Published online Jun 15, 2026. doi: 10.4251/wjgo.v18.i6.116770
Revised: January 15, 2026
Accepted: March 3, 2026
Published online: June 15, 2026
Processing time: 178 Days and 18 Hours
Hepatocellular carcinoma (HCC) is a common malignant tumor. Early diagnosis and treatment are crucial for improving patient prognosis. Interventional therapy is an important treatment method for HCC. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), an effective imaging assessment technique, can monitor changes in tumor blood flow in real time and provide important in
To determine the clinical effectiveness of diffusion-weighted imaging (DWI) in conjunction with DCE-MRI in evaluating the therapeutic response to interventional therapy for HCC.
Between February 2023 and March 2024, 120 HCC patients who received interventional therapy at First Affiliated Hospital of Naval Military Medical University were retrospectively analyzed. Patients were divided into two groups: (1) 71 received effective treatment; and (2) 49 received ineffective treatment. Fifty-two males and 19 females, with an average age of 53.16 ± 8.47 years, composed the effective group. The mean age of the ineffective group, which consisted of 18 females and 31 males, was 53.21 ± 8.69 years. All patients had regular MRI, DCE-MRIs, and DWIs taken before and three weeks after the intervention. The tumor volume, extracellular volume fraction (Ve), transport constant (Ktrans), apparent diffusion coefficient (ADC), and rate constant (Kep) are among the important imaging parameters that were examined.
The ADC significantly increased to (1.23 ± 0.14) × 10-3 mm2/second (t = 10.970, P < 0.05), the tumor volume decreased to 10.67 ± 2.48 cm3 (t = 26.683, P < 0.05), the Ktrans significantly decreased to 0.18 ± 0.07 minute-1 (t = 9.090, P < 0.05), the Kep significantly decreased to 0.31 ± 0.06 minute-1 (t = 11.829, P < 0.05), and the Ve significantly increased to 0.40 ± 0.05 (t = 6.252, P < 0.05) following the intervention. The ADC [(0.35 ± 0.08) × 10-3 mm2/second], Ktrans (0.24 ± 0.06 minute-1), Kep (0.47 ± 0.12 minute-1), Ve (0.46 ± 0.13), and tumor volume (10.57 ± 2.34 cm3) substantially differed between the effective treatment group and the ineffective group (all P < 0.05). According to the receiver operating characteristic (ROC) analysis, therapeutic success was predicted by an ADC difference greater than 0.380 × 10-3 mm2/second, with an area under the ROC curve of 0.953 (95%CI: 0.898-0.983, P < 0.001), a sensitivity of 91.84%, and a specificity of 91.55%. With a sensitivity and specificity of 89.80% and 88.73%, respectively, an area under the ROC curve of 0.933 (95%CI: 0.872-0.970, P < 0.001) was obtained for a Ktrans difference greater than 0.250 minute-1.
There is substantial clinical relevance in combining DCE-MRI with DWI to assess how well HCC patients respond to interventional treatments. For patients with HCC, changes in imaging parameters before and after treatment offer objective information that shows the effectiveness of the therapy and can direct future clinical management and treatment planning.
Core Tip: To evaluate the efficacy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in interventional therapy for hepatocellular carcinoma (HCC). DCE-MRI, as an advanced imaging technique, can provide dynamic infor
- Citation: Huang YH, Liu XL, Yang Z. Evaluating the efficacy of interventional hepatocellular carcinoma via dynamic contrast-enhanced magnetic resonance imaging: A retrospective study. World J Gastrointest Oncol 2026; 18(6): 116770
- URL: https://www.wjgnet.com/1948-5204/full/v18/i6/116770.htm
- DOI: https://dx.doi.org/10.4251/wjgo.v18.i6.116770
Mostly hepatocellular carcinoma (HCC), primary liver cancer (HCC) is a malignant tumor of the digestive system[1-3]. Owing to the rapid progression and limited patient survival time of this disease, it becomes more difficult to treat and poses a major risk to patients’ lives. The various stages of liver cancer determine whether a patient should receive nonsurgical or surgical treatment; interventional treatment is typically utilized for patients with middle and advanced liver cancer who are unable to have their malignancy surgically removed[4]. After treatment, a thorough assessment of the therapeutic benefits might help direct the subsequent course of treatment. Currently, therapeutic benefits are fre
As a result, DCE-MRI in conjunction with DWI offers substantial benefit when assessing the effectiveness of treatments for patients with liver cancer. This research offers a theoretical foundation for clinical practice and focuses on the application value of DCE-MRI in conjunction with DWI in assessing the effectiveness of interventional therapy for liver cancer.
