Skip to main content
SpringerLink
Log in

The diffusion-weighted imaging perfusion fraction f is a potential marker of sorafenib treatment in advanced hepatocellular carcinoma: a pilot study

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine the total Apparent Diffusion Coefficient (ADC), the pure Diffusion coefficient (D) and the perfusion fraction (f) in advanced hepatocellular carcinoma (HCC) under sorafenib treatment.

Materials and methods

Two target tumors were prospectively analyzed in 12 patients at baseline, 2-weeks and 2-months treatment using b values of 0, 200, 400, 800 s/mm. Repeatability error was estimated on a healthy volunteer.

Results

Lesion sizes, ADC and D values did not significantly change during treatment (overall mean values, respectively, 47.8 ± 31.0 mm, 1.34 ± 0.14 × 10−3 mm2/s and 1.18 ± 0.22 × 10−3 mm2/s). However, f values significantly increased in seven responder patients (+38.39% at 2-weeks, +50.94% at 2-months, P = 0.005) while they decreased in five non responder patients (−41.93% at 2-weeks, P = 0.006). Furthermore, f was inversely correlated with αFP levels (P = 0.032) and responder patients had a higher mean overall survival (OS) than non responder patients (12.29 ± 4.46 vs. 7.80 ± 4.97 months). The % variation of f relative to baseline at 2-months was correlated with OS (P = 0.038) and symptomatic time to progression (P = 0.022).

Conclusion

Contrary to ADC and D, the perfusion fraction f is a valuable marker of sorafenib treatment in advanced HCC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Llovet JM, Ricci S, Mazzaferro V et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359:378–390

    Article  CAS  PubMed  Google Scholar 

  2. Padhani AR, Liu G, Koh DM et al (2009) Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia 11:102–125

    CAS  PubMed  Google Scholar 

  3. Koh DM, Collins DJ (2007) Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 188:1622–1635

    Article  PubMed  Google Scholar 

  4. Le Bihan D, Breton E, Lallemand D et al (1988) Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 168:497–505

    PubMed  Google Scholar 

  5. Yamada I, Aung W, Himeno Y et al (1999) Diffusion coefficients in abdominal organs and hepatic lesions: evaluation with intravoxel incoherent motion echo-planar MR imaging. Radiology 210:617–623

    CAS  PubMed  Google Scholar 

  6. Lewin M, Poujol-Robert A, Boëlle PY et al (2007) Diffusion-weighted magnetic resonance imaging for the assessment of fibrosis in chronic hepatitis C. Hepatology 46:658–665

    Article  CAS  PubMed  Google Scholar 

  7. Luciani A, Vignaud A, Cavet M et al (2008) Liver cirrhosis: intravoxel incoherent motion MR imaging-pilot study. Radiology 249:891–899

    Article  PubMed  Google Scholar 

  8. Taouli B, Koh DM (2010) Diffusion-weighted MR imaging of the liver. Radiology 254:47–66

    Article  PubMed  Google Scholar 

  9. Kamel IR, Liapi E, Reyes DK et al (2009) Unresectable hepatocellular carcinoma: serial early vascular and cellular changes after transarterial chemobolization as detected with MR imaging. Radiology 250:466–473

    Article  PubMed  Google Scholar 

  10. Chen CY, Li CW, Kuo YT et al (2006) Early response of hepatocellular carcinoma to transcatheter arterial chemoembolization: choline levels and MR diffusion constants-initial experience. Radiology 239:448–456

    Article  PubMed  Google Scholar 

  11. Schraml C, Schwenzer NF, Martirosian P et al (2009) Diffusion-weighted MRI of advanced hepatocellular carcinoma during sorafenib treatment: initial results. AJR Am J Roentgenol 193:W301–W307

    Article  PubMed  Google Scholar 

  12. Jain RK, Duda DG, Willett CG et al (2009) Biomarkers of response and resistance to antiangiogenic therapy. Nat Rev Clin Oncol 6:327–338

    Article  CAS  PubMed  Google Scholar 

  13. Semela D, Dufour JF (2004) Angiogenesis and hepatocellular carcinoma. J Hepatol 41:864–880

    Article  PubMed  Google Scholar 

  14. Bruix J, Sherman M, Practice Guidelines Committee, American Association for the Study of Liver Diseases (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236

    Article  PubMed  Google Scholar 

  15. Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumors: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247

    Article  CAS  PubMed  Google Scholar 

  16. Llovet JM, Di Bisceglie AM, Bruix J et al (2008) Design and endpoints of clinical trials in hepatocellular carcinoma. J Natl Cancer Inst 100:698–711

