Predictive Value Of MR Diffusion Kurtosis Imaging In Evaluation Of Hepatocellular Carcinoma’ Response To Transcatheter Arterial Chemoembolization

ObjectiveUse DKI to quantitatively measure the value of MK and MD of preoperative tumor tissue,postoperative necrotic and residual tissues to compare DKI with conventional diffusion-weighted imaging(DWI)for the application of assessing the therapeutic effect of TACE in HCC.MethodsThis study was approved by the local institutional review board,and all patients gave written informed consent before the study.Data from 34 patients(27 males,7 females;median age,54.7 years;range,26-76 years)with hepatic cancer between June 2016 and September 2017 were recruited for this study.All the samples of HCC corresponded with the clinical or pathological diagnosis criteria.Magnetic resonance imaging(MRI)and DKI(b=0,800,1500,2000 mm2/s)were performed before and 4-6 weeks after initiating TACE.All the pathological tissue were divided into the following three groups:Group A:Preoperative tumor tissue.Group B:Postoperative necrotic tissues.Group C:Postoperative residual tissues.The quantitative parameters,including ADC,MK and MD value,were measured by MRToolbox.Analyzed all dates with Paired sample t-test or Mann-Whitney U test.P<0.05 was considered as statistical differences.Evaluate the discriminability of ADC,MK and MD in identify residual tissue by receiver operating characteristic(ROC)curves,and then find the sensitivity,specificity and so on.ResultsIn 34 patients with HCC,there was no significant change in tumor size after TACE,in which 8 lesions had no obvious enhancement and were completely necrotic,the other 26 lesions showed heterogeneous enhancement,both having enhancement area and non-enhancement area,means necrosis and residual tissue.The ADC value,MK value and MD value in Group A were(1.03 ± 0.19)X10-3mm2/s,0.73 ±0.13,(1.42 ± 0.34)×10-3mm2/s.The ADC value,MK value and MD value in Group B were(1.51±0.43)×10-3mm2/s,0.39±0.07,(2.08±0.4)×10-3mm2/s.The ADC value,MK value and MD value in Group C were(1.07±0.24)×10-3mm2/s,0.70±0.12,(1.49±0.38)×10-3mm2/s.The MK values in B group was significantly lower than those in A group,the MD and ADC values in B group were significantly higher than those in A group.After TACE,ADC,MK and MD value of the tumor had significant differences between group preoperative tumor tissue and group postoperative necrotic tissues(P<0.05).The MK value was slightly lower for the C group than for the A group,the ADC and MD value were slightly lower for the C group than for the A group.The ADC,MD,and the MK value were not significantly different(P>0.05)between the group A and group C.ADC,MK and MD value of the tumor had significant differences between Group preoperative tumor and residual tissue(P<0.05).When differentiating residual tissue after TACE,the value of MK had best ability with a largest AUC(0.981,P<0.001),follows MD(AUC=0.839,P<0.05)and ADC(AUC=0.815,P<0.05).ConclusionDKI can be a new option for the assessment of posttherapeutic response in HCC,and The MK value had higher clinical value than ADC value in the evaluation of the curative effects of TACE in HCC.