Significance of the Signal Intensity of Gadoxetic Acid-enhanced MR Imaging for Predicting the Efficacy of Hepatic Arterial Infusion Chemotherapy in Hepatocellular Carcinoma.
OBJECTIVE
We attempted to clarify the relationship between the signal intensity (SI) in the hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance (MR) imaging and the efficacy of hepatic arterial infusion chemotherapy (HAIC) in hepatocellular carcinomas (HCCs).


METHODS
We enrolled 14 patients with HCCs who underwent gadoxetic acid-enhanced MR imaging prior to HAIC using cisplatin and 5-fluorouracil. In the hepatobiliary phase, we calculated the SI of the HCCs and the background liver. In cases with multiple HCCs, we calculated the SI of the largest lesion. Patients were classified into high (n = 7) and low intensity (n = 7) groups based on the median value of the SI ratio (SI of the tumor/SI of the background liver). We analyzed progression-free survival using the Kaplan-Meier method and the log-rank test. In the 5 patients with a history of HCC surgery, we compared the expression of immunohistochemical organic anion-transporting polypeptide (OATP) 8 between the high and low intensity groups by chi-square test.


RESULTS
The SI ratios were 0.568 ± 0.093 (mean ± standard deviation) in the high intensity group and 0.251 ± 0.086 in the low intensity group. Compared to the group with low signal intensity, the group with high signal intensity demonstrated significantly lower serum levels of alpha fetoprotein (AFP) (P = 0.0350), significantly higher progression-free survival (P = 0.0108), better differentiation of tumor grade at histologic examination (P = 0.0253), and significantly higher OATP8 expression (P = 0.0253).


CONCLUSIONS
Patients with HCCs of high SI ratio in the hepatobiliary phase of gadoxetic acid-enhanced MR imaging can respond better to HAIC.
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University.
Nobuhiro
N
Fujita
Akihiro
A
Nishie
Yoshiki
Y
Asayama
Kousei
K
Ishigami
Yasuhiro
Y
Ushijima
Yukihisa
Y
Takayama
Daisuke
D
Okamoto
Koichiro
K
Morita
Ken
K
Shirabe
Kazuhiro
K
Koto
Yuichiro
Y
Kubo
Yoshinao
Y
Oda
Hiroshi
H
Honda
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003287:Contrast Media; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005544:Forecasting; D019786:Gadolinium DTPA; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods; D015918:Infusion Pumps, Implantable; D008113:Liver Neoplasms / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D029362:Organic Anion Transporters, Sodium-Independent / Q000032:analysis / Q000187:drug effects; D012189:Retrospective Studies; D000074542:Solute Carrier Organic Anion Transporter Family Member 1B3; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis / Q000187:drug effects
C097353:AFP protein, human; D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D003287:Contrast Media; D029362:Organic Anion Transporters, Sodium-Independent; C421209:SLCO1B3 protein, human; D000074542:Solute Carrier Organic Anion Transporter Family Member 1B3; D000509:alpha-Fetoproteins; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA; D002945:Cisplatin; D005472:Fluorouracil