Baseline and early MR apparent diffusion coefficient quantification as a predictor of response of unresectable hepatocellular carcinoma to doxorubicin drug-eluting bead chemoembolization

Nima Kokabi, Johannes M. Ludwig, Juan C. Camacho, Minzhi Xing, Pardeep Kumar Mittal, Hyun S. Kim

Research output: Contribution to journalArticle

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Abstract

Purpose To investigate baseline and early apparent diffusion coefficients (ADC) derived from diffusion-weighted imaging (DWI) as a predictor of objective response (OR) and survival in unresectable hepatocellular carcinoma (HCC) treated with doxorubicin drug-eluting bead (DEB) transcatheter arterial chemoembolization. Materials and Methods In a prospective study, 57 patients underwent DEB chemoembolization. Dynamic contrast-enhanced magnetic resonance imaging and DWI were performed at baseline and 1 and 3 months after DEB chemoembolization. OR was evaluated per modified Response Evaluation Criteria In Solid Tumors (mRECIST) and European Association for the Study of the Liver (EASL) guidelines. Baseline ADCs of tumors that showed OR at 1 and 3 months were compared with nonresponding tumor ADCs by two-sample t test and receiver operating characteristic curves. Additionally, ADC changes at 30 days were correlated with OR. Finally, Kaplan-Meier analysis was used to compare survival between patients with lesions demonstrating more restricted baseline diffusion and others. Results At 1 month, 33 patients (60%) showed OR (21 complete responses and 12 partial responses). At baseline, tumors with OR at 1 month showed significantly more restricted diffusion (0.731 × 10-3 mm2/s) compared with others (1.057 × 10-3 mm2/s; P =.031). No difference between response rates at 1 and 3 months according to mRECIST and EASL was observed. For an area under the curve of 0.965, the sensitivity and specificity of predicting objective tumor response at 1 month using a baseline HCC ADC of 0.83 × 10-3 mm2/s were 91% and 96%, respectively. In addition, patients with lesions with a baseline ADC < 0.83 × 10-3 mm2/s showed prolonged survival compared with others (P <.001). Conclusions In unresectable HCC, a baseline ADC < 0.83 × 10-3 mm2/s is a predictor of survival and treatment response at 1 and 3 months after DEB chemoembolization with high sensitivity and specificity.

Original languageEnglish (US)
Pages (from-to)1777-1786
Number of pages10
JournalJournal of Vascular and Interventional Radiology
Volume26
Issue number12
DOIs
StatePublished - Dec 1 2015

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Doxorubicin
Hepatocellular Carcinoma
Pharmaceutical Preparations
Survival
Neoplasms
Sensitivity and Specificity
Diffusion Magnetic Resonance Imaging
Kaplan-Meier Estimate
ROC Curve
Area Under Curve
Prospective Studies
Guidelines
Liver

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Baseline and early MR apparent diffusion coefficient quantification as a predictor of response of unresectable hepatocellular carcinoma to doxorubicin drug-eluting bead chemoembolization. / Kokabi, Nima; Ludwig, Johannes M.; Camacho, Juan C.; Xing, Minzhi; Mittal, Pardeep Kumar; Kim, Hyun S.

In: Journal of Vascular and Interventional Radiology, Vol. 26, No. 12, 01.12.2015, p. 1777-1786.

Research output: Contribution to journalArticle

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abstract = "Purpose To investigate baseline and early apparent diffusion coefficients (ADC) derived from diffusion-weighted imaging (DWI) as a predictor of objective response (OR) and survival in unresectable hepatocellular carcinoma (HCC) treated with doxorubicin drug-eluting bead (DEB) transcatheter arterial chemoembolization. Materials and Methods In a prospective study, 57 patients underwent DEB chemoembolization. Dynamic contrast-enhanced magnetic resonance imaging and DWI were performed at baseline and 1 and 3 months after DEB chemoembolization. OR was evaluated per modified Response Evaluation Criteria In Solid Tumors (mRECIST) and European Association for the Study of the Liver (EASL) guidelines. Baseline ADCs of tumors that showed OR at 1 and 3 months were compared with nonresponding tumor ADCs by two-sample t test and receiver operating characteristic curves. Additionally, ADC changes at 30 days were correlated with OR. Finally, Kaplan-Meier analysis was used to compare survival between patients with lesions demonstrating more restricted baseline diffusion and others. Results At 1 month, 33 patients (60{\%}) showed OR (21 complete responses and 12 partial responses). At baseline, tumors with OR at 1 month showed significantly more restricted diffusion (0.731 × 10-3 mm2/s) compared with others (1.057 × 10-3 mm2/s; P =.031). No difference between response rates at 1 and 3 months according to mRECIST and EASL was observed. For an area under the curve of 0.965, the sensitivity and specificity of predicting objective tumor response at 1 month using a baseline HCC ADC of 0.83 × 10-3 mm2/s were 91{\%} and 96{\%}, respectively. In addition, patients with lesions with a baseline ADC < 0.83 × 10-3 mm2/s showed prolonged survival compared with others (P <.001). Conclusions In unresectable HCC, a baseline ADC < 0.83 × 10-3 mm2/s is a predictor of survival and treatment response at 1 and 3 months after DEB chemoembolization with high sensitivity and specificity.",
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T1 - Baseline and early MR apparent diffusion coefficient quantification as a predictor of response of unresectable hepatocellular carcinoma to doxorubicin drug-eluting bead chemoembolization

AU - Kokabi, Nima

AU - Ludwig, Johannes M.

AU - Camacho, Juan C.

AU - Xing, Minzhi

AU - Mittal, Pardeep Kumar

AU - Kim, Hyun S.

PY - 2015/12/1

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AB - Purpose To investigate baseline and early apparent diffusion coefficients (ADC) derived from diffusion-weighted imaging (DWI) as a predictor of objective response (OR) and survival in unresectable hepatocellular carcinoma (HCC) treated with doxorubicin drug-eluting bead (DEB) transcatheter arterial chemoembolization. Materials and Methods In a prospective study, 57 patients underwent DEB chemoembolization. Dynamic contrast-enhanced magnetic resonance imaging and DWI were performed at baseline and 1 and 3 months after DEB chemoembolization. OR was evaluated per modified Response Evaluation Criteria In Solid Tumors (mRECIST) and European Association for the Study of the Liver (EASL) guidelines. Baseline ADCs of tumors that showed OR at 1 and 3 months were compared with nonresponding tumor ADCs by two-sample t test and receiver operating characteristic curves. Additionally, ADC changes at 30 days were correlated with OR. Finally, Kaplan-Meier analysis was used to compare survival between patients with lesions demonstrating more restricted baseline diffusion and others. Results At 1 month, 33 patients (60%) showed OR (21 complete responses and 12 partial responses). At baseline, tumors with OR at 1 month showed significantly more restricted diffusion (0.731 × 10-3 mm2/s) compared with others (1.057 × 10-3 mm2/s; P =.031). No difference between response rates at 1 and 3 months according to mRECIST and EASL was observed. For an area under the curve of 0.965, the sensitivity and specificity of predicting objective tumor response at 1 month using a baseline HCC ADC of 0.83 × 10-3 mm2/s were 91% and 96%, respectively. In addition, patients with lesions with a baseline ADC < 0.83 × 10-3 mm2/s showed prolonged survival compared with others (P <.001). Conclusions In unresectable HCC, a baseline ADC < 0.83 × 10-3 mm2/s is a predictor of survival and treatment response at 1 and 3 months after DEB chemoembolization with high sensitivity and specificity.

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