Tumor Response after Yttrium-90 Radioembolization for Hepatocellular Carcinoma: Comparison of Diffusion-weighted Functional MR Imaging with Anatomic MR Imaging

Thomas K. Rhee, Neel K. Naik, Jie Deng, Bassel Atassi, Mary F. Mulcahy, Laura M. Kulik, Robert K. Ryu, Frank H. Miller, Andrew C. Larson, Riad Salem, Reed A. Omary*

*Corresponding author for this work

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Abstract

Purpose: Anatomic magnetic resonance (MR) imaging assessment of hepatocellular carcinoma (HCC) response to yttrium-90 (90Y) radioembolization may require 3 months before therapeutic effectiveness can be determined. The relationship between anatomic MR and diffusion-weighted imaging (DWI) changes after 90Y therapy is unclear. The present study tested the hypothesis that apparent diffusion coefficient (ADC) values on DWI at 1 month precede anatomic tumor size change at 3 months after 90Y radioembolization. Materials and Methods: In this prospective study, 20 patients with HCC (16 men) enrolled between April 2005 and July 2006 underwent lobar 90Y therapy with mean doses of 141 Gy (right lobe) and 98 Gy (left lobe). Anatomic 1.5-T MR imaging (gadolinium-enhanced T1-weighted gradient-recalled echo) and DWI (single-shot spin-echo echo-planar imaging; b value of 0, 500 sec/mm2) were performed at baseline (0-3 weeks before 90Y therapy) and at 1 and 3 months after 90Y therapy. Tumor size and ADC values were measured and compared, and the percentage change in ADC was compared to the change in tumor size (minimum >5% change in size), with use of a paired t test (α = .05). Results: Yttrium-90 therapy was successfully delivered in all patients. The mean baseline ADC of 1.64 × 10-3 mm2/sec ± 0.30 significantly increased to 1.81 × 10-3 mm2/sec ± 0.37 at 1 month (P = .02), and to 1.82 × 10-3 mm2/sec ± 0.23 at 3 months (P = .02). The mean baseline tumor size of 83.0 cm2 ± 63.7 did not change statistically at 1 month (84.1 cm2 ± 62.1; P = .75) or 3 months (74.0 cm2 ± 57.0; P = .10). The overall mean ADC percentage change at 1 month of 10.5% ± 23.1% preceded an overall mean tumor size percentage change at 3 months of -18.5% ± 31.5% (P = .03). Conclusions: HCC tumor response assessed with DWI at 1 month preceded anatomic size changes at 3 months after 90Y therapy. DWI may assist in early determination of the response or failure of 90Y therapy for HCC.

Original languageEnglish (US)
Pages (from-to)1180-1186
Number of pages7
JournalJournal of Vascular and Interventional Radiology
Volume19
Issue number8
DOIs
StatePublished - Aug 1 2008

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Yttrium
Hepatocellular Carcinoma
Magnetic Resonance Imaging
Neoplasms
Therapeutics
Echo-Planar Imaging
Diffusion Magnetic Resonance Imaging
Gadolinium
Prospective Studies

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{252d2f797c2e4e76bfd0ad1541cdc971,
title = "Tumor Response after Yttrium-90 Radioembolization for Hepatocellular Carcinoma: Comparison of Diffusion-weighted Functional MR Imaging with Anatomic MR Imaging",
abstract = "Purpose: Anatomic magnetic resonance (MR) imaging assessment of hepatocellular carcinoma (HCC) response to yttrium-90 (90Y) radioembolization may require 3 months before therapeutic effectiveness can be determined. The relationship between anatomic MR and diffusion-weighted imaging (DWI) changes after 90Y therapy is unclear. The present study tested the hypothesis that apparent diffusion coefficient (ADC) values on DWI at 1 month precede anatomic tumor size change at 3 months after 90Y radioembolization. Materials and Methods: In this prospective study, 20 patients with HCC (16 men) enrolled between April 2005 and July 2006 underwent lobar 90Y therapy with mean doses of 141 Gy (right lobe) and 98 Gy (left lobe). Anatomic 1.5-T MR imaging (gadolinium-enhanced T1-weighted gradient-recalled echo) and DWI (single-shot spin-echo echo-planar imaging; b value of 0, 500 sec/mm2) were performed at baseline (0-3 weeks before 90Y therapy) and at 1 and 3 months after 90Y therapy. Tumor size and ADC values were measured and compared, and the percentage change in ADC was compared to the change in tumor size (minimum >5{\%} change in size), with use of a paired t test (α = .05). Results: Yttrium-90 therapy was successfully delivered in all patients. The mean baseline ADC of 1.64 × 10-3 mm2/sec ± 0.30 significantly increased to 1.81 × 10-3 mm2/sec ± 0.37 at 1 month (P = .02), and to 1.82 × 10-3 mm2/sec ± 0.23 at 3 months (P = .02). The mean baseline tumor size of 83.0 cm2 ± 63.7 did not change statistically at 1 month (84.1 cm2 ± 62.1; P = .75) or 3 months (74.0 cm2 ± 57.0; P = .10). The overall mean ADC percentage change at 1 month of 10.5{\%} ± 23.1{\%} preceded an overall mean tumor size percentage change at 3 months of -18.5{\%} ± 31.5{\%} (P = .03). Conclusions: HCC tumor response assessed with DWI at 1 month preceded anatomic size changes at 3 months after 90Y therapy. DWI may assist in early determination of the response or failure of 90Y therapy for HCC.",
author = "Rhee, {Thomas K.} and Naik, {Neel K.} and Jie Deng and Bassel Atassi and Mulcahy, {Mary F.} and Kulik, {Laura M.} and Ryu, {Robert K.} and Miller, {Frank H.} and Larson, {Andrew C.} and Riad Salem and Omary, {Reed A.}",
year = "2008",
month = "8",
day = "1",
doi = "10.1016/j.jvir.2008.05.002",
language = "English (US)",
volume = "19",
pages = "1180--1186",
journal = "Journal of Vascular and Interventional Radiology",
issn = "1051-0443",
publisher = "Elsevier Inc.",
number = "8",

}

TY - JOUR

T1 - Tumor Response after Yttrium-90 Radioembolization for Hepatocellular Carcinoma

T2 - Comparison of Diffusion-weighted Functional MR Imaging with Anatomic MR Imaging

AU - Rhee, Thomas K.

