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Gadoxetic Acid-Enhanced MRI Features for Predicting Treatment Outcomes of Early Hepatocellular Carcinoma (< 3 cm) After Transarterial Chemoembolization

Published:February 09, 2022DOI:https://doi.org/10.1016/j.acra.2021.10.012

      Rationale and Objectives

      Magnetic resonance imaging (MRI) is the most useful imaging tool for small hepatocellular carcinoma (HCC) evaluation. Patients undergoing transarterial chemoembolization (TACE) might have predictive imaging prognostic factors. This study aimed to find predictive gadoxetic acid (GA)-enhanced MRI features that affect tumor response and outcomes in patients with early HCC who underwent conventional TACE.

      Materials and Methods

      Among patients who underwent conventional TACE as a first-line treatment for Barcelona clinic liver cancer stage 0 or A (<3 cm), 135 patients who underwent GA-enhanced MRI before treatment were included in this retrospective study. The patients’ pretreatment clinical characteristics and MRI features were evaluated. Post-treatment tumor response, progression-free survival (PFS), and overall survival (OS) were also investigated.

      Results

      The median follow-up period was 47 (range: 7-133) months, with 90 (67%) patients showing complete remission (CR) at the 1-month follow-up after TACE. Tumor number (odds ratio [OR] 0.602, 95% confidence interval [CI]: 0.375-0.967), central location (OR: 0.349, 95% CI: 0.145-0.837) were inversely associated with CR achievement. Median PFS and OS time were 22 (range: 1-133) and 67 (range: 7-133) months, respectively. The MRI features affecting poor survival outcomes were tumor number (PFS: hazard ratio [HR]=1.444, 95% CI=1.124-1.854; OS: HR=1.459, 95% CI=1.018-2.090), central location (PFS: HR=1.664, 95% CI=1.038-2.667; OS: HR=1.890, 95% CI=1.021-3.497), and marginal irregularity (PFS: HR=3.099, 95% CI=1.953-4.979; OS: HR=1.985, 95% CI=1.084-3.634).

      Conclusion

      Multiplicity, central location, and marginal irregularity of HCC on GA-enhanced MRI were significant factors associated with poor prognosis of patients with early HCC after conventional TACE.

      Key Words

      Abbreviations:

      BCLC (Barcelona clinic liver cancer), BMI (Body mass index), CI (Confidence interval), CR (Complete remission), CT (Computed tomography), Fr (French), GA (Gadoxetic acid), HASTE (Half-Fourier acquisition single-shot turbo-spin echo), HBP (Hepatobiliary phase), HCC (Hepatocellular carcinoma), HR (Hazard ratio), HU (Hounsfield unit), m-RECIST (modified Response Evaluation Criteria In Solid Tumors), MRI (Magnetic resonance imaging), OR (Odds ratio), OS (Overall survival), PD (Progressive disease), PR (Partial response), PFS (Progression-free survival), RFA (Radiofrequency ablation), SI (Signal intensity), T1WI (T1-weighted images), T2WI (T2-weighted images), TACE (Transarterial chemoembolization), VIBE (volumetric interpolated breath-hold examination))
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