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摘要
Purpose: To explore the threshold of intravoxel incoherent motion (IVIM) parameters, apparent diffusion coefficient [ADC(total) and ADC((0,500))] ratios 24-48 hours after transarterial chemoembolization (TACE) to assess early response in patients with unresectable hepatocellular carcinoma (HCC) and to compare the association between diffusion-weighted imaging with the intravoxel incoherent motion (IVIM-DWI) and mRECIST with survival. @@@ Materials and Methods: Institutional Review Board approval and informed consent were obtained for this prospective study. There were 30 patients undergoing 1.5T magnetic resonance imaging (MRI) with IVIM-DWI of 12 b values (0, 10, 20, 30, 40, 50, 70, 100, 200, 300, 500, 800 s/mm(2)) 1 week before and 24-48 hours after TACE. Response was assessed with the change of true diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (PF), ADC(total), and ADC((0,500)) values relative to baseline and with mRECIST. Receiver operating characteristic (ROC) curve analysis was used to explore the threshold of these parameters ratios. Kaplan-Meier, log-rank tests, and the Cox hazard model were used to correlate the response variables with progression-free survival (PFS) and to assess the incidence and potential clinical risk factors for PFS. Mann-Whitney U-test was used to compare the difference in parameters between different groups with progression within and beyond median PFS prior to TACE. @@@ Results: Median PFS was 99 days, within which 16 patients progressed. The threshold of ADC(total) ratio, D ratio, and ADC((0,500)) ratio were 13.1% (P=0.001), 7.0% (P=0.011), and 3.6% (P=0.018) with sensitivity and specificity of 78.6% and 87.5%, 85.7% and 62.5%, 78.6% and 75%, respectively. The predictive utility of ADC(total) ratio, D ratio, and ADC((0,500)) ratio for PFS were 0.848, 0.772, and 0.754, respectively. Survival analyses showed ADC(total) ratio, D ratio, ADC((0,500)) ratio, liver cirrhosis, and mRECIST had a significant effect on PFS (P < 0.05). ADC(total) ratio and D ratio were independent predictors for 99-day PFS (P=0.025, P=0.036). There were no significant differences in pretreatment IVIM-DWI parameters between PFS > 99-day group and PFS <= 99-day group with P values of 0.547 for D, 0.394 for D*, 0.575 for PF, 0.901 for ADC((0,500)), and 0.506 for ADC(total), respectively. @@@ Conclusion: The ADC(total) ratio and D ratio 24-48 hours after TACE were independent predictors for response to TACE for HCC, and showed stronger association with PFS than mRECIST.
