title: The Role of Diffusion-Weighted Imaging (DWI) in Locoregional Therapy Outcome Prediction and Response Assessment for Hepatocellular Carcinoma (HCC): The New Era of Functional Imaging Biomarkers.
abstract: Reliable response criteria are critical for the evaluation of therapeutic response in hepatocellular carcinoma (HCC). Current response assessment is mainly based on: (1) changes in size, which is at times unreliable and lag behind the result of therapy; and (2) contrast enhancement, which can be difficult to quantify in the presence of benign post-procedural changes and in tumors presenting with a heterogeneous pattern of enhancement. Given these challenges, functional magnetic resonance imaging (MRI) techniques, such as diffusion-weighted imaging (DWI) have been recently investigated, aiding specificity to locoregional therapy response assessment and outcome prediction. Briefly, DWI quantifies diffusion of water occurring naturally at a cellular level (Brownian movement), which is restricted in multiple neoplasms because of high cellularity. Disruption of cellular integrity secondary to therapy results in increased water diffusion across the injured membranes. This review will provide an overview of the current literature on DWI therapy response assessment and outcome prediction in HCC following treatment with locoregional therapies.
authors: Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT 06510, USA. johannes.ludwig@yale.edu.
authors: Johannes M
authors: JM
authors: Ludwig
authors: Division of Interventional Radiology and Image-guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA. juan.camacho@emory.edu.
authors: Juan C
authors: JC
authors: Camacho
authors: Division of Interventional Radiology and Image-guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA. nima.kokabi@emory.edu.
authors: Nima
authors: N
authors: Kokabi
authors: Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT 06510, USA. minzhi.xing@yale.edu.
authors: Minzhi
authors: M
authors: Xing
authors: Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT 06510, USA. kevin.kim@yale.edu.|Yale Cancer Center, Yale School of Medicine, New Haven, CT 06519, USA. kevin.kim@yale.edu.
authors: Hyun S
authors: HS
authors: Kim
keywords: diffusion-weighted MRI (magnetic resonance imaging); hepatocellular carcinoma; imaging biomarker; locoregional therapies; therapy outcome