According to varying therapeutic effects, data from 120 patients who received interventional therapy for liver cancer at First Affiliated Hospital of Naval Military Medical University between February 2023 and March 2024 were gathered for a retrospective study. These patients were split into an effective group (71 patients) and an ineffective group (49 patients). Fifty-two men and 19 women between the ages of 41 years and 65 years (53.16 ± 8.47) composed the effective group. Among the patients, 26 had viral hepatitis, and 45 had cirrhosis. Among the patients with liver cancer, 34 had stage IIb illness, 29 had stage IIIa disease, and 8 had stage IIIb disease.
Eighteen females and 31 males between the ages of 41 years and 64 years (53.21 ± 8.69) were included in the invalid group. Twenty-two individuals had viral hepatitis, while 27 patients had cirrhosis.
Twenty-three patients had stage IIb liver cancer, 19 had stage IIIan liver cancer, and 7 had stage IIIb liver cancer[8].
Informed consent was given by the patients and their families, and the study was authorized by the Institutional Review Board of First Affiliated Hospital of Naval Military Medical University (No. SSZ20249-20).
MRI, arteriography, tumor marker analysis, and other tests can be used to validate symptoms, including liver discomfort, weakness, and wasting.
Inclusion criteria: (1) Aged 40-65 years; (2) Had numerous nodular liver malignancies with a survival duration of more than three months; (3) Had comprehensive medical records; and (4) Met the diagnostic criteria for concurrent interventional therapy mentioned above.
Exclusion criteria: (1) Inability to completely comply with the investigation; (2) Severe liver dysfunction or renal insufficiency; (3) History of drug allergy; (4) Severe heart or lung illness; and (5) Total blockage of the hepatic portal vein and fewer collateral veins.
Prior to and three weeks following the intervention, all patients underwent MRI examinations via a Siemens, Germany-made Verio 3.0T. Table 1 displays the primary scanning parameters, and the instrument’s relative standard deviation was 3%. DWI sequences were employed after routine T1-weighted image and T2-weighted image scans. The contrast agent glucumine gadoterate (377 mg/mL) was given intravenously during DCE-MRI, and the diffusion gradient factor (b value) was between 0 second/mm2 and 1000 second/mm2. With a high-pressure syringe, 20 mL (GUERBET, France, No. H20110120) was injected at a rate of 2 mL/second.
| Time | Apparent diffusion coefficient value | Transport constant (minute-1) | Rate constant (minute-1) | Volume fraction | Tumor volume (cm3) |
| Preoperative intervention | 0.89 ± 0.13 | 0.36 ± 0.10 | 0.62 ± 0.15 | 0.57 ± 0.16 | 21.03 ± 3.42 |
| After intervention surgery | 1.23 ± 0.14 | 0.18 ± 0.07 | 0.31 ± 0.06 | 0.40 ± 0.05 | 10.67 ± 2.48 |
| t value | 10.970 | 9.090 | 11.829 | 6.252 | 26.863 |
| P value | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Following the injection of the contrast agent, 20 milliliters of 0.9% sodium chloride were administered, and 32P was continuously collected for a total scanning duration of 320 seconds.
The image was sent to the instrument workstation for analysis following the DCE-MRI scan. The image correction procedure is used to correct the swing difference and remove the incorrect phase after the region of interest of the observation target has been established. The rate constant (Kep), volume transfer constant, and apparent diffusion coefficient (ADC), tumor volume, and the extracellular vascular space volume fraction (Ve) were determined. Two region of interest regions were chosen from the lesion’s center, and the average values of the two regions were calculated. Two senior physicians reviewed the pictures of 120 patients before and after treatment. Calculations were made before and two weeks after surgery to compare the ADC, transport constant (Ktrans), Kep, Ve, and tumor volume.
The effectiveness of interventional liver cancer treatment is assessed via the European Association for the Study of the Liver, and modified Response Evaluation Criteria in Solid Tumors. If the lesion disappears, the lesion’s total diameter decreases by more than 30%, and if the lesion decreases by less than 30% and increases by less than 20%, then the evaluation criteria are considered effective. It was deemed ineffective if the lesion’s overall diameter increased by more than 20% or if new lesions were added.
