiphasic dynamic images with precontrast T1-and T2-weighted images of 23 patients treated with TACE, two radiologists independently sorted the confidence levels for the presence of a viable tumor in the vicinity of the treated lesions into five grades. In another session, images from DWI (b factor ϭ 50, 400, and 800 s/mm 2 ) were added to the previously reviewed images and the same radiologists sorted the confidence levels.Results: A total of 26 lesions (0.7-3.5 cm) from 16 patients were confirmed to be perilesional recurrences of HCC. The area under the receiver operating characteristic curve (A z ) for the second interpretation session (0.826) was not significantly different (P ϭ 0.299) from that of the first session (0.859). The overall sensitivity was increased from 85% to 92%, but the specificity decreased from 65% to 50% after adding DWI. Conclusion:The addition of DWI has the potential to improve sensitivity, but not the overall diagnostic accuracy, in the assessment of perilesional recurrence of HCCs after chemoembolization. DUE TO THE LIMITED curative surgical indications aside from liver transplantation, transcatheter arterial chemoembolization (TACE) is widely performed for the curative or palliative treatment of hepatocellular carcinoma (HCC) in a cirrhotic liver. In the majority of cases, however, the tumors are not completely necrotized and the incidence of recurrence after TACE is still high (1-3). To prevent further complications and advanced stages of the disease with an unfavorable prognosis, it is critical that follow-up imaging studies focus on early recognition of intralesional viable tumors or localized recurrences.Dynamic CT with a precontrast scan and multiphasic post-contrast-enhanced imaging is generally used as a follow-up imaging modality of choice after TACE, based on the radio-opacity of the iodized oil that selectively accumulates in the tumor. However, due to partial volume or beam-hardening artifact, the high attenuation density of the iodized oil can limit the accuracy of CT in depicting a small viable tumor portion in or adjacent to the lesion (4 -6). To avoid the interference of accumulated iodized oil, Doppler ultrasonography or dynamic MRI has been used as an alternative to dynamic CT (7-11); however, inherent ultrasonic attenuation or T1-weighted hyperintensity of hemorrhagic-necrotic changes still affects the correct interpretation of contrast-enhanced viable tumor tissue.Meanwhile, diffusion-weighted imaging (DWI) has been applied to body MRI including liver imaging for the assessment of focal lesions according to restricted water diffusion and low apparent diffusion coefficient (ADC) values for malignant lesions, including HCCs. There have been several studies on the decrease of signal intensity...

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Section: Discussionmentioning

confidence: 99%

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confidence: 95%

Added value of diffusion‐weighted imaging in the MRI assessment of perilesional tumor recurrence after chemoembolization of hepatocellular carcinomas

Kim

Chung

et al. 2009

Magnetic Resonance Imaging

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“…The development and application of MRI as a guidance tool for endovascular and endoluminal interventions is furthermore motivated by the potential of MRI to acquire relevant morphologic and functional information that cannot be retrieved with other methods. In particular, the measurement of blood flow and perfusion (for example, after stent implantation in the carotid or renal artery) (19) or diffusion (eg, during embolizations) (20) might enable an early evaluation of the therapeutic success during the intervention, thus enabling therapeutically relevant decision-making with the patient still on the table.…”

Section: Endovascular Interventionsmentioning

confidence: 99%

MR‐guided intravascular interventions: Techniques and applications

Bock

Wacker

2008

Magnetic Resonance Imaging

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Magnetic resonance imaging (MRI) offers several advantages over other imaging modalities that make it an attractive imaging tool for diagnostic and therapeutic procedures. This tremendous potential of MRI has provided the rationale for increased attention toward MR-guided endovascular interventions. MR guidance has been used recently to navigate endovascular catheters and deliver stents, vena cava filters, embolization materials, and septum closure devices. However, its potential goes beyond just copying existing procedures toward the development of new minimally invasive techniques that cannot be performed with conventional guiding techniques. Because of technical limitations and safety issues associated with some of the currently available devices, a limited number of clinical studies have been performed so far. The overall success for this developing field requires considerable interdisciplinary research within both the interventional and the MR community. Only through a combined effort can this complex technology find its way into clinical practice. This review discusses the hardware and software improvements that have helped to advance endovascular interventions under MR imaging guidance from a pure research tool to become a clinical reality. In addition, technical and safety issues specific to endovascular MR image guidance will be described and practical applications will be shown that take advantage of the benefits of MR for endovascular interventions.

