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Current Cancer Therapy Reviews


ISSN (Print): 1573-3947
ISSN (Online): 1875-6301

Research Article

Value of CT and MR Imaging in Assessment of Loco-regional Ablated Hepatocellular Carcinoma using LI-RADS Treatment Response Algorithm (version 2018)

Author(s): Carmen Ali Zarad, Waleed Elagawy, Basma Badreldin Hasan, Sherief Abd-Elsalam* and Waleed S. Abo Shanab

Volume 19, Issue 3, 2023

Published on: 15 March, 2023

Page: [260 - 270] Pages: 11

DOI: 10.2174/1573394719666230117111353

Price: $65


Aim: The aim of this work is to evaluate the role of multiphasic CT and dynamic contrast enhanced MRI using LI-RADS treatment response algorithm (version 2018) and the added values of diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps in the assessment of loco-Regional ablated Hepatocellular Carcinoma (HCC).

Methods: This study included 45 patients with 50 loco-Regional ablated HCC lesions. All patients underwent multiphasic CT scan, diffusion weighted and dynamic contrast enhanced MRI. The reference standards for assessment were based on serum alpha-fetoprotein level and dynamic contrast enhanced MRI.

Results: Multi-phasic CT had moderate sensitivity (87.5%) and high specificity (100%) for assessment of HCC LI-RADS treatment response algorithm. Dynamic contrast enhanced MRI had high sensitivity (100%) and specificity (100%) for the assessment of HCC LI-RADS treatment response algorithm. The sensitivity and specificity of DWI to diagnose HCC malignant residual or recurrence were 93.7% and 100%, respectively, with very good performance. The mean ADC values of the malignant residual or recurrence were significantly lower than that of benign post-ablation tissue changes areas and the best ADC cutoff value for differentiation between viable and nonviable lesions was 1.1x10-3 mm²/s.

Conclusion: Performance of dynamic contrast enhanced MRI is better than that of multiphasic CT in the assessment of LIRADS treatment response algorithm. DWI and ADC maps could be used as ancillary methods for differentiation between viable and non-viable loco-regional ablated HCC lesions and should be included in LR-TR treatment response algorithm.

Keywords: Hepatocellular carcinoma, loco-regional ablation therapies, LI-RADS treatment response, apparent diffusion coefficient, DWI, MRI.

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Forner A, Reig M, Varel AM, et al. Diagnosis and treatment of hepatocellular carcinoma. Update consensus document from the AEEH, SEOM, SERAM. SERVEI and SETH Medicina Clínica (English Edition) 2016; 146(11): 511-e1.
Inchingolo R, Posa A, Mariappan M, et al. Locoregional treatments for hepatocellular carcinoma: Current evidence and future directions. World J Gastroenterology 2019; 25(32): 4614-28.
Villanueva A. Hepatocellular Carcinoma. N Engl J Med 2019; 380(15): 1450-62.
[] [PMID: 30970190]
Kielar A, Fowler KJ, Lewis S, et al. Locoregional therapies for hepatocellular carcinoma and the new LI-RADS treatment response algorithm. Abdom Radiol (NY) 2018; 43(1): 218-30.
[] [PMID: 28780679]
Voizard N, Cerny M, Assad A, et al. Assessment of hepatocellular carcinoma treatment response with LI-RADS: a pictorial review. Insights Imaging 2019; 10(1): 121.
[] [PMID: 31853668]
Tang A, Fowler KJ, Chernyak V, Chapman WC, Sirlin CB. LI-RADS and transplantation for hepatocellular carcinoma. Abdom Radiol (NY) 2018; 43(1): 193-202.
[] [PMID: 28612162]
Mahmoud BEMH, Elkholy SF, Nabeel MM, et al. Role of MRI in the assessment of treatment response after radiofrequency and microwave ablation therapy for hepatocellular carcinoma. Egypt J Radiol Nucl Med 2016; 47(2): 377-85.
Smith S, Gillams A. Imaging appearances following thermal ablation. Clin Radiol 2008; 63(1): 1-11.
[] [PMID: 18068784]
Morsi AH, Refaat MM, Galal AT. The role of diffusion weighted MRI in the assessment of post ablation HCC viability. Benha Med J 2020; 37(2): 326-39.
Chernyak V, Fowler KJ, Kamaya A, et al. Liver Imaging Reporting and Data System (LI-RADS) version 2018: imaging of hepatocellular carcinoma in at-risk patients. Radiology 2018; 289(3): 816-30.
[] [PMID: 30251931]
Mahmoud BE, Gadalla AAEH, Elkholy SF. The role of dynamic and diffusion MR imaging in therapeutic response assessment after microwave ablation of hepatocellular carcinoma using LI-RADS v2018 treatment response algorithm. Egypt J Radiol Nucl Med 2021; 52(1): 60.
Elsayes KM, Fowler KJ, Chernyak V, et al. User and system pitfalls in liver imaging with LI RADS. J Magn Reson Imaging 2019; 50(6): 1673-86.
[] [PMID: 31215119]
Fowler KJ, Potretzke TA, Hope TA, Costa EA, Wilson SR. LI-RADS M (LR-M): definite or probable malignancy, not specific for hepatocellular carcinoma. Abdom Radiol (NY) 2018; 43(1): 149-57.
[] [PMID: 28580538]
Chicco D, Jurman G. The advantages of the Matthews correlation coefficient (MCC) over F1 score and accuracy in binary classification evaluation. BMC Genomics 2020; 21(1): 6.
[] [PMID: 31898477]
Chaudhry M, McGinty KA, Mervak B, et al. The LI-RADS Version 2018 MRI Treatment Response Algorithm: Evaluation of ablated hepatocellular carcinoma. Radiology 2020; 294(2): 320-6.
[] [PMID: 31845843]
Cools KS, Moon AM, Burke LMB, McGinty KA, Strassle PD, Gerber DA. Validation of the liver imaging reporting and data system treatment response criteria after thermal ablation for hepatocellular carcinoma. Liver Transpl 2020; 26(2): 203-14.
[] [PMID: 31677319]
Shropshire EL, Chaudhry M, Miller CM, et al. LI-RADS treatment response algorithm: performance and diagnostic accuracy. Radiology 2019; 292(1): 226-34.
[] [PMID: 31038409]
Bae JS, Lee JM, Yoon JH, et al. Evaluation of LI-RADS version 2018 treatment response algorithm for hepatocellular carcinoma in liver transplant candidates: intraindividual comparison between CT and hepatobiliary agent–enhanced MRI. Radiology 2021; 299(2): 336-45.
[] [PMID: 33650901]
Bashir MR, Mendiratta-Lala M. CT versus MRI in treatment response assessment with LI-RADS: The choice is unclear. Radiology 2021; 299(2): 346-8.
[] [PMID: 33656383]
Liang Y, Xu F, Guo Y, et al. Diagnostic performance of LI-RADS for MRI and CT detection of HCC: A systematic review and diagnostic meta-analysis. Eur J Radiol 2021; 134: 109404.
[] [PMID: 33276248]
Lee YJ, Lee JM, Lee JS, et al. Hepatocellular carcinoma: diagnostic performance of multidetector CT and MR imaging-a systematic review and meta-analysis. Radiology 2015; 275(1): 97-109.
[] [PMID: 25559230]
Park S, Joo I, Lee DH, et al. Diagnostic performance of LI-RADS treatment response algorithm for hepatocellular carcinoma: Adding ancillary features to MRI compared with enhancement patterns at CT and MRI. Radiology 2020; 296(3): 554-61.
[] [PMID: 32692297]
Moura Cunha G, Chernyak V, Fowler KJ, Sirlin CB. Up-to-date role of CT/MRI LI-RADS in hepatocellular carcinoma. J Hepatocell Carcinoma 2021; 8: 513-27.
[] [PMID: 34104640]
El-Kholy MR, Al Warraky MS, Hassanien SA. Diffusion-weighted MRI after radiofrequency ablation for hepatocellular carcinoma. Menoufia Med J 2021; 34(1): 264-8.
Schraml C, Schwenzer NF, Clasen S, et al. Navigator respiratory-triggered diffusion-weighted imaging in the follow-up after hepatic radiofrequency ablation-initial results. J Magn Reson Imaging 2009; 29(6): 1308-16.
[] [PMID: 19418557]
Mohammed AO, Ali MM, Hassan HR, Wagdy WM. Role of diffusion-weighted magnetic resonance imaging in the diagnosis of hepatic focal lesions. Egypt J Hosp Med 2020; 80(3): 958-63.
Kim SW, Joo I, Kim HC, et al. LI-RADS treatment response categorization on gadoxetic acid-enhanced MRI: diagnostic performance compared to mRECIST and added value of ancillary features. Eur Radiol 2020; 30(5): 2861-70.
[] [PMID: 32006170]
Elhendawy M, Abdul-Baki EA, Abd-Elsalam S, et al. MicroRNA signature in hepatocellular carcinoma patients: identification of potential markers. Mol Biol Rep 2020; 47(7): 4945-53.
[] [PMID: 32430845]
Negm O, Abou Saif S, El Gharib M, Yousef M, Abd-Elsalam S. Role of low-molecular-weight heparins in prevention of thromboembolic complication after transarterial chemoembolization in hepatocellular carcinoma. Eur J Gastroenterol Hepatol 2017; 29(3): 317-21.
[] [PMID: 27893491]
Watany M, Badawi R, Elkhalawany W, Abd-Elsalam S. Study of dickkopf-1 (DKK-1) gene expression in hepatocellular carcinoma patients. J Clin Diagn Res 2017; 11(2): OC32-4.
[] [PMID: 28384913]
Abdelfattah AAM, Rizk F, Hawash N, Hanafy A, El-kalla F, Abd-Elsalam S. Randomized trial of preoperative administration of oral pregabalin for postoperative analgesia in patients scheduled for radiofrequency ablation of focal lesions in the liver. Int J Hyperthermia 2018; 34(8): 1367-71.
[] [PMID: 29308685]
Abdel Ghafar MT, Morad MA, El-Zamarany EA, et al. Autologous dendritic cells pulsed with lysate from an allogeneic hepatic cancer cell line as a treatment for patients with advanced hepatocellular carcinoma: A pilot study. Int Immunopharmacol 2020; 82: 106375.
[] [PMID: 32169808]
El-Gebaly F, Abou-saif S, Elkadeem M, et al. Study of serum soluble programmed death ligand 1 as a prognostic factor in hepatocellular carcinoma in egyptian patients. Curr Cancer Drug Targets 2019; 19(11): 896-905.
[] [PMID: 31538897]

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