Fabrizio Chegai MD, Presenter: Nothing to Disclose

Antonio Orlacchio MD, Abstract Co-Author: Nothing to Disclose

Marco Nezzo MD, Abstract Co-Author: Nothing to Disclose

Costantino Del Giudice MD, Abstract Co-Author: Nothing to Disclose

Giovanni Simonetti MD, Abstract Co-Author: Nothing to Disclose

Daniele Morosetti MD, Abstract Co-Author: Nothing to Disclose

To investigate usefulness of diffusion-weighted magnetic resonance imaging (DWI) for early detection of the response after transcatheter arterial chemoembolization using degradable starch microsphere (DSM)-TACE for hepatocellular carcinoma (HCC) compared with contrast enhanced computed tomography (CECT) using the modified RECIST (mRECIST).

Thirty patients with inoperable multifocal HCC underwent to DSM TACE. DSM TACE was performed every 4 to 6 weeks with a mixture of DSMs and Doxorubicin at a dose of 50 mg/m2 for three time. Magnetic resonance imaging (MRI) including breathhold echoplanar DWI sequences was performed prior to therapy (baseline MRI), 15 days after every DSM TACE (early MRI) as well as after 3 months (follow-up MRI). Intratumoral apparent diffusion coefficient (ADC) were measured independently by two radiologists. Relative change in ADC values (%ADC), α-fetoprotein level and tumor response on follow-up with contrast CECT after 3 months were determined. HCC lesions were divided into two groups, responder and non-responder. The correlation between %ADC and mRecist results was determined, and %ADC was compared between the two groups. Statistical analysis was performed using univariate comparison, and paired t test as well as Pearson's correlation. 

Median progression-free survival (PFS) was 8 months, and overall survival was 21 months. Survival analyses showed significant effects of pretreatment α-fetoprotein level (P = .03) and ADC ratio (P < .005) on PFS and substantial effects of mRECIST (.05 < P < .1). After DSM TACE, the percent change in ADC (%ADC) from before to after therapy was significantly increased in non-responder lesions (79.2+/-11.4%) compared to responder lesions (7.0+/-49.7%, p=0.001).Positive correlations were observed for relative change between %mean ADC and complete or partial response (r = 0 .536). Mean ADC were significantly greater in the responder group than in the non-responder group. 

The ADC ratio 1 month after DSM TACE was an independent predictor of PFS, which showed stronger association with tumor response than mRECIST evaluated with CECT. In this study, therapeutic efficacy of DSM-TACE in HCC using DWI MRI analysis could be demonstrated.

Diffusion-weighted magnetic resonance imaging (DWI) could be useful for early detection of response in patients with multifocal HCC treated with DSM TACE.

Chegai, F, Orlacchio, A, Nezzo, M, Del Giudice, C, Simonetti, G, Morosetti, D, Degradable Starch Microspheres Transarterial Chemoembolisation (DSM-TACE) of Multifocal HCC: Diffusion-weighted Magnetic Resonance Imaging (DWI) Evaluation of Therapeutic Efficacy Compared with Contrast Enhanced CT.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14019595.html