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“…DW-PROPELLER images in the brain and the abdomen have demonstrated improved image quality with less image distortion and artifact levels compared to single-shot DW-EPI (3,4). Abdominal DWI has increasingly been used for oncologic applications in tumor detection (5), differentiation of lesion types (6), characterization of intratumoral tissue heterogeneity (7), and evaluation of tumor therapy response (8,9).A critical challenge of DW-PROPELLER is that the FSE signal of each segment acquired after DW preparation violates the Carr-Purcell-Meiboom-Gill (CPMG) conditions (2). Imperfect 180°refocusing RF pulses will generate both spin echoes (SE) and stimulated echoes (STE).…”

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confidence: 99%

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Multishot diffusion‐weighted SPLICE PROPELLER MRI of the abdomen

Deng

Omary

Larson

2008

Magnetic Resonance in Med

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Diffusion-weighted MRI (DWI) provides a noninvasive method for in vivo evaluation of tissue water mobility. Water mobility can serve as an endogenous probe sensitive to tissue alterations at the microstructural level. For the DWI pulse sequence, strong motion-probing gradients are applied prior to image acquisition. These motion-probing gradients induce incoherent magnetization phase due to the random Brownian motion of water protons. Incoherent magnetization phase within a voxel leads to diffusionweighted signal loss.Most DWI studies employ single-shot DW-EPI (echoplanar imaging) approaches because these are generally insensitive to those artifacts arising from bulk motion during DW preparation. However, single-shot DW-EPI techniques are sensitive to field inhomogeneities and may suffer from image distortion, chemical shift artifacts, and limited spatial resolution. The multishot FSE (fast spin echo)-based PROPELLER (periodically rotated overlapping parallel lines with enhanced reconstruction) approach (1,2) has demonstrated less sensitivity to field inhomogeneities and reduced motion artifacts due to intrinsic properties of segmental phase correction and oversampling at the central k-space. DW-PROPELLER images in the brain and the abdomen have demonstrated improved image quality with less image distortion and artifact levels compared to single-shot DW-EPI (3,4). Abdominal DWI has increasingly been used for oncologic applications in tumor detection (5), differentiation of lesion types (6), characterization of intratumoral tissue heterogeneity (7), and evaluation of tumor therapy response (8,9).A critical challenge of DW-PROPELLER is that the FSE signal of each segment acquired after DW preparation violates the Carr-Purcell-Meiboom-Gill (CPMG) conditions (2). Imperfect 180°refocusing RF pulses will generate both spin echoes (SE) and stimulated echoes (STE). If the initial signal phase after excitation RF pulse aligns with the phase of subsequent refocusing pulses, SE and STE signal components will add up constructively; otherwise, SE and STE components will add up destructively. After DW preparation, spins are left with unpredictable magnetization phases, a condition significantly worsened by the presence of bulk tissue motion during DW preparation. The combination of imperfect refocusing RF pulses and random signal phase after DW preparation leads to destructive interference between SE and STE, inconsistent signal losses, and consequent image artifacts.These non-CPMG conditions can be mitigated by phase cycling the refocusing RF pulses and reconstructing data based on the Hermetian symmetry properties of odd and even echoes of the FSE echo train (2). However, the latter strategy is only possible when using a combined transmitreceive coil and therefore is not generally applicable for routine abdominal imaging with body transmit and surface-receive coils. Modifications have been proposed whereby odd and even echoes are separately combined to form independent k-space segments prior to image space combination (10,1...

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Diffusion-weighted MR Imaging for Determination of Hepatocellular Carcinoma Response to Yttrium-90 Radioembolization

Cited by 104 publications

References 19 publications

Added value of diffusion‐weighted imaging in the MRI assessment of perilesional tumor recurrence after chemoembolization of hepatocellular carcinomas

Added value of diffusion‐weighted imaging in the MRI assessment of perilesional tumor recurrence after chemoembolization of hepatocellular carcinomas

MR‐guided intravascular interventions: Techniques and applications

Multishot diffusion‐weighted SPLICE PROPELLER MRI of the abdomen

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