Value of Dynamic Subtraction MRI in Assessing HCC Response to Image-guided loco-regional Therapy

Document Type : Original Clinical

Authors

1 Radiology Department, National Liver Institute, Menoufia University

2 Tropical Medicine Department, Alexandria University

Abstract

Background: Hepatocellular carcinoma (HCC) is considered one of the foremost cancers worldwide. Although the hepatic resection of HCC has a high existence in the clinical scenarios, locoregional management is preferred owing to the preservation of hepatic parenchyma with lower morbidity and mortality. Dynamic contrast-enhanced MR with subtraction imaging improves the evaluation of managed HCC with easy detection of residual or recurrent viable lesions.
Patients and methods: This study was designed in a retrospective pattern from December 2020 to December 2022. Forty patients were referred to our radiology department with solitary HCC, underwent therapeutic intervention, then underwent follow-up by dynamic MRI study.
Results: Forty patients with solitary HCC were conducted during our study; all underwent locoregional therapy with follow-up by dynamic MRI with subtraction technique one month later. The subtraction image has a sensitivity of 100%, specificity of 100%, PPV of 100%, NPV of 100%, and 100% accuracy, compared to 90.91%, 77.78%, 83.33%, 87.5%, and 85% for conventional dynamic images, 45.45%, 100%, 100%, 60% and 70% for diffusion-weighted images. Analysis of those results exhibited a considerable additive value of the subtraction technique to the dynamic MRI to detect the response of HCC after management.
Conclusions: Subtraction MRI is a pivotal tool to assess the interventional treatment of HCC, particularly in lesions having pre-contrast high signal intensity with distinguished radiologists’ confidence.

Keywords

Footnotes. List of abbreviations HCC; Hepatocellular carcinoma. MRI; Magnetic resonance imaging. PPV; Positive predictive value. NPV; Negative predictive value. TACE; Transarterial chemoembolization. RFA; Radiofrequency ablation. MWA; Microwave ablation. TARE; Transarterial Yttrium-90 radioembolization. CT; Computed tomography. SGPT; Serum glutamic oxaloacetic transaminase. SGOT; Serum glutamic pyruvic transaminase. DCE-MRI; Dynamic contrast-enhanced magnetic resonance imaging. DWI; Diffusion weighted imaging. ADC; Apparent diffusion coefficient. Gd-DTPA; Gadolinium-diethylenetriamine penta-acetic acid. 3D; Three-dimensional. THID; Transient hepatic intensity difference. SPSS; Statistical Package for Social Science. Peer-Reviewers: Emad Emara (lecturer of radiology), Ola Elfarargy (professor of medical oncology), Sameh Saber (assistant professor of interventional radiology), and Mohamed Gawad (professor of clinical oncology). E- Editor: Salem Youssef Mohamed, Osama Ahmed Khalil. Copyright ©. This open-access article is distributed under the Creative Commons Attribution License (CC BY). The use, distribution, or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited. The original publication in this journal is cited by accepted academic practice. No use, distribution, or reproduction is permitted, complying with these terms. Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent their affiliated organizations or those of the publisher, the editors, and the reviewers. Any product evaluated in this article or its manufacturer's claim is not guaranteed or endorsed by the publisher. Ethics Approval and Consent to Participate: All procedures followed were by the ethical standards of the responsible committee on human experimentation (Institutional Review Board (IRB)” (00464/2023) of National Liver Institute Menoufia University and with the Helsinki Declaration of 1964 and later version. Consent for publication: All patients included in this research gave written informed permission to publish the data contained within this study. Availability of data and materials: The datasets used or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This study had no funding from any resource. Authors’ contributions: RAA, writing the research, selecting research cases, preparing the figures for case demonstration, and reviewing the study. DH, assess patients for initial diagnosis. RAM and HS were considered in case selection and carried out cases on workstations. “All authors read and approved the final manuscript.” Acknowledgments: Not Applicable.

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