Value of Gd-EOB-DTPA-Enhanced MRI and Diffusion-Weighted Imaging in Detecting Residual Hepatocellular Carcinoma After Drug-Eluting Bead Transarterial Chemoembolization

Acad Radiol. 2021 Jun;28(6):790-798. doi: 10.1016/j.acra.2020.04.003. Epub 2020 May 13.

Abstract

Rationale and objectives: To investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in diagnosing residual hepatocellular carcinoma (HCC) after drug-eluting bead transarterial chemoembolization (DEB-TACE).

Materials and methods: Sixty-two patients (50 men, 12 women; mean age, 56.8 ± 1.4 years) with 74 HCCs who underwent Gd-EOB-DTPA-enhanced MRI and DWI in 1-2-month intervals after DEB-TACE were retrospectively studied. Imaging features derived from Gd-EOB-DTPA-enhanced MRI and DWI were analyzed and compared between residual HCCs and necrotic tumors. The sensitivity and specificity of Gd-EOB-DTPA-enhanced MRI and DWI with quantitative apparent diffusion coefficient (ADC) values in diagnosing residual HCCs were calculated and compared, based on the reference standard of pathology and/or angiography.

Results: Thirty-three residual HCCs and 41 necrotic tumors were diagnosed. Residual HCCs presented characteristics of arterial hypervascularity (90.91%) and DWI hyperintensity (78.78%), which were of importance in differentiating necrotic tumors (p< 0.05). DWI showed lower sensitivity (78.79% vs. 96.97%, p< 0.001) and specificity (78.05% vs. 100%, p< 0.001) than Gd-EOB-DTPA-enhanced MRI in diagnosing residual HCCs after DEB-TACE. Residual HCCs had a significantly higher mean ADC value than necrotic tumors (1.30 ± 0.32 × 10-3 mm2/s vs. 1.55 ± 0.50 × 10-3 mm2/s, p< 0.001). Receiver operating characteristic curve analysis for identifying residual HCCs demonstrated that the threshold ADC value of 1.25 × 10-3 mm2/s had 84.85% sensitivity and 87.80% specificity.

Conclusion: Gd-EOB-DTPA-enhanced MRI is superior to DWI in diagnosing residual HCCs after DEB-TACE, and arterial hypervascularity and DWI hyperintensity are important imaging features in distinguishing residual HCCs from necrotic tumors.

Keywords: Diffusion-weighted imaging (DWI); Drug-eluting bead transarterial chemoembolization (DEB-TACE); Gd-EOB-DTPA-enhanced MRI; Hepatocellular carcinoma (HCC).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Carcinoma, Hepatocellular* / diagnostic imaging
  • Carcinoma, Hepatocellular* / therapy
  • Chemoembolization, Therapeutic*
  • Contrast Media
  • Female
  • Gadolinium DTPA
  • Humans
  • Liver Neoplasms* / diagnostic imaging
  • Liver Neoplasms* / therapy
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Pharmaceutical Preparations*
  • Retrospective Studies
  • Sensitivity and Specificity

Substances

  • Contrast Media
  • Pharmaceutical Preparations
  • gadolinium ethoxybenzyl DTPA
  • Gadolinium DTPA