Dynamic Contrast-Enhanced MRI Analysis of Perfusion Changes in Advanced Hepatocellular Carcinoma Treated with an Antiangiogenic Agent: A Preliminary Study
Jane Wang1,
Li-Tzong Chen2,3,
Yuk-Ming Tsang1,
Tsang-Wu Liu2 and
Tiffany Ting-Fang Shih1
1 Department of Medical Imaging, National Taiwan University Hospital and
Department of Radiology, National Taiwan University College of Medicine, No.
7, Chung-Shan S Rd., Taipei 100, Taiwan.
2 Division of Cancer Research, National Health Research Institute, Taipei,
Taiwan.
3 Department of Medicine, Kaohsiung Medical University Hospital, Kaohsiung,
Taiwan.
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Fig. 1A. —Patterns of time–intensity curve and related parameters.
Scanning began 5 sec after initiation of contrast injection. First breathing
interval was 23–33 sec. Second breathing interval was 51–61 sec.
Baseline signal intensity (SI) value (SIbase) in
time–intensity curve = mean SI value on first three MR images obtained,
SI1st = peak SI value in first-pass study of contrast
enhancement, SImax= maximal SI value. Contrast rise time
( T in seconds) = time interval between
SIbase and SI1st. In A (pattern 1) and
C (pattern 3), SI1st = SImax. Pattern
I is rapid wash-in phase followed by washout phase in latter portion.
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Fig. 1B. —Patterns of time–intensity curve and related parameters.
Scanning began 5 sec after initiation of contrast injection. First breathing
interval was 23–33 sec. Second breathing interval was 51–61 sec.
Baseline signal intensity (SI) value (SIbase) in
time–intensity curve = mean SI value on first three MR images obtained,
SI1st = peak SI value in first-pass study of contrast
enhancement, SImax= maximal SI value. Contrast rise time
(T in seconds) = time interval between
SIbase and SI1st. In A (pattern 1) and
C (pattern 3), SI1st = SImax. Pattern
II is initially rapid-rising slope followed by second slow-rising phase.
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Fig. 1C. —Patterns of time–intensity curve and related parameters.
Scanning began 5 sec after initiation of contrast injection. First breathing
interval was 23–33 sec. Second breathing interval was 51–61 sec.
Baseline signal intensity (SI) value (SIbase) in
time–intensity curve = mean SI value on first three MR images obtained,
SI1st = peak SI value in first-pass study of contrast
enhancement, SImax= maximal SI value. Contrast rise time
(T in seconds) = time interval between
SIbase and SI1st. In A (pattern 1) and
C (pattern 3), SI1st = SImax. Pattern
III is rapid wash-in followed by plateau after peak enhancement.
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Fig. 2. —Pretreatment MR image obtained in 67-year-old man with advanced
hepatocellular carcinoma. Axial contrast-enhanced dynamic 2D turbo fast
low-angle shot MR image acquired during arterial phase shows hyperintense
tumors in right lobe of liver. Tumoral region of interest with maximal
enhancement (circle with arrow) and parenchymal region of interest
(circle with arrowhead) are depicted. Follow-up MR image (not shown)
obtained during treatment revealed no morphologic change in any hepatic tumors
but increase in all tumor perfusion parameters, compatible with clinical
disease progression evidenced by elevated serum  -fetoprotein level.
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Fig. 3A. —67-year-old woman with unresectable hepatocellular carcinoma.
Contrast-enhanced axial delayed fat-suppressed fast low-angle shot MR image
obtained before thalidomide treatment shows 4 x 5 cm hepatic tumor in
right lobe of liver, with central necrosis after transarterial
chemoembolization. Focal solid tumor enhancement (arrow) along
posterior wall of tumor is noted.
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Fig. 3B. —67-year-old woman with unresectable hepatocellular carcinoma.
Follow-up MR image obtained with same pulse sequence at level corresponding to
that of A shows that tumor size has not changed. However, increases in
solid tumor portion in central and posterior parts of tumor (arrows)
and increases in solid tumor enhancement (arrowhead) are found
posterior to tumor. Disease progression is predicted on basis of radiologic
findings and is compatible with clinical follow-up findings.
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Fig. 4. —Pretreatment MR image of 77-year-old man with advanced
hepatocellular carcinoma. Coronal contrast-enhanced dynamic turbo fast
low-angle shot MR image obtained during late arterial phase shows multiple
hyperintense tumors in right lobe of liver. Tumoral region of interest with
maximal enhancement (circle with arrow) and parenchymal region of
interest (circle with arrowhead) are depicted. Follow-up MR image
obtained during treatment (not shown) showed no morphologic change in any of
liver tumors. However, reduction of all tumor perfusion parameters was noted,
corresponding to clinically stable disease.
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Copyright © 2004 by the American Roentgen Ray Society.
