Share this content in WeChat
Experience Exchang
Application of magnetic resonance diffusion-weighted imaging in prognostic evaluation of microwave ablation of hepatocellular carcinoma
LIU Tiefang  ZANG Xiao  LI Meng  HU Jianxing  ZHANG Dekang  ZHANG Zhaohe 

Cite this article as: Liu TF, Zang X, Li M, et al. Application of magnetic resonance diffusion-weighted imaging in prognostic evaluation of microwave ablation of hepatocellular carcinoma[J]. Chin J Magn Reson Imaging, 2022, 13(6): 112-116. DOI:10.12015/issn.1674-8034.2022.06.022.

[Abstract] Objective To investigate the application value of magnetic resonance diffusion-weighted imaging (MR-DWI) in the prognostic assessment of patients with hepatocellular carcinoma (HCC) that underwent microwave ablation (MVA).Materials and Methods Sixty two consecutive patients with HCC treated by MVA in the Department of Interventional Ultrasound, PLA General Hospital from October 2016 to August 2017 [35 males, 25 females, age (57.8±3.56) years old] were retrospectively enrolled in our study. All patients underwent MR-DWI examination within 1 week before and after MVA, and regular follow-up. To analyze the value of DWI in the prognostic evaluation of MVA for HCC.Results A total of 73 lesions in 62 patients with primary liver cancer were completely ablated. During follow-up, 23 cases had early recurrence and metastasis (13 cases of local recurrence, 8 cases of intrahepatic metastasis, and 2 cases of extrahepatic metastasis). The area under the ROC curve of the apparent diffusion coefficient (ADC) and exponential apparent diffusion coefficient (eADC) for evaluating early recurrence and metastasis after microwave elimination are 0.901 and 0.875 respectively, and the best diagnostic cut-off value is 1.27×10-3 mm2/s (sensitivity: 93.1%, specificity: 90.6%), 0.364 (sensitivity: 87.9%, specificity: 89.5%); according to the follow-up results, the enrolled patients were divided into early recurrence group and no-early recurrence group. The ADC value of patients in no-early recurrence group [(1.43±1.52)×10-3 mm2/s] was significantly higher than that of the early recurrence and metastasis group [(1.15±0.94)×10-3 mm2/s] (P<0.05); eADC value in no-recurrence group (0.42±0.04) was significantly higher than that of early recurrence group (0.32±0.04), and the difference was statistically significant (P<0.05). Multivariate analysis showed that ADC value and eADC value and safety margin after ablation were independent predictors of recurrence-free survival (RFS) after MVA of liver cancer.Conclusions The preoperative ADC value and eADC value have certain clinical value in predicting the early recurrence and metastasis of liver cancer after MVA.
[Keywords] hepatocellular carcinoma;diffusion weighted imaging;exponential apparent diffusion coefficient;apparent diffusion coefficient;microwave ablation;recurrence-free survival;magnetic resonance imaging

LIU Tiefang1   ZANG Xiao1   LI Meng1   HU Jianxing1   ZHANG Dekang1   ZHANG Zhaohe2*  

1 Department of Medical Imaging, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China

2 Department of Interventional Ultrasound, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China

Zhang ZH, E-mail:

Conflicts of interest   None.

Received  2021-11-22
Accepted  2022-05-23
DOI: 10.12015/issn.1674-8034.2022.06.022
Cite this article as: Liu TF, Zang X, Li M, et al. Application of magnetic resonance diffusion-weighted imaging in prognostic evaluation of microwave ablation of hepatocellular carcinoma[J]. Chin J Magn Reson Imaging, 2022, 13(6): 112-116. DOI:10.12015/issn.1674-8034.2022.06.022.

