Dynamic contrast-enhanced MRI benefits HCC

Dynamic contrast-enhanced MRI (DCE-MRI) is useful in not only quantifying the perfusion metrics of hepatocellular carcinoma (HCC) and liver parenchyma, but also assessing perfusion changes after HCC chemoembolization, according to a study published in the October issue of the American Journal of Roentgenology.

Angiogenesis is largely involved in the metastatic growth and progression of HCC, which is treated with transarterial chemoembolization (TACE) and systemic molecular targeted therapies. DCE-MRI, requiring IV injection of contrast agents, allows for the quantification of tissue and tumor’s vascular characteristics. This imaging technique can cover the entire liver with spatial and temporal resolution using a volumetric three-dimensional sequence, enabling assessment of multiple lesions and regional differences in liver parenchyma.

Little research has been conducted on DCE-MRI data assessing HCC lesions and cirrhosis. Bachir Taouli, MD, of New York’s Mount Sinai School of Medicine, and colleagues designed a study in which they reported their initial experience with DCE-MRI for perfusion quantification of HCC and the surrounding liver.

31 patients with HCC, ages 41 to 83, underwent DCE-MRI in this study. Regions of interest included the abdominal aorta, the portal vein, liver parenchyma and HCC lesions. Perfusion parameters were arterial flow, portal venous flow, arterial fraction, distribution volume and mean transit time (MTT). Two observers in consensus analyzed the data gathered from the DCE-MRIs of the study’s participants.

Results indicated that compared with liver parenchyma, HCC had a significantly higher arterial hepatic blood flow and arterial fraction, with a significantly lower distribution volume and portal venous hepatic blood flow. There was no difference found in MTT. Untreated HCCs had higher arterial fraction and lower portal venous hepatic blood flow value than chemoembolized HCCs.

“These results suggest that DCE-MRI can be used as a noninvasive marker of HCC angiogenesis and may potentially be useful for characterizing cirrhotic nodules and for predicting and monitoring response to TACE and targeted antiangiogenic drugs currently in use in HCC,” wrote Taouli and colleagues.