Relationship of apparent diffusion coefficient to survival for patients with unresectable primary hepatocellular carcinoma after chemoembolization

Department of Radiology, Changzheng Hospital, the Second Military Medical University, 415 Feng Yang Road, Shanghai 200003, PR China.
European journal of radiology (Impact Factor: 2.37). 02/2011; 81(3):472-7. DOI: 10.1016/j.ejrad.2010.12.081
Source: PubMed


to evaluate the prognostic value of apparent diffusion coefficient (ADC) values from MR diffusion-weighted imaging of unresectable hepatocellular carcinoma after chemoembolization.
our study was proved by our institute and informed consent was obtained from all patients before commencement of the study. Twenty-three patients with unresectable hepatocellular carcinoma were scanned immediately before and after chemoembolization within 24h using conventional anatomical MR imaging and diffusion-weighted imaging, from which ADC values in the lesions were measured. The changes in ADC values after chemoembolization were calculated. The relationship between the lesion ADC and the survival time was analyzed by correlation analysis. The overall cumulative survival was analyzed by the Kaplan-Meier method, and survival curves were compared by the log-rank test.
the mean overall survival period was (25.0±8.7) months. The pre-chemoembolization lesion ADC value was (1.36±0.249)×10(-3) mm2/s; the change in ADC values post-chemoembolization was (0.377±0.332)×10(-3) mm2/s. There were significant linear regression relation between the survival time and pre-chemoembolization lesion ADC values (r=-0.698, P<0.001) or the changes in ADC value post-chemoembolization (r=0.702, P<0.001). And Log-rank test showed that pre-chemoembolization ADC values (χ2=7.339, P=0.007) or the changes in ADC value post-chemoembolization (χ2=9.820, P=0.002) significantly influenced the overall cumulative survival.
Pre-treatment ADC values as well as changes in ADC values after treatment may provide useful information for predicting survival for patients with unresectable hepatocellular carcinoma.

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    • "Diffusion-weighted (DW) imaging allows for the assessment of water molecule motion to monitor treatment-associated alterations in the tumor microenvironment . Quantification of the changes in water diffusion, the apparent diffusion coefficient (ADC), has been advocated as a better cellular biomarker than MR morphological criteria for assessing advanced HCC [15] [16] [17]. The correlation of ADC values with histologic grades of HCC differentiation has also been reported [18] [19]. "
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    ABSTRACT: We sought to evaluate the effects of adipose-derived mesenchymal stem cells (ADMSCs) exosomes on hepatocellular carcinoma (HCC) in rats using apparent diffusion coefficient (ADC), natural killer T-cell (NKT-cell) responses, and histopathological features. ADMSC-derived exosomes appeared as nanoparticles (30–90 nm) on electron microscopy and were positive for CD63, tumor susceptibility gene-101, and β -catenin on western blotting. The control ( n = 8 ) and exosome-treated ( n = 8 ) rats with N1S1-induced HCC underwent baseline and posttreatment day 10 and day 20 magnetic resonance imaging and measurement of ADC. Magnetic resonance imaging showed rapidly enlarged HCCs with low ADCs in the controls. The exosome-treated rats showed partial but nonsignificant tumor reduction, and significant ADC and ADC ratio increases on day 10. On day 20, the exosome-treated rats harbored significantly smaller tumors and volume ratios, higher ADC and ADC ratios, more circulating and intratumoral NKT-cells, and low-grade HCC ( P < 0.05 for all comparisons) compared to the controls. The ADC and volume ratios exhibited significant inverse correlations ( P < 0.001 , R 2 = 0.679 ). ADMSC-derived exosomes promoted NKT-cell antitumor responses in rats, thereby facilitating HCC suppression, early ADC increase, and low-grade tumor differentiation. ADC may be an early biomarker of treatment response.
    Full-text · Article · Sep 2015 · Stem cell International
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    • "In particular, the degree of tumor necrosis of large HCC following TACE may be predicted by DWI, and patient management may be guided by the results (6). The ADC value may also be used to predict the survival of patients with HCC following TACE (7). "
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    ABSTRACT: The purpose of the present study was to evaluate whether diffusion-weighted imaging (DWI) can be used to assess hepatocellular carcinoma (HCC) viability following transarterial chemoembolization (TACE). A total of 41 consecutive patients were treated according to chemoembolization protocols. The follow-up was performed between six and eight weeks post-chemoembolization by multidetector computed tomography [or enhanced magnetic resonance imaging (MRI)] and DW-MRI on the same day. The presence of any residual tumor and the extent of tumor necrosis were evaluated according to the European Association for the Study of the Liver. The apparent diffusion coefficient (ADC) values of the entire area of the treated mass and the vital and necrotic tumor tissues were recorded. Correlation coefficients were also calculated to compare the percentage of necrosis with ADC values. The mean ADC values of the necrotic and vital tumor tissues were 2.22±0.31×10(-3) mm(2)/sec and 1.42±0.25×10(-3) mm(2)/sec, respectively (Mann-Whitney U test, P<0.001). The results from the receiver operating characteristic analysis showed that the threshold ADC value was 1.84×10(-3) mm(2)/sec with 92.3% sensitivity and 100% specificity for identifying the necrotic tumor tissues. A significant linear regression correlation was identified between the ADC value of the entire area of the treated mass and the extent of tumor necrosis (r=0.58; P<0.001). In conclusion, DWI can be used to assess HCC viability following TACE.
    Full-text · Article · Aug 2014 · Oncology letters
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    ABSTRACT: To investigate diffusion-weighted imaging (DWI) as a response biomarker in patients undergoing chemoradiation for postoperative recurrences of cervical cancer. From October 2008 to March 2011, 20 patients were included. All underwent T2-weighted (T2W) and DWI before and after chemoradiation. Gross tumor volume (GTV), lateral extent, apparent diffusion coefficient (ADC), and presence of regions of focally restricted diffusion were determined at baseline. Response to chemoradiation was categorized as either partial or complete. Receiver operator characteristics (ROC) curve identified thresholds of GTV and ADC that best predict for partial response. Univariate and multivariate analysis were performed on SPSS version 15. The median GTV was 24.5 cc (4.1-110 cc). Central and lateral disease was present in 8 and 12 patients, respectively. The median ADC was 1 × 10 -3 mm² /s (0.8-1.3 × 10⁻³ mm² /s) and 12/20 (60%) patients had focal restricted diffusion. Overall 10/20 patients had partial response. ROC analysis identified volume of 25 cc or higher [sensitivity = 80%, specificity = 80%, area under curve (AUC) = 0.76, P = 0.04] and ADC more than 1 × 10⁻³ mm² /s (sensitivity = 70%, specificity = 50%, AUC = 0.62; P = 0.34) to best predict for partial response. On univariate analysis bulky disease (77.7% vs. 27%; P = 0.03), lateral disease (66.6% vs. 25%; P = 0.08), and focal regions of restricted diffusion (66.6% vs. 25%; P = 0.06) predicted for partial response to chemoradiation. All factors continued to be significant on multivariate analysis. On restricting analysis to bulky tumors ADC greater than 0.95 × 10⁻³ mm² /s predicted partial response with high sensitivity (85.7%) and specificity (100%) (AUC 0.96; P = 0.05). On univariate analysis lateral disease (P = 0.04), high baseline ADC (P = 0.07) predicted for partial response. Baseline ADC and focal regions of ADC restriction predict for partial response with moderate sensitivity and specificity in patients with postoperative recurrences of cervical cancer and need to be validated in larger cohort.
    No preview · Article · Jan 2012 · Journal of cancer research and therapeutics
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