Maucort-Boulch D, de Martel C, Franceschi S, et al. Fraction and incidence of liver cancer attributable to hepatitis B and C viruses worldwide[J]. Int J Cancer, 2018, 142(12): 2471-2477. DOI: 10.1002/ijc.31280.
Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015, 65(2): 87-108. DOI: 10.3322/caac.21262.
Shaghaghi M, Aliyari Ghasabeh M, Ameli S, et al. Post-TACE changes in ADC histogram predict overall and transplant-free survival in patients with well-defined HCC: a retrospective cohort with up to 10 years follow-up[J]. Eur Radiol, 2021, 31(3): 1378-1390. DOI: 10.1007/s00330-020-07237-2.
Sberna AL, Bouillet B, Rouland A, et al. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD) and European Association for the Study of Obesity (EASO) clinical practice recommendations for the management of non-alcoholic fatty liver disease: evaluation of their application in people with Type 2 diabetes[J]. Diabet Med, 2018, 35(3): 368-375. DOI: 10.1111/dme.13565.
Vogel A, Cervantes A, Chau I, et al. Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2019, 30(5): 871-873. DOI: 10.1093/annonc/mdy510.
Boas FE, Do B, Louie JD, et al. Optimal imaging surveillance schedules after liver-directed therapy for hepatocellular carcinoma[J]. J Vasc Interv Radiol, 2015, 26(1): 69-73. DOI: 10.1016/j.jvir.2014.09.013.
Jiang T, Xu JH, Zou Y, et al. Diffusion-weighted imaging (DWI) of hepatocellular carcinomas: a retrospective analysis of the correlation between qualitative and quantitative DWI and tumour grade[J]. Clin Radiol, 2017, 72(6): 465-472. DOI: 10.1016/j.crad.2016.12.017.
Zhang T, Huang ZX, Wei Y, et al. Hepatocellular carcinoma: can LI-RADS v2017 with gadoxetic-acid enhancement magnetic resonance and diffusion-weighted imaging improve diagnostic accuracy?[J]. World J Gastroenterol, 2019, 25(5): 622-631. DOI: 10.3748/wjg.v25.i5.622.
Young S, Golzarian J. Locoregional therapies in the treatment of 3- to 5-cm hepatocellular carcinoma: critical review of the literature[J]. AJR Am J Roentgenol, 2020, 215(1): 223-234. DOI: 10.2214/AJR.19.22098.
Joo I, Morrow KW, Raman SS, et al. CT-monitored minimal ablative margin control in single-session microwave ablation of liver tumors: an effective strategy for local tumor control[J/OL]. Eur Radiol, 2022 [2022-5-23]. DOI: 10.1007/s00330-022-08723-5.
Yoon JH, Lee JM, Klotz E, et al. Prediction of local tumor progression after radiofrequency ablation (RFA) of hepatocellular carcinoma by assessment of ablative margin using pre-RFA MRI and post-RFA CT registration[J]. Korean J Radiol, 2018, 19(6): 1053-1065. DOI: 10.3348/kjr.2018.19.6.1053.
Teng W, Liu KW, Lin CC, et al. Insufficient ablative margin determined by early computed tomography may predict the recurrence of hepatocellular carcinoma after radiofrequency ablation[J]. Liver Cancer, 2015, 4(1): 26-38. DOI: 10.1159/000343877.
Gao ZH, Liu C, Wang YM, et al. Evaluation of ADC and eADC values of MR diffusion weighted imaging on the biological behaviors of hepatocellular carcinoma[J]. J Clin Radiol, 2012, 31(11): 1587-1590. DOI: 10.13437/j.cnki.jcr.2012.11.009.
Kierans AS, Elazzazi M, Braga L, et al. Thermoablative treatments for malignant liver lesions: 10-year experience of MRI appearances of treatment response[J]. AJR Am J Roentgenol, 2010, 194(2): 523-529. DOI: 10.2214/AJR.09.2621.
Gluskin JS, Chegai F, Monti S, et al. Hepatocellular carcinoma and diffusion-weighted MRI: detection and evaluation of treatment response[J]. J Cancer, 2016, 7(11): 1565-1570. DOI: 10.7150/jca.14582.
Rimola J, Forner A, Sapena V, et al. Performance of gadoxetic acid MRI and diffusion-weighted imaging for the diagnosis of early recurrence of hepatocellular carcinoma[J]. Eur Radiol, 2020, 30(1): 186-194. DOI: 10.1007/s00330-019-06351-0.
Hoffmann R, Rempp H, Schraml C, et al. Diffusion-weighted imaging during MR-guided radiofrequency ablation of hepatic malignancies: analysis of immediate pre- and post-ablative diffusion characteristics[J]. Acta Radiol, 2015, 56(8): 908-916. DOI: 10.1177/0284185114545148.
Schraml C, Schwenzer NF, Clasen S, et al. Navigator respiratory-triggered diffusion-weighted imaging in the follow-up after hepatic radiofrequency ablation-initial results[J]. J Magn Reson Imaging, 2009, 29(6): 1308-1316. DOI: 10.1002/jmri.21770.
Suh YJ, Kim MJ, Choi JY, et al. Preoperative prediction of the microvascular invasion of hepatocellular carcinoma with diffusion-weighted imaging[J]. Liver Transpl, 2012, 18(10): 1171-1178. DOI: 10.1002/lt.23502.
Izzo F, Granata V, Grassi R, et al. Radiofrequency ablation and microwave ablation in liver tumors: an update[J]. Oncologist, 2019, 24(10): e990-e1005. DOI: 10.1634/theoncologist.2018-0337.
Ye WC, Chen CM, Wu XL, et al. Correlation analysis between short-term invasive recurrence and functional MRI after radiofrequency ablation of hepatocellular carcinoma[J]. Chin J Radiol, 2020, 54(1): 28-32. DOI: 10.3760/cma.j.issn.1005-1201.2020.01.006.
Lee S, Kim SH, Hwang JA, et al. Pre-operative ADC predicts early recurrence of HCC after curative resection[J]. Eur Radiol, 2019, 29(2): 1003-1012. DOI: 10.1007/s00330-018-5642-5.
An C, Wu SS, Huang ZM, et al. A novel nomogram to predict the local tumor progression after microwave ablation in patients with early-stage hepatocellular carcinoma: a tool in prediction of successful ablation[J]. Cancer Med, 2020, 9(1): 104-115. DOI: 10.1002/cam4.2606.
Bonekamp S, Jolepalem P, Lazo M, et al. Hepatocellular carcinoma: response to TACE assessed with semiautomated volumetric and functional analysis of diffusion-weighted and contrast-enhanced MR imaging data[J]. Radiology, 2011, 260(3): 752-761. DOI: 10.1148/radiol.11102330.
Laimer G, Schullian P, Jaschke N, et al. Minimal ablative margin (MAM) assessment with image fusion: an independent predictor for local tumor progression in hepatocellular carcinoma after stereotactic radiofrequency ablation[J]. Eur Radiol, 2020, 30(5): 2463-2472. DOI: 10.1007/s00330-019-06609-7.
Notarpaolo A, Layese R, Magistri P, et al. Validation of the AFP model as a predictor of HCC recurrence in patients with viral hepatitis-related cirrhosis who had received a liver transplant for HCC[J]. J Hepatol, 2017, 66(3): 552-559. DOI: 10.1016/j.jhep.2016.10.038.

PREV A comparison of the Kaiser score and apparent diffusion coefficient mapping in the assessment of breast lesions
NEXT The differential diagnosis value of quantitative parameters of hepatobiliary phase from Gd-EOB-DTPA enhanced MRI in differentiating benign biliary strictures from malignant strictures

Tel & Fax: +8610-67113815    E-mail: