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Role of Diffusion-Weighted Imaging in Estimating Tumor Necrosis After Chemoembolization of Hepatocellular Carcinoma

Ihab R. Kamel1, David A. Bluemke1, Douglas Ramsey1, Mohammad Abusedera1, Michael Torbenson2, John Eng1, Gilberto Szarf1 and Jean-Francois Geschwind1

1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 600 N. Wolfe St., Rm. 100, Baltimore, MD 21287.
2 Department of Pathology, Johns Hopkins Hospital, Baltimore, MD 21287.



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  		Fig. 1A. —68-year-old man with hepatocellular carcinoma who 1 month earlier had transarterial chemoembolization. T2-weighted image (TR/TE, 5000/100) reveals 2-cm treated mass in right lobe of liver (arrow). Note small component of relatively hyperintense signal along left margin.

 


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  		Fig. 1B. —68-year-old man with hepatocellular carcinoma who 1 month earlier had transarterial chemoembolization. Gadolinium-enhanced T1-weighted image (TE, 1.2; flip angle, 15°) reveals residual enhancement of left portion of mass (arrow), estimated to represent 30% tumor viability.

 


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  		Fig. 1C. —68-year-old man with hepatocellular carcinoma who 1 month earlier had transarterial chemoembolization. Diffusion-weighted image (6500/110; b value, 500) shows mass (arrow), with apparent diffusion coefficient value of 1.51 x 10-3 mm2/sec, indicating 50% necrosis, which was confirmed at pathology (not shown).

 


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  		Fig. 2. —Graph shows correlation between apparent diffusion coefficient and percentage of necrosis as detected at pathology in nine lesions (r = 0.95; 95% Confidence interval = 0.78-0.99; p < 0.05). Note linear increase in apparent diffusion coefficient values with increase in tumor necrosis.

 

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