title: Quantitative 4D transcatheter intraarterial perfusion MRI for monitoring chemoembolization of hepatocellular carcinoma.
abstract: OBJECTIVE
  To develop a fully quantitative 4D transcatheter intraarterial perfusion (TRIP) magnetic resonance imaging (MRI) technique and prospectively test the hypothesis that quantitative 4D TRIP-MRI can be used clinically to monitor intraprocedural liver tumor perfusion reductions during transcatheter arterial chemoembolization (TACE).
  
  
  METHODS
  TACE was performed within an x-ray digital subtraction angiography (DSA)-MRI procedure suite in 16 patients with hepatocellular carcinoma. Quantitative 4D TRIP-MRI with targeted radiofrequency field mapping and dynamic longitudinal relaxation rate mapping was used to monitor changes in tumor perfusion during TACE. First-pass perfusion analysis was performed to produce intraprocedural blood flow (Frho) maps. Mean liver tumor perfusions before and after TACE were compared with a paired t-test (alpha = 0.05).
  
  
  RESULTS
  Perfusion reductions were successfully measured with quantitative 4D TRIP-MRI in 22 separate tumors during 18 treatment sessions. Mean tumor perfusion Frho decreased from 16.3 (95% confidence interval [CI]: 10.7-21.9) before TACE to 5.0 (95% CI: 3.5-6.5) (mL/min/100 mL) after TACE. Tumor perfusion reductions were statistically significant (P < 0.0005), with a mean absolute perfusion change of 11.4 (95% CI: 5.6-17.1) (mL/min/100 mL) and a mean percentage reduction of 61.0% (95% CI: 48.3%-73.6%).
  
  
  CONCLUSIONS
  Quantitative 4D TRIP-MRI can be successfully performed within clinical interventional settings to monitor intraprocedural changes in liver tumor perfusion during TACE.
authors.affiliation: Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
authors.forename: Dingxin
authors.initials: D
authors.lastname: Wang
authors.forename: Brian
authors.initials: B
authors.lastname: Jin
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Kent T
authors.initials: KT
authors.lastname: Sato
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Laura M
authors.initials: LM
authors.lastname: Kulik
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.forename: Debiao
authors.initials: D
authors.lastname: Li
authors.forename: Reed A
authors.initials: RA
authors.lastname: Omary
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Larson
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000628:therapy*; D002404:Catheterization; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents