title: Dynamic Contrast-enhanced MR Imaging of Advanced Hepatocellular Carcinoma: Comparison with the Liver Parenchyma and Correlation with the Survival of Patients Receiving Systemic Therapy.
abstract: Purpose To retrospectively compare the perfusion parameters of advanced hepatocellular carcinoma (HCC) measured with dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging with surrounding liver parenchyma to determine the relationship between these parameters and uncensored overall survival (OS). Materials and Methods This retrospective study had institutional review board approval, and informed consent was waived. DCE MR imaging was performed in 92 patients with advanced HCC before systemic treatment was administered (19 patients received a placebo). Three semiquantitative (peak, slope, and area under the gadolinium concentration-time curve [AUC]) and six quantitative (arterial fraction, arterial flow, portal flow, total blood flow, distribution volume, and mean transit time) parameters were calculated by placing regions of interest in the largest area of the tumor and background liver parenchyma. The DCE MR imaging parameters between the tumor and normal liver were compared with paired Wilcoxon test. By using the Cox proportional hazards model for univariate and multivariate analyses, the association of DCE MR imaging parameters and OS was investigated. Results HCC demonstrated significantly higher peak, slope, AUC, arterial fraction, and arterial flow but lower portal flow, distribution volume, and mean transit time than did the background liver (all P < .05). Patients with high peak in the tumor had longer OS (P = .005) than did those with low peak. Cox multivariate analysis identified peak as an independent predictor of OS (P = .032) after adjusting for age, sex, treatment, tumor size, and portal vein thrombosis. Conclusion DCE MR imaging parameters can be used to differentiate advanced HCC from the background liver, and peak, a semiquantitative parameter, is associated with outcome in patients with advanced HCC before systemic therapy.©RSNA, 2016 An earlier incorrect version of this article appeared online. This article was corrected on July 22, 2016.
authors.affiliation: From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.).
authors.forename: Bang-Bin
authors.initials: BB
authors.lastname: Chen
authors.affiliation: From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.).
authors.forename: Chao-Yu
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.).
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yu
authors.affiliation: From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.).
authors.forename: Po-Chin
authors.initials: PC
authors.lastname: Liang
authors.affiliation: From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.).
authors.forename: Chiun
authors.initials: C
authors.lastname: Hsu
authors.affiliation: From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.).
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Hsu
authors.affiliation: From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.).
authors.forename: Ann-Lii
authors.initials: AL
authors.lastname: Cheng
authors.affiliation: From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.).
authors.forename: Tiffany Ting-Fang
authors.initials: TT
authors.lastname: Shih
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D003287:Contrast Media; D019786:Gadolinium DTPA; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA