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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
ARTICLE HIGHLIGHTS
Research background
Transcatheter arterial chemoembolization (TACE) has been used to treat patients with hepatocellular carcinoma (HCC) as a palliative therapy. Nevertheless, HCC is prone to recur after TACE. Traditional anatomical MRI has certain limitations in assessing recurrence. Diffusion kurtosis imaging (DKI) provides a detailed depiction of the microstructural environment. Whether DKI-derived metrics can provide clinical feasibility in predicting HCC recurrence and cellular invasion of the peritumoral liver zone after TACE remains to be a concern.
Research motivation
To investigate the clinical use of DKI in predicting recurrence and cellular invasion of HCC in the peritumoral liver zone after TACE.
Research objectives
In this study, 76 patients with 82 hepatic cancer nodules were enrolled and underwent DKI after TACE. Forty-eight and 34 nodules were divided into two groups: True progression and pseudo-progression, respectively.
Research methods
DKI-derived metric maps were used to assess the TACE-treated area, peritumoral liver zone, and far-tumoral zone. To compare the prediction performance of each DKI metric between the true progression and pseudo-progression groups, the non-parametric U test and receiver operating characteristic curve (ROC) analysis were performed. The independent t-test was utilized to compare each DKI metric between the peritumoral and far-tumoral zones in the true progression group.
Research results
DKI metrics, including mean diffusivity (MD), axial diffusivity (DA), radial diffusivity (DR), axial kurtosis (KA), and anisotropy fraction of kurtosis (Fak), exhibited significantly different values between the true progression and pseudo-progression groups, respectively (P < 0.05). Furthermore, the peritumoral zone had substantially different DA, DR, KA, and FAk values than the far-tumoral zone in the true progression group. Additionally, MD values of the liver parenchyma (peritumoral and far-tumoral zones) were substantially lower in the true progression group compared to the pseudo-progression group (P < 0.05).
Research conclusions
DKI has been shown to predict the therapeutic response of HCC to TACE with high accuracy. Furthermore, DKI may indicate cellular invasion of the peritumoral zone by molecular diffusion-restricted change.
Research perspectives
This study systematically investigated the clinical feasibility of all DKI-derived metrics in predicting recurrence and cellular invasion of the peritumoral liver zone of HCC after TACE, providing an accurate evaluation method to help guide subsequent therapeutic planning in clinical practice for patients with HCC after TACE.
