Published Online:https://doi.org/10.1148/radiol.13130591

The 1-month apparent diffusion coefficient ratio after initial transcatheter arterial chemoembolization (TACE) was an independent predictor of progression-free survival; the stronger association between response at 1-month diffusion-weighted (DW) imaging and PFS compared with Response Evaluation Criteria in Solid Tumors (RECIST), European Association for the Study of the Liver criteria, and modified RECIST suggests that DW imaging may be a more reliable response marker after a single TACE procedure.

Purpose

To evaluate the predictive utility of apparent diffusion coefficient (ADC) changes at diffusion-weighted (DW) magnetic resonance (MR) imaging 1 month after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) compared with the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, European Association for the Study of the Liver (EASL) criteria, and modified RECIST (mRECIST).

Materials and Methods

Institutional review board approval and informed consent were obtained for this prospective study. Thirty-eight patients with inoperable HCC underwent 1.5-T MR imaging, including DW imaging, before and 1 month after TACE. Responses 1 month after TACE were assessed with the ADC change relative to baseline (ADC ratio), RECIST, EASL criteria, and mRECIST. Eight patients underwent transplantation 4 months after TACE, allowing the association between response and histopathologic necrosis ratio to be determined. In 30 patients, Kaplan-Meier and log-rank tests were used to correlate the response variables with progression-free and overall survival.

Results

Median progression-free survival (PFS) was 5 months, and overall survival was 17.5 months. Survival analyses showed significant effects of pretreatment α-fetoprotein level (P = .03) and ADC ratio (P < .0001) on PFS and substantial effects of mRECIST, RECIST, and EASL criteria (.05 < P < .1). ADC ratio was a significant predictor of 5-month PFS (P < .001), with an accuracy of 93.3% compared with 53.3% with mRECIST and EASL criteria and 66.7% with RECIST. No response variables correlated with overall survival. Only the ADC ratio was significantly associated with histopathologic tumor necrosis (P = .03).

Conclusion

The ADC ratio 1 month after TACE was an independent predictor of PFS, which showed stronger association with tumor response than did RECIST, EASL criteria, or mRECIST.

© RSNA, 2013

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Article History

Received March 7, 2013; revision requested April 22; revision received August 23; accepted September 24; final version accepted October 25.
Published online: Dec 12 2013
Published in print: Mar 2014