Abstract：
BACKGROUND: Response evaluation of hepatocellular carcinoma (HCC) currently is based on arterial phase enhancement which doesn\'t take into microstructural changes in the tumor after trans-arterial chemoembolization (TACE).
OBJECTIVE: This prospective study was conducted to assess the feasibility and efficacy of intravascular incoherent motion imaging (IVIM) in response evaluation of HCC after TACE. 39 cirrhotic patients with 48 HCC underwent MR imaging 1 week within and 6weeks after TACE. IVIM parameters like Dslow (true diffusion), Dfast (pseudodiffusion), perfusion fraction and ADC were measured prior to and postTACE. The pre and post TACE values in LR-TR (LIRADS - treatment response) nonviable and viable lesions were compared using paired t-tests. ROC curve analysis was done to calculate sensitivity and specificity and propose cut-off values.
RESULTS: Non-viable lesions showed a significant increase in Dslow (1.208 ± 0.581 vs 1.560 ± 0.494, P-value -.0207) and ADC (1.37 ± 0.53 vs 1.65 ± 0.4287, P value .016) after TACE. There was also significant decrease in Dfast (33.7 ± 10.4 vs 23.75 ± 12.13, P value .0005) and f (19.92 ± 10.54 vs 12.9 ± 10.41, P value .012) values after TACE in non-viable lesions compared to viable lesions. The change in true diffusion had the highest AUC (0.741) among IVIM parameters with greater than 0.075 increase between preTACE and postTACE values having a sensitivity and specificity of 81.8% and 60% respectively for complete response.
CONCLUSIONS: IVIM imaging is feasible to assess the response in HCC after TACE. True diffusion is more sensitive and specific than apparent diffusion in evaluating the response.
OBJECTIVE: This prospective study was conducted to assess the feasibility and efficacy of intravascular incoherent motion imaging (IVIM) in response evaluation of HCC after TACE. 39 cirrhotic patients with 48 HCC underwent MR imaging 1 week within and 6weeks after TACE. IVIM parameters like Dslow (true diffusion), Dfast (pseudodiffusion), perfusion fraction and ADC were measured prior to and postTACE. The pre and post TACE values in LR-TR (LIRADS - treatment response) nonviable and viable lesions were compared using paired t-tests. ROC curve analysis was done to calculate sensitivity and specificity and propose cut-off values.
RESULTS: Non-viable lesions showed a significant increase in Dslow (1.208 ± 0.581 vs 1.560 ± 0.494, P-value -.0207) and ADC (1.37 ± 0.53 vs 1.65 ± 0.4287, P value .016) after TACE. There was also significant decrease in Dfast (33.7 ± 10.4 vs 23.75 ± 12.13, P value .0005) and f (19.92 ± 10.54 vs 12.9 ± 10.41, P value .012) values after TACE in non-viable lesions compared to viable lesions. The change in true diffusion had the highest AUC (0.741) among IVIM parameters with greater than 0.075 increase between preTACE and postTACE values having a sensitivity and specificity of 81.8% and 60% respectively for complete response.
CONCLUSIONS: IVIM imaging is feasible to assess the response in HCC after TACE. True diffusion is more sensitive and specific than apparent diffusion in evaluating the response.
摘要：
背景：目前肝细胞癌（HCC）的反应评估基于动脉期增强，不考虑经肝动脉化疗栓塞（TACE）后肿瘤的微观结构变化。
目的：这项前瞻性研究旨在评估血管内不相干运动成像（IVIM）在TACE后HCC反应评估中的可行性和有效性。39例肝硬化患者48例HCC在TACE后1周内和6周内接受了MR成像。IVIM参数，如Dslow（真扩散），Dfast(伪扩散),在TACE之前和之后测量灌注分数和ADC。使用配对t检验比较LR-TR（LIRADS-治疗反应）中的TACE前值和后值。进行ROC曲线分析以计算灵敏度和特异性并提出截止值。
结果：TACE后Dslow（1.208±0.581vs1.560±0.494，P值-0.0207）和ADC（1.37±0.53vs1.65±0.4287，P值.016）显着增加。与可行病变相比，TACE后Dfast（33.7±10.4vs23.75±12.13，P值.0005）和f（19.92±10.54vs12.9±10.41，P值.012）值也显着降低。在IVIM参数中，真实扩散的变化具有最高的AUC（0.741），在TACE前和TACE后的值之间增加超过0.075，对于完全反应的敏感性和特异性分别为81.8％和60％。
结论：IVIM成像可用于评估TACE后HCC的反应。在评估响应时，真实扩散比表观扩散更敏感和特异。
目的：这项前瞻性研究旨在评估血管内不相干运动成像（IVIM）在TACE后HCC反应评估中的可行性和有效性。39例肝硬化患者48例HCC在TACE后1周内和6周内接受了MR成像。IVIM参数，如Dslow（真扩散），Dfast(伪扩散),在TACE之前和之后测量灌注分数和ADC。使用配对t检验比较LR-TR（LIRADS-治疗反应）中的TACE前值和后值。进行ROC曲线分析以计算灵敏度和特异性并提出截止值。
结果：TACE后Dslow（1.208±0.581vs1.560±0.494，P值-0.0207）和ADC（1.37±0.53vs1.65±0.4287，P值.016）显着增加。与可行病变相比，TACE后Dfast（33.7±10.4vs23.75±12.13，P值.0005）和f（19.92±10.54vs12.9±10.41，P值.012）值也显着降低。在IVIM参数中，真实扩散的变化具有最高的AUC（0.741），在TACE前和TACE后的值之间增加超过0.075，对于完全反应的敏感性和特异性分别为81.8％和60％。
结论：IVIM成像可用于评估TACE后HCC的反应。在评估响应时，真实扩散比表观扩散更敏感和特异。
