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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Can DKI-MRI predict recurrence and invasion of peritumoral zone of hepatocellular carcinoma after transcatheter arterial chemoembolization?
Xin Cao, Hao Shi, Wei-Qiang Dou, Xin-Yao Zhao, Ying-Xin Zheng, Ya-Ping Ge, Hai-Chao Cheng, Dao-Ying Geng, Jun-Ying Wang
Xin Cao, Hao Shi, Ya-Ping Ge, Hai-Chao Cheng, Jun-Ying Wang, Department of Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Province Qianfoshan Hospital, Jinan 250014, Shandong Province, China
Xin Cao, Dao-Ying Geng, Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China
Xin Cao, Dao-Ying Geng, Center for Shanghai Intelligent Imaging for Critical Brain Diseases Engineering and Technology Research, Shanghai 200040, China
Wei-Qiang Dou, MR Research, GE Healthcare, Beijing 10076, China
Xin-Yao Zhao, Department of Radiology, Yantaishan Hospital, Yantai 264001, Shandong Province, China
Ying-Xin Zheng, Department of Magnetic Resonance Imaging, Zhangqiu District People's Hospital, Jinan 250200, Shandong Province, China
Author contributions: Cao X and Wang JY designed and performed the research, and wrote the paper; Shi H designed the research and supervised the report; Zheng YX, Ge YP, and Cheng HC contributed to the analysis; Dou WQ, Zhao XY, and Geng DY provided clinical advice.
Supported by the Greater Bay Area Institute of Precision Medicine, No. KCH2310094; Shanghai Sailing Program, No. 22YF1405000; Research Startup Fund of Huashan Hospital Fudan University, No. 2021QD035; and Clinical Research Plan of SHDC, No. SHDC2020CR3020A.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Huashan Hospital and First Affiliated Hospital of Shandong First Medical University.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to protecting patient privacy.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jun-Ying Wang, MD, Doctor, Department of Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Province Qianfoshan Hospital, No. 66 Jingshi Road, Jinan 250014, Shandong Province, China.
jywang1120@163.com
Received: April 18, 2022
Peer-review started: April 18, 2022
First decision: July 14, 2022
Revised: July 29, 2022
Accepted: September 21, 2022
Article in press: September 21, 2022
Published online: October 27, 2022
Processing time: 190 Days and 2.4 Hours
BACKGROUND
Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality worldwide. Transcatheter arterial chemoembolization (TACE) has been performed as a palliative treatment for patients with HCC. However, HCC is easy to recur after TACE. Magnetic resonance imaging (MRI) has clinical potential in evaluating the TACE treatment effect for patients with liver cancer. However, traditional MRI has some limitations.
AIM
To explore the clinical potential of diffusion kurtosis imaging (DKI) in predicting recurrence and cellular invasion of the peritumoral liver zone of HCC after TACE.
METHODS
Seventy-six patients with 82 HCC nodules were recruited in this study and underwent DKI after TACE. According to pathological examinations or the overall modified response evaluation criteria in solid tumors (mRECIST) criterion, 48 and 34 nodules were divided into true progression and pseudo-progression groups, respectively. The TACE-treated area, peritumoral liver zone, and far-tumoral zone were evaluated on DKI-derived metric maps. Non-parametric U test and receiver operating characteristic curve (ROC) analysis were used to evaluate the prediction performance of each DKI metric between the two groups. The independent t-test was used to compare each DKI metric between the peritumoral and far-tumoral zones of the true progression group.
RESULTS
DKI metrics, including mean diffusivity (MD), axial diffusivity (DA), radial diffusivity (DR), axial kurtosis (KA), and anisotropy fraction of kurtosis (Fak), showed statistically different values between the true progression and pseudo-progression groups (P < 0.05). Among these, MD, DA, and DR values were higher in pseudo-progression lesions than in true progression lesions, whereas KA and FAk values were higher in true progression lesions than in pseudo-progression lesions. Moreover, for the true progression group, the peritumoral zone showed significantly different DA, DR, KA, and FAk values from the far-tumoral zone. Furthermore, MD values of the liver parenchyma (peritumoral and far-tumoral zones) were significantly lower in the true progression group than in the pseudo-progression group (P < 0.05).
CONCLUSION
DKI has been demonstrated with robust performance in predicting the therapeutic response of HCC to TACE. Moreover, DKI might reveal cellular invasion of the peritumoral zone by molecular diffusion-restricted change.
Core Tip: This study demonstrated feasible performance and advantages of diffusion kurtosis imaging metrics (i.e., mean diffusivity, axial diffusivity, radial diffusivity, axial kurtosis, and anisotropy fraction of kurtosis) in evaluating liver cancer and tumoral cell invasion of peritumoral zone between hepatocellular carcinoma progressive group and pseudo-progressive group after transcatheter arterial chemoembolization treatment.
