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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

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An Erratum to this article was published on 01 July 2014

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.

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Authors and Affiliations

  1. Division of Interventional Radiology & Image Guided Medicine, Department of Radiology, Emory University School of Medicine, Suite AG05, 1364 Clifton Road, NE, Atlanta, GA, 30322, USA

    Nima Kokabi, Juan C. Camacho, Minzhi Xing & Hyun S. Kim

  2. Division of Abdominal Imaging, Department of Radiology, Emory University School of Medicine, 1364 Clifton Road, NE, Atlanta, GA, 30322, USA

    Juan C. Camacho & Pardeep K. Mittal

  3. Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Presbyterian South Tower, Suite 3950, 200 Lothrop Street, Pittsburgh, PA, 15213-3553, USA

    Minzhi Xing & Hyun S. Kim

  4. Division of MR Research, Department of Radiology, Emory University School of Medicine, 1364 Clifton Road, NE, Atlanta, GA, 30322, USA

    Deqiang Qiu & Hiroumi Kitajima

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  1. Nima Kokabi
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  2. Juan C. Camacho
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  3. Minzhi Xing
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Correspondence to Nima Kokabi.

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Kokabi, N., Camacho, J.C., Xing, M. et al. 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. Abdom Imaging 39, 969–978 (2014). https://doi.org/10.1007/s00261-014-0127-8

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  • DOI: https://doi.org/10.1007/s00261-014-0127-8

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