    Article  PubMed  Google Scholar 

  17. Forner A, Ayuso C, Varela M et al (2009) Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma: are response evaluation criteria in solid tumors reliable? Cancer 115:616–623

    Article  PubMed  Google Scholar 

  18. Koh DM, Blackledge M, Collins DJ et al (2009) Reproducibility and changes in the apparent diffusion coefficients of solid tumours treated with combretastatin A4 phosphate and bevacizumab in a two-centre phase I clinical trial. Eur Radiol 19:2728–2738

    Article  PubMed  Google Scholar 

  19. Lewin M, Arrivé L, Lacombe C et al (2010) Diffusion-weighted MR imaging of liver pathology: principles and clinical applications. J Radiol 91:11–26

    Article  CAS  PubMed  Google Scholar 

  20. Taouli B, Vilgrain V, Dumont E et al (2003) Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echo-planar MR imaging sequences: prospective study in 66 patients. Radiology 226:71–78

    Article  PubMed  Google Scholar 

  21. Parikh T, Drew SJ, Lee VS et al (2008) Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 246:812–822

    Article  PubMed  Google Scholar 

  22. Gourtsoyianni S, Papanikolaou N, Yarmenitis S et al (2008) Respiratory gated diffusion-weighted imaging of the liver: value of apparent diffusion coefficient measurements in the differentiation between most commonly encountered benign and malignant focal liver lesions. Eur Radiol 18:486–492

    Article  PubMed  Google Scholar 

  23. Namimoto T, Yamashita Y, Sumi S et al (1997) Focal liver masses: characterization with diffusion-weighted echo-planar MR imaging. Radiology 204:739–744

    CAS  PubMed  Google Scholar 

  24. Kim T, Murakami T, Takahashi S et al (1999) Diffusion-weighted single-shot echoplanar MR imaging for liver disease. AJR Am J Roentgenol 173:393–398

    CAS  PubMed  Google Scholar 

  25. Bruegel M, Holzapfel K, Gaa J et al (2008) Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol 18:477–485

    Article  PubMed  Google Scholar 

  26. Kamel IR, Bluemke DA, Ramsey D et al (2003) Role of diffusion-weighted imaging in estimating tumor necrosis after chemoembolization of hepatocellular carcinoma. AJR Am J Roentgenol 181:708–710

    PubMed  Google Scholar 

  27. Mannelli L, Kim S, Hajdu CH et al (2009) Assessment of tumor necrosis of hepatocellular carcinoma after chemoembolization: diffusion-weighted and contrast-enhanced MRI with histopathologic correlation of the explanted liver. AJR Am J Roentgenol 193:1044–1052

    Article  PubMed  Google Scholar 

  28. Horger M, Lauer UM, Schraml C et al (2009) Early MRI response monitoring of patients with advanced hepatocellular carcinoma under treatment with the multikinase inhibitor sorafenib. BMC Cancer 9:208

    Article  PubMed  Google Scholar 

  29. Jain RK (2005) Normalization of tumor vasculature: an emerging concept in antiangiogenic therapy. Science 307:58–62

    Article  CAS  PubMed  Google Scholar 

  30. Mitsuhashi N, Kobayashi S, Doki T et al (2008) Clinical significance of a-fetoprotein: involvement in proliferation, angiogenesis, and apoptosis of hepatocellular carcinoma. J Gastroenterol Hepatol 23:e189–e197

    Article  CAS  PubMed  Google Scholar 

  31. Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:52–60

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

    Maïté Lewin, Lionel Arrivé & Yves Menu

  2. Departments of Hepatology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

    Laetitia Fartoux & Olivier Rosmorduc

  3. University Paris VI Pierre et Marie Curie, Paris, France

    Maïté Lewin, Lionel Arrivé, Yves Menu & Olivier Rosmorduc

  4. France and Siemens Medical Department, Saint-Denis, France

    Alexandre Vignaud

  5. Service de Radiologie, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine, 75012, Paris, France

    Maïté Lewin

Authors
  1. Maïté Lewin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laetitia Fartoux
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexandre Vignaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lionel Arrivé
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yves Menu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Olivier Rosmorduc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maïté Lewin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lewin, M., Fartoux, L., Vignaud, A. et al. The diffusion-weighted imaging perfusion fraction f is a potential marker of sorafenib treatment in advanced hepatocellular carcinoma: a pilot study. Eur Radiol 21, 281–290 (2011). https://doi.org/10.1007/s00330-010-1914-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-010-1914-4

Keywords

Search

Navigation