| Purpose:To evaluate the early therapeutic response in patients with liver carcinoma after transarterial chemoembolization (TACE) by the functional diffusion map (FDM), through a retrospective analysis of the FDM features in the lesions with different later response. Furthermore, we tried to validate whether FDM showed better evaluation performance than the mean ADC value and whether the evaluation results of the FDM were consistent with those by the classic means of imaging. An early and important reference for the clinical treatment options could be provided after the application of this new technology.Materials and methods:From October2011to December2012,45patients with clinical or imaging diagnosis of liver carcinoma and followed by TACE treatment in our hospital were enrolled. They received diffusion MRI and conventional imaging examination (CT enhanced scan or MRI scans) in one week ahead of TACE and one month after the treatment, and only conventional imaging examination in three months and six months after the treatment. We toke±39×10"5mm2/s as the threshold (range of the normal liver tissue), and registered the images of the two diffusion MRI (b=0,600s/mm2) to the previous T1WI image (baseline). Here are the information showed in the FDM:VR (the percentage of red Voxel), representing the area that ADC values increased exceeding the threshold in the lesion after treatment; VB (the percentage of blue Voxel), representing the area that ADC values decreased exceeding the threshold in the lesion after treatment; VT (VR+VB), representing the area with significantly changed ADC values; VG (the percentage of green Voxel), representing the area that ADC values changed within the threshold in the lesion after treatment. The mean ADC values were measured on the diffusion MRI images in1week ahead of TACE and one month after the treatment. The outcome of conventional imaging in patients in one, three and six months after treatment by the Response Evaluation Criteria In Solid Tumors (RECIST) was divided into three group:partial remission (PR), disease stable (SD) and progressive disease (PD). Analysis the difference between the FDM and the mean ADC value in these three groups in one month after treatment and whether FDM could predict the later therapeutic response after TACE treatment in patients with liver carcinoma.Results:In1month after TACE, there were1PR patient,42SD patients and2PD patients (RECIST), without statistically difference in VR, VB or VT of lesions between these three groups (F=1.107,0.810,1.534; p=0.340,0.452,0.228). The mean ADC value ahead of TACE and one month after the treatment, and the change rate of the mean ADC value were also not statistically different (F=0.339,0.581,0.770; p=0.714,0.564,0.469).In3months after TACE, four patients died, and there were8PR patients,23SD patients and10PD patients (RECIST) in the remaining41patients. VR and VT in the FDM between these three groups were significantly different (F=12.937,7.892; p<0.001,0.001). The VR in PR patients (69.41%±11.45%) was significantly higher than that in SD patients (47.47%±18.89%) and PD patients (29.43%±13.62%). The area under the ROC curve was0.883, and the sensitivity and the specificity of the diagnosis of PR was100%and69.7%respectively when VR was50.16%. The VR in SD patients (47.47%±18.89%) was significantly higher than that in PD patients (29.43%±13.62%). The area under the ROC curve was0.783, and the sensitivity and the specificity of the diagnosis of PR was78.3%and70%respectively when VR was32.85%. The VT in PR patients (79.64%±11.36%) was significantly higher than that in SD patients (63.17%±20.27%) and PD patients (46.44%±14.68%). The area under the ROC curve was0.803, and the sensitivity and the specificity of the diagnosis of PR was100%and63.6%respectively when VT was67.80%. The VT in SD patients (63.17%±20.27%) was significantly higher than that in PD patients (46.44%±14.68%). The area under the ROC curve was0.743, and the sensitivity and the specificity of the diagnosis of PR was56.5%and90%respectively when VT was61.95%. The sensitivity and specificity of the combination of VR and VT for distinguishing PR patients from SD and PD patients was100%and73.7%, while that for distinguishing SD patients from PD patients was69.6%and80.0%.The mean ADC value before TACE in PR patients,(179.28±27.94) X10-5mm2/s, was significantly greater than that of SD patients,(149.36±29.84)×10-5mm2/s (t=2.480, p=0.019), and that of PD patients,(140.90±27.75)×10-5mm2/s (t=2.907, p=0.010). But there was no significant difference between the SD patients with PD patients (t=0.764, p=0.451). The VB, the mean ADC value in one month after TACE and the change ratio of the mean ADC value were not significantly different between those three groups(F=0.781,1.758,0.163; p=0.465,0.186,0.850).In6months after TACE,12patients died, and there were4PR patients,18SD patients and7PD patients (RECIST) in the remaining29patients. The VR in PR patients (66.48%±11.69%) was significantly higher than that in PD patients (44.34%±15.42%)(t=2.473, p=0.035). The VR in SD patients (57.76%±18.21%) was not significantly different with that of PR and PD patients (t=-0.908,1.719; p=0.375,0.099). The VB, the VT, the mean ADC value before TACE, the mean ADC in one month after TACE and the change ratio of the mean ADC value were not significantly different between those three groups (F=0.151,2.194,1.736,1.025,0.451; p=0.861,0.132,0.196,0.372,0.642).Conclusion:FDM could evaluate the early therapeutic response in patients with liver carcinoma after TACE, and showed a significantly higher evaluation efficacy than the mean ADC value and a fairly close association with those by the conventional means of imaging. It will be a powerful and promising tool and could provide an early and important reference for the clinical treatment options. |
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