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Early Response of Hepatic Malignancies to Locoregional Therapy-Value of Diffusion-Weighted Magnetic Resonance Imaging and Proton Magnetic Resonance Spectroscopy

Bonekamp, Susanne DVM, PhD*; Shen, Jialin MD; Salibi, Nouha PhD; Lai, Hong C. PhD*; Geschwind, Jeff MD*; Kamel, Ihab R. MD*

Journal of Computer Assisted Tomography: March-April 2011 - Volume 35 - Issue 2 - p 167-173
doi: 10.1097/RCT.0b013e3182004bfb
Abdominal Imaging

Purpose: The objective of our study was to determine the usefulness of the diffusion-weighted magnetic resonance imaging and proton magnetic resonance spectroscopy (1H-MRS) of hepatic malignancies for the assessment of response to locoregional treatment.

Methods: Forty-four patients (29 men; mean age, 58 years) with hepatic malignancies were treated locally. Magnetic resonance imaging examinations obtained before and at 1 and 6 months after transarterial chemoembolization were analyzed retrospectively. Imaging criteria included change in tumor size, percentage of enhancement in the arterial and portal venous phases, diffusion-weighted magnetic resonance imaging apparent diffusion coefficients, and choline concentration by quantitative 1H-MRS. Response to treatment was grouped according to RECIST (Response Evaluation Criteria in Solid Tumors) and European Association for the Study of the Liver (EASL) criteria based on magnetic resonance imaging at 6 months after treatment. Statistical analysis used paired t test, Fisher exact test, and univariate and multivariate Cox proportional hazards models.

Results: Before treatment, the median tumor diameter was 6 cm; at 6 months after treatment, median tumor diameter was 5.1 cm. According to RECIST and EASL, 66% of the patients achieved partial response, 31% had stable disease, and 3% of the patients showed progressive disease. One month after transarterial chemoembolization, apparent diffusion coefficient increased (P < 0.14), and mean choline concentration of the tumors decreased (P < 0.008).

Conclusions: Diffusion-weighted imaging and hepatic choline levels by 1H-MRS could predict response to locoregional therapy.

From the *Russell H Morgan Department of Radiology and Radiology Science, Johns Hopkins University School of Medicine, Baltimore, MD; †Department of Radiology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; and ‡Siemens Corporate Research, Princeton, NJ.

Received for publication June 2, 2010; accepted October 5, 2010.

Reprints: Ihab R. Kamel, MD, PhD, Russell H. Morgan Department of Radiology and Radiological Sciences, 600 N Wolfe St, MRI 143, Baltimore, MD 21287 (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.