title: Does diffusion-weighted imaging improve therapy response evaluation in patients with hepatocellular carcinoma after radioembolization? comparison of MRI using Gd-EOB-DTPA with and without DWI.
abstract: OBJECTIVE
  To investigate whether additional diffusion-weighted imaging (DWI) improves therapy response evaluation by Gd-EOB magnetic resonance imaging (MRI) in hepatocellular carcinoma (HCC) after radioembolization.
  
  
  METHODS
  Fifty patients with radioembolization for HCC underwent gadobutrol and Gd-EOB MRI with DWI prior to and 30, 90, and 180 days after radioembolization. A combination of gadobutrol MRI, alpha-fetoprotein, and imaging follow-up served as the reference standard. Two radiologists reviewed Gd-EOB alone (Gd-EOB), DWI alone (DWI), and the combination of both (Gd-EOB+DWI) separately and in consensus using a 4-point-scale: 1 = definitely no tumor progression (TP), 2 = probably no TP, 3 = probably TP, 4 = definitely TP. Receiver operating characteristic (ROC) and kappa analysis were performed.
  
  
  RESULTS
  Kappa values for Gd-EOB, DWI, and Gd-EOB+DWI ranged between 0.712 and 0.892 (P < 0.001). 30 days after radioembolization three out of 38 patients showed TP, which was missed by DWI in one case. No significant area under the curve (AUC) difference between Gd-EOB (1.0, P = 0.004), DWI (0.881, P = 0.030), and Gd-EOB+DWI (1.0, P = 0.004) was found (P = 0.320). 90 days after radioembolization six out of 28 patients showed TP, which was detected in one patient only by DWI and Gd-EOB+DWI. The AUC did not differ significantly (P = 0.319) between Gd-EOB (0.890, P = 0.004), DWI (1.0, P < 0.001), and Gd-EOB+DWI (1.0, P < 0.001). 180 days after radioembolization five patients showed TP, which in one case was missed by DWI. The AUC did not differ significantly (P1 = 0.322, P2 = 0.369, P3 = 0.350) between Gd-EOB (1.0, P = 0.003), DWI (0.913, P = 0.016), and Gd-EOB+DWI (0.963, P = 0.007).
  
  
  CONCLUSIONS
  Additional DWI does not substantially improve therapy response evaluation by Gd-EOB MRI in HCC after radioembolization but proved helpful in single cases.
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Schelhorn
authors.affiliation: Department of Gastroenterology und Hepatology, University Hospital Essen, Essen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Best
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
authors.forename: Marcus P
authors.initials: MP
authors.lastname: Reinboldt
authors.affiliation: Department of Gastroenterology und Hepatology, University Hospital Essen, Essen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Dechêne
authors.affiliation: Department of Gastroenterology und Hepatology, University Hospital Essen, Essen, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.affiliation: Clinic of Nuclear Medicine, University Hospital Essen, Essen, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Ruhlmann
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Lauenstein
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany.
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Kinner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D003287:Contrast Media / Q000737:chemistry; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005260:Female; D019786:Gadolinium DTPA / Q000737:chemistry*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000737:chemistry; D012372:ROC Curve; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000737:chemistry
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D000509:alpha-Fetoproteins; C073590:gadolinium ethoxybenzyl DTPA; C090600:gadobutrol; D019786:Gadolinium DTPA
keywords: Gd-EOB-DTPA; diffusion-weighted imaging; hepatocellular carcinoma; magnetic resonance imaging; radioembolization