AU - Naik, Neel K.

AU - Deng, Jie

AU - Atassi, Bassel

AU - Mulcahy, Mary F.

AU - Kulik, Laura M.

AU - Ryu, Robert K.

AU - Miller, Frank H.

AU - Larson, Andrew C.

AU - Salem, Riad

AU - Omary, Reed A.

PY - 2008/8/1

Y1 - 2008/8/1

N2 - Purpose: Anatomic magnetic resonance (MR) imaging assessment of hepatocellular carcinoma (HCC) response to yttrium-90 (90Y) radioembolization may require 3 months before therapeutic effectiveness can be determined. The relationship between anatomic MR and diffusion-weighted imaging (DWI) changes after 90Y therapy is unclear. The present study tested the hypothesis that apparent diffusion coefficient (ADC) values on DWI at 1 month precede anatomic tumor size change at 3 months after 90Y radioembolization. Materials and Methods: In this prospective study, 20 patients with HCC (16 men) enrolled between April 2005 and July 2006 underwent lobar 90Y therapy with mean doses of 141 Gy (right lobe) and 98 Gy (left lobe). Anatomic 1.5-T MR imaging (gadolinium-enhanced T1-weighted gradient-recalled echo) and DWI (single-shot spin-echo echo-planar imaging; b value of 0, 500 sec/mm2) were performed at baseline (0-3 weeks before 90Y therapy) and at 1 and 3 months after 90Y therapy. Tumor size and ADC values were measured and compared, and the percentage change in ADC was compared to the change in tumor size (minimum >5% change in size), with use of a paired t test (α = .05). Results: Yttrium-90 therapy was successfully delivered in all patients. The mean baseline ADC of 1.64 × 10-3 mm2/sec ± 0.30 significantly increased to 1.81 × 10-3 mm2/sec ± 0.37 at 1 month (P = .02), and to 1.82 × 10-3 mm2/sec ± 0.23 at 3 months (P = .02). The mean baseline tumor size of 83.0 cm2 ± 63.7 did not change statistically at 1 month (84.1 cm2 ± 62.1; P = .75) or 3 months (74.0 cm2 ± 57.0; P = .10). The overall mean ADC percentage change at 1 month of 10.5% ± 23.1% preceded an overall mean tumor size percentage change at 3 months of -18.5% ± 31.5% (P = .03). Conclusions: HCC tumor response assessed with DWI at 1 month preceded anatomic size changes at 3 months after 90Y therapy. DWI may assist in early determination of the response or failure of 90Y therapy for HCC.

AB - Purpose: Anatomic magnetic resonance (MR) imaging assessment of hepatocellular carcinoma (HCC) response to yttrium-90 (90Y) radioembolization may require 3 months before therapeutic effectiveness can be determined. The relationship between anatomic MR and diffusion-weighted imaging (DWI) changes after 90Y therapy is unclear. The present study tested the hypothesis that apparent diffusion coefficient (ADC) values on DWI at 1 month precede anatomic tumor size change at 3 months after 90Y radioembolization. Materials and Methods: In this prospective study, 20 patients with HCC (16 men) enrolled between April 2005 and July 2006 underwent lobar 90Y therapy with mean doses of 141 Gy (right lobe) and 98 Gy (left lobe). Anatomic 1.5-T MR imaging (gadolinium-enhanced T1-weighted gradient-recalled echo) and DWI (single-shot spin-echo echo-planar imaging; b value of 0, 500 sec/mm2) were performed at baseline (0-3 weeks before 90Y therapy) and at 1 and 3 months after 90Y therapy. Tumor size and ADC values were measured and compared, and the percentage change in ADC was compared to the change in tumor size (minimum >5% change in size), with use of a paired t test (α = .05). Results: Yttrium-90 therapy was successfully delivered in all patients. The mean baseline ADC of 1.64 × 10-3 mm2/sec ± 0.30 significantly increased to 1.81 × 10-3 mm2/sec ± 0.37 at 1 month (P = .02), and to 1.82 × 10-3 mm2/sec ± 0.23 at 3 months (P = .02). The mean baseline tumor size of 83.0 cm2 ± 63.7 did not change statistically at 1 month (84.1 cm2 ± 62.1; P = .75) or 3 months (74.0 cm2 ± 57.0; P = .10). The overall mean ADC percentage change at 1 month of 10.5% ± 23.1% preceded an overall mean tumor size percentage change at 3 months of -18.5% ± 31.5% (P = .03). Conclusions: HCC tumor response assessed with DWI at 1 month preceded anatomic size changes at 3 months after 90Y therapy. DWI may assist in early determination of the response or failure of 90Y therapy for HCC.

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U2 - 10.1016/j.jvir.2008.05.002

DO - 10.1016/j.jvir.2008.05.002

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JO - Journal of Vascular and Interventional Radiology

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SN - 1051-0443

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