Can DKI-MRI predict recurrence and invasion of peritumoral zone of hepatocellular carcinoma after transcatheter arterial chemoembolization?

Figure 1 Flowchart of patient enrollment. n: Number of cases; TACE: Transcatheter arterial chemoembolization; mRECIST: Modified response evaluation criteria in solid tumors; DSA: Digital subtraction angiography.

Figure 2 Representative maps of transcatheter arterial chemoembolization-treated and recurrent hepatocellular carcinoma foci. The patient was a 46-year-old man with transcatheter arterial chemoembolization-treated and recurrent hepatocellular carcinoma foci. A: Diffusion map with b = 0 s/mm²; B: Maps of mean kurtosis (MK); C: Maps of mean diffusivity (MD); D: Maps of radial kurtosis (KR); E: Maps of axial kurtosis (KA); F: Maps of axial diffusivity (DA); G: Maps of radial diffusivity (DR); H: Maps of anisotropy coefficient of kurtosis (FAk). In the first map (A), the region of interest (ROI) (1) corresponds to the arrow pointing to a new lesion. The peritumoral zone (distance < 2 cm) refers to ROI (2) (red circle), and far-tumoral zone (diameter > 5 cm) refers to ROI (3) (green square).

Figure 3 Receiver operating characteristic curves of diffusion kurtosis imaging metric in predicting recurrence. AUC value greater than 0.7 indicates a higher diagnostic value. A: Mean diffusivity; B: Mean kurtosis; C: Anisotropy coefficient of kurtosis; D: Axial kurtosis; E: Radial kurtosis; F: Axial diffusivity; G: Radial diffusivity. FAk: Anisotropy coefficient of kurtosis; ROC: Receiver operating characteristic curve; MD: Mean diffusivity; MK: Mean kurtosis; KA: Axial kurtosis; KR: Radial kurtosis; DA: Axial diffusivity; DR: Radial diffusivity.

Figure 4 Box plots showing diffusion kurtosis imaging derived metrics of peritumoral zones between true and pseudo-progressing groups. A: Mean kurtosis (MK); B: Axial kurtosis (KA); C: Radial kurtosis (KR); D: Mean diffusivity (MD); E: Axial diffusivity (DA); F: Radial diffusivity (DR); G: Anisotropy coefficient of kurtosis (FAk). ^aP < 0.05; the unit of MD, DA, and DR is 10^-3 mm²/s. N = pseudo-progressing group; Y = true progressing group. FAk: Anisotropy coefficient of kurtosis; MD: Mean diffusivity; MK: Mean kurtosis; KA: Axial kurtosis; KR: Radial kurtosis; DA: Axial diffusivity; DR: Radial diffusivity.