Apparent diffusion coefficient quantification as an early imaging biomarker of response and predictor of survival following yttrium-90 radioembolization for unresectable infiltrative hepatocellular carcinoma with portal vein thrombosis

Nima Kokabi, Juan C. Camacho, Minzhi Xing, Deqiang Qiu, Hiroumi Kitajima, Pardeep K. Mittal, Hyun S. Kim

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

Purpose: To investigate early diffusion-weighted imaging (DWI) at 30-days post-yttrium-90 (Y-90) radioembolization as a predictor of treatment response and survival in unresectable infiltrative hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT).

Materials and methods: In a prospective study, 18 consecutive patients with unresectable infiltrative HCC and PVT underwent Y-90 therapy. MR imaging was obtained pre Y-90, and at 1 and 3 months post-therapy with DWI fat-suppressed tri-directional diffusion gradient (b = 50, 400, 800 s/mm2). Response was evaluated using target mRECIST and EASL. Relative change in apparent diffusion coefficient (ADC) value of tumors was evaluated. Statistical analysis using receiver operator characteristic curves was performed. Paired t test and Pearson correlation coefficient (r) were used to assess intra- and inter-observer variability. Survival analysis was performed using Kaplan-Meier estimation and log-rank test.

Results: Mean ADC values of all HCC’s at baseline and at 30-days post-Y90 therapy was 0.86 × 10−3 and 1.17×10−3 mm2/s, respectively (p < 0.001). Tumors with objective response by mRECIST had significantly increased ADC value when compared to “non-responders” (1.27 vs. 1.05×10−3 mm2/s, p = 0.002). A >30% increase in ADC value at 30-days was found to be at least 90% sensitive in predicting response at 90 days. A >30% increase in ADC value at 30-days predicted significantly prolonged survival.

Conclusion: A 30% increase in ADC value at 30-days measured post Y90 is a reproducible early imaging response biomarker predicting tumor response and prolonged survival following Y-90 therapy in infiltrative HCC with PVT.

Original languageEnglish (US)
Pages (from-to)969-978
Number of pages10
JournalAbdominal Imaging
Volume39
Issue number5
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Keywords

  • Diffusion weighted imaging
  • Early tumor response
  • Imaging biomarker
  • Infiltrative hepatocellular carcinoma
  • Portal vein thrombosis
  • Survival
  • Y-90

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

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