Diffusion-Weighted Magnetic Resonance Imaging in Hepatocellular Carcinoma as a Predictor of a Response to Cisplatin-Based Hepatic Arterial Infusion Chemotherapy

Pil Soo Sung, Moon Hyung Choi, Hyun Yang, Soon Kyu Lee, Ho Jong Chun, Jeong Won Jang, Jong Young Choi, Seung Kew Yoon, Joon-Il Choi, Young Joon Lee, Si Hyun Bae, Pil Soo Sung, Moon Hyung Choi, Hyun Yang, Soon Kyu Lee, Ho Jong Chun, Jeong Won Jang, Jong Young Choi, Seung Kew Yoon, Joon-Il Choi, Young Joon Lee, Si Hyun Bae

Abstract

This study aimed to identify the utility of diffusion-weighted magnetic resonance (MR) imaging with an apparent diffusion coefficient (ADC) map as a predictor of the response of hepatocellular carcinoma (HCC) to cisplatin-based hepatic arterial infusion chemotherapy (HAIC). We retrospectively evaluated 113 consecutive patients with Barcelona Clinical Liver Cancer (BCLC) stage B or C HCC, who underwent gadoxetic acid-enhanced and diffusion-weighted MR imaging. The appropriate cutoff for the pretreatment tumor-to-liver ADC ratio was determined to be 0.741. Of the 113 patients, 50 (44%) presented with a pretreatment tumor-to-liver ADC ratio < 0.741 (low group). Evaluation of the treatment response after 2-3 cycles of HAIC in these 50 patients revealed that 21 patients (42%) experienced an objective response to HAIC. On the other hand, only 11 of the 63 patients (17%) with a pretreatment tumor-to-liver ADC ratio ≥ 0.741 (high group) showed an objective response. Thus, the objective response rate was significantly higher in the low group than in the high group (P = 0.006). Multivariate logistic regression analysis using parameters including perfusion alteration, percentage of non-enhancing portions, and pretreatment tumor-to-liver ADC ratio revealed that a pretreatment tumor-to-liver ADC ratio < 0.741 (odds ratio 3.217; P = 0.014) was the sole predictor of an objective response to HAIC. Overall survival rates were significantly higher in patients with objective responses to HAIC than in those without objective responses (P = 0.001 by log-rank test). In conclusion, patients with BCLC stage C or C HCC with a pretreatment tumor-to-liver ADC ratio < 0.741 showed a favorable intrahepatic response to cisplatin-based HAIC. Therefore, diffusion-weighted MR imaging can play a critical role as a predictor of response to cisplatin-based HAIC in unresectable HCC.

Keywords: diffusion restriction; hepatic arterial infusion chemotherapy; hepatocellular carcinoma; magnetic resonance; objective response.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2020 Sung, Choi, Yang, Lee, Chun, Jang, Choi, Yoon, Choi, Lee and Bae.

Figures

Figure 1
Figure 1
Study population.
Figure 2
Figure 2
Pretreatment tumor-to-liver ADC ratio according to the response to HAIC. **P < 0.01.
Figure 3
Figure 3
MR imaging of a patient having HCC with strong diffusion restriction and good response to HAIC.

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