MRI Evaluation of Hepatocellular Carcinoma Post Locoregional Therapy Using Post Processing Arterial Subtraction

Document Type : Original Article

Authors

1 Department of Interventional and Diagnostic Radiology, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt.

2 Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt.

Abstract

Background: Hepatocellular carcinoma [HCC] is the commonest primary tumor of the liver and the leading cause of cancer-related death globally. Early detection is crucial for improving outcomes. For patients who are not surgical candidates, locoregional therapies like trans-arterial chemoembolization [TACE] and radio-frequency ablation [RFA] are important palliative options. Conventional magnetic resonance imaging [MRI] had limitations in differentiating viable tumor from post-treatment changes and dynamic subtraction imaging. However, it adds significant value to dynamic MRI and diffusion-weighted imaging [DWI].
Aim of Study: The purpose of this research was to evaluate the utility of dynamic subtracted MRI sequences for evaluation of HCC after locoregional therapy.
Patients and Methods: A cross-sectional study involved 60 HCC patients [aged 42–73] who had hepatic MRI. The following pictures were obtained: precontract T1, T2, and dynamic contrast enhanced sequences, diffusion-weighted. On the workstation, subtracted dynamic images and dynamic curve were produced. A radiology consultant interpreted the magnetic resonance images. For the ordinary dynamic, subtracted dynamic and diffusion images, the following metrics were determined: overall agreement, sensitivity, specificity, negative predictive value, positive predictive value
Results: Ordinary dynamic [Arterial T1 with fat sat] showed a sensitivity of 96.77%, specificity of 58.6%, PPV of 71.4% and NPV of 94.4%, While subtraction MRI showed a sensitivity of 100%, specificity of 100%, PPV of 100% and NPV of 100% compared to DWI showed a sensitivity of 100%, specificity 93%, PPV 93.9% and NPV 100%. So Dynamic subtraction imaging was found to have a significant additive value when compared to traditional dynamic MRI and DWI.
Conclusion: The subtraction approach is a valuable confirmatory tool for the diagnosis of HCC following locoregional therapy. It also had higher sensitivity, specificity, positive and negative predictive values.

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