Alana Thibodeau-Antonacci1, Léonie Petitclerc1, Guillaume Gilbert2, Laurent Bilodeau3, Damien Olivié3, Milena Cerny1, Hélène Castel4, Simon Turcotte5, Catherine Huet3, Pierre Perreault3, Gilles Soulez3, Miguel Chagnon6, Samuel Kadoury7, An Tang8. 1. Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada. 2. MR Clinical Science, Philips Healthcare, Canada. 3. Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada. 4. Department of Hepatology and Liver transplantation, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada. 5. Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Service, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada. 6. Department of Mathematics and Statistics, Université de Montréal, QC, Canada. 7. Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; École Polytechnique, Montréal, Québec, Canada. 8. Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada. Electronic address: an.tang@umontreal.ca.
Abstract
PURPOSE: To identify quantitative dynamic contrast-enhanced (DCE)-MRI perfusion parameters indicating tumor response of hepatocellular carcinoma (HCC) to transarterial chemoembolization (TACE). MATERIALS AND METHODS: This prospective pilot study was approved by our institutional review board; written and informed consent was obtained for each participant. Patients underwent DCE-MRI examinations before and after TACE. A variable flip-angle unenhanced 3D mDixon sequence was performed for T1 mapping. A dynamic 4D mDixon sequence was performed after contrast injection for assessing dynamic signal enhancement. Nonparametric analysis was conducted on the time-intensity curves. Parametric analysis was performed on the time-concentration curves using a dual-input single-compartment model. Treatment response according to Liver Reporting and Data System (LI-RADS) v2018 was used as the reference standard. The comparisons within groups (before vs. after treatment) and between groups (nonviable vs. equivocal or viable tumor) were performed using nonparametric bootstrap taking into account the clustering effect of lesions in patients. RESULTS: Twenty-eight patients with 52 HCCs (size: 10-104 mm) were evaluated. For nonviable tumors (n = 27), time to peak increased from 62.5 ± 18.2 s before to 83.3 ± 12.8 s after treatment (P< 0.01). For equivocal or viable tumors (n = 25), time to peak and mean transit time significantly increased (from 54.4 ± 24.1 s to 69.5 ± 18.9 s, P < 0.01 and from 14.2 ± 11.8 s to 33.9 ± 36.8 s, P= 0.01, respectively) and the transfer constant from the extracellular and extravascular space to the central vein significantly decreased from 14.8 ± 14.1 to 8.1 ± 9.1 s-1 after treatment (P= 0.01). CONCLUSION: This prospective pilot DCE-MRI study showed that time to peak significantly changed after TACE treatment for both groups (nonviable tumors and equivocal or viable tumors). In our cohort, several perfusion parameters may provide an objective marker for differentiation of treatment response after TACE in HCC patients.
PURPOSE: To identify quantitative dynamic contrast-enhanced (DCE)-MRI perfusion parameters indicating tumor response of hepatocellular carcinoma (HCC) to transarterial chemoembolization (TACE). MATERIALS AND METHODS: This prospective pilot study was approved by our institutional review board; written and informed consent was obtained for each participant. Patients underwent DCE-MRI examinations before and after TACE. A variable flip-angle unenhanced 3D mDixon sequence was performed for T1 mapping. A dynamic 4D mDixon sequence was performed after contrast injection for assessing dynamic signal enhancement. Nonparametric analysis was conducted on the time-intensity curves. Parametric analysis was performed on the time-concentration curves using a dual-input single-compartment model. Treatment response according to Liver Reporting and Data System (LI-RADS) v2018 was used as the reference standard. The comparisons within groups (before vs. after treatment) and between groups (nonviable vs. equivocal or viable tumor) were performed using nonparametric bootstrap taking into account the clustering effect of lesions in patients. RESULTS: Twenty-eight patients with 52 HCCs (size: 10-104 mm) were evaluated. For nonviable tumors (n = 27), time to peak increased from 62.5 ± 18.2 s before to 83.3 ± 12.8 s after treatment (P< 0.01). For equivocal or viable tumors (n = 25), time to peak and mean transit time significantly increased (from 54.4 ± 24.1 s to 69.5 ± 18.9 s, P < 0.01 and from 14.2 ± 11.8 s to 33.9 ± 36.8 s, P= 0.01, respectively) and the transfer constant from the extracellular and extravascular space to the central vein significantly decreased from 14.8 ± 14.1 to 8.1 ± 9.1 s-1 after treatment (P= 0.01). CONCLUSION: This prospective pilot DCE-MRI study showed that time to peak significantly changed after TACE treatment for both groups (nonviable tumors and equivocal or viable tumors). In our cohort, several perfusion parameters may provide an objective marker for differentiation of treatment response after TACE in HCC patients.
Authors: Ali Pirasteh; E Aleks Sorra; Hector Marquez; Robert C Sibley; Julia R Fielding; Abhinav Vij; Nicole E Rich; Ana Arroyo; Adam C Yopp; Gaurav Khatri; Amit G Singal; Takeshi Yokoo Journal: Abdom Radiol (NY) Date: 2021-03-23