Does diffusion‐weighted imaging improve therapy response evaluation in patients with hepatocellular carcinoma after radioembolization? comparison of MRI using Gd‐EOB‐DTPA with and without DWI. Issue 3 (17th December 2014)

• Record Type: Journal Article
• Authors: Schelhorn, Juliane; Best, Jan; Reinboldt, Marcus P.; Dechêne, Alexander; Gerken, Guido; Ruhlmann, Marcus; Lauenstein, Thomas C.; Antoch, Gerald; Kinner, Sonja
• Is Part Of: Journal of magnetic resonance imaging. Volume 42:Issue 3(2015)
• Page Start: 818
• Page End: 827
• Publication Date: 2014-12-17
• Subjects: Magnetic resonance imaging -- Periodicals; 616
• DOI: 10.1002/jmri.24827
• Languages: English
• ISSNs: 1053-1807

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jmri24827-sec-0001" sec-type="section"> <title>Purpose</title> <p>To investigate whether additional diffusion‐weighted imaging (DWI) improves therapy response evaluation by Gd‐EOB magnetic resonance imaging (MRI) in hepatocellular carcinoma (HCC) after radioembolization.</p> </sec> <sec id="jmri24827-sec-0002" sec-type="section"> <title>Materials and Methods</title> <p>Fifty patients with radioembolization for HCC underwent gadobutrol and Gd‐EOB MRI with DWI prior to and 30, 90, and 180 days after radioembolization. A combination of gadobutrol MRI, alpha‐fetoprotein, and imaging follow‐up served as the reference standard. Two radiologists reviewed Gd‐EOB alone (Gd‐EOB), DWI alone (DWI), and the combination of both (Gd‐EOB+DWI) separately and in consensus using a 4‐point‐scale: 1 = definitely no tumor progression (TP), 2 = probably no TP, 3 = probably TP, 4 = definitely TP. Receiver operating characteristic (ROC) and kappa analysis were performed.</p> </sec> <sec id="jmri24827-sec-0003" sec-type="section"> <title>Results</title> <p>Kappa values for Gd‐EOB, DWI, and Gd‐EOB+DWI ranged between 0.712 and 0.892 (<italic>P</italic> < 0.001). 30 days after radioembolization three out of 38 patients showed TP, which was missed by DWI in one case. No significant area under the curve (AUC) difference between Gd‐EOB (1.0, <italic>P</italic> = 0.004), DWI (0.881, <italic>P</italic> = 0.030), and Gd‐EOB+DWI (1.0, <italic>P</italic> = 0.004) was found (<italic>P</italic> = 0.320). 90 days after radioembolization six out of 28 patients showed TP, which was detected in one patient only by DWI and Gd‐EOB+DWI. The AUC did not differ significantly (<italic>P</italic> = 0.319) between Gd‐EOB (0.890, <italic>P</italic> = 0.004), DWI (1.0, <italic>P</italic> < 0.001), and Gd‐EOB+DWI (1.0, <italic>P</italic> < 0.001). 180 days after radioembolization five patients showed TP, which in one case was missed by DWI. The AUC did not differ significantly (<italic>P</italic>1 = 0.322, <italic>P</italic>2 = 0.369, <italic>P</italic>3 = 0.350) between Gd‐EOB (1.0, <italic>P</italic> = 0.003), DWI (0.913, <italic>P</italic> = 0.016), and Gd‐EOB+DWI (0.963, <italic>P</italic> = 0.007).</p> </sec> <sec id="jmri24827-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Additional DWI does not substantially improve therapy response evaluation by Gd‐EOB MRI in HCC after radioembolization but proved helpful in single cases. J. Magn. Reson. Imaging 2015;42:818–827.</p> </sec> </abstract>