Comparisons between groups were made via independent sample t tests, whereas comparisons before and after therapy were made via paired t-tests. The relationships between the ADC, Ktrans, Kep, Ve, and tumor volume differences were examined via Pearson correlation analysis, and a value of P < 0.05 was considered statistically significant. The area under the receiver operating characteristic (ROC) curve represents the difference in the ADC, Ktrans, Kep, and Ve when as
The postoperative ADC values were greater than the preoperative values, whereas the tumor volume and the Ktrans, Kep, and Ve values were lower (all P < 0.05; Table 1).
By comparing and analyzing the parameter changes in DCE-MRI and DWI in patients with HCC before and after interventional therapy, significant changes in imaging features were revealed. After treatment, a clear and statistically significant change pattern was generally presented: (1) The ADC value, which reflects the diffusion ability of water molecules, increased significantly; and (2) The tumor volume reflecting the tumor burden was significantly reduced. In terms of DCE-MRI parameters related to vascular function, both the Ktrans, which characterizes the rate at which the contrast agent enters the interstitial space from the blood vessels, and the Kep, which reflects the rate at which the contrast agent reflukes back into the blood vessels from the interstitial space, have decreased significantly. However, the Ve value, which represents the Ve of the extracellular space outside the blood vessels, increased significantly. These parameters also significantly differed between the effective treatment group and the ineffective treatment group. There is a significant positive correlation between the amplitude of parameter changes, especially the strongest correlation between the changes in the ADC and Ktrans.
Total 49 (40.83%) of the 120 patients received unsuccessful treatment, whereas 71 (59.17%) received effective treatment. The changes in the ADC, Ktrans, Kep, Ve, and tumor volume were considerably greater in the effective treatment group than in the ineffective treatment group (all P < 0.05; Table 2).
| Group | Number of cases | Apparent diffusion coefficient difference | Transport constant difference (minute-1) | Rate constant difference | Volume fraction difference | Tumor volume difference (cm3) |
| Effective group | 71 | 0.34 ± 0.08 | 0.24 ± 0.06 | 0.47 ± 0.12 | 0.46 ± 0.13 | 10.57 ± 2.34 |
| Ineffective group | 49 | 0.14 ± 0.03 | 0.13 ± 0.02 | 0.18 ± 0.04 | 0.19 ± 0.05 | 2.86 ± 0.45 |
| t value | 17.525 | 12.355 | 16.285 | 13.835 | 22.747 | |
| P value | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Among patients with HCC who received interventional therapy, there were significant differences in the changes in key DCE-MRI and DWI parameters between the effective treatment group and the ineffective treatment group. The ADC, which reflects the ability of tumor tissues to diffuse water molecules, was significantly greater in the effective group than in the ineffective group. In terms of vascular function-related parameters, the decrease in the Ktrans of the contrast agent from the blood vessel to the interstitial space and the decrease in the Kep of the contrast agent returning from the interstitial space to the blood vessel in the effective group were significantly greater than those in the ineffective group. Moreover, the variation range of the extracellular space Ve outside the blood vessels in the effective group was also significantly different from that in the ineffective group. In addition, the degree of lesion volume reduction reflecting the tumor burden was significantly different between the two groups.
The difference in tumor volume was positively related to the ADC, Ktrans, Kep, and Ve (all P < 0.05; Figure 1 and Table 3).
| Index | Tumor volume difference | |
| R value | P value | |
| Apparent diffusion coefficient difference | 0.474 | < 0.001 |
| Transport constant difference | 0.495 | < 0.001 |
| Rate constant difference | 0.375 | < 0.001 |
| Volume fraction difference | 0.365 | < 0.001 |
By analyzing the relationships between changes in DCE-MRI parameters (Ktrans, Kep, extravascular extracellular space Ve) and DWI parameters (ADC) and changes in tumor volume in patients with HCC before and after interventional therapy, a significant positive correlation pattern was found. The changes in all the key imaging functional parameters (ADC, Ktrans, Kep, Ve) evaluated before and after treatment were positively correlated with each other. Notably, changes in the ADC, which reflects the diffusion capacity of tissue water molecules, are most closely correlated with changes in Ktrans, which reflects the permeability of microvessels. In addition, there is a significant positive correlation between the changes in these functional parameters reflecting the microscopic environment of tumor tissues (such as cell density, vascular function, and the extracellular space) and the degree of tumor volume reduction, which is a structural indicator reflecting the macroscopic tumor burden. This collaborative correlation pattern of multidimensional imaging parameter changes indicates that the reduction in tumor volume after interventional therapy is accompanied by characteristic microstructure and functional changes, which jointly reflect the effective biological effect of the treatment and support the combined application of the functional and structural parameters of DCE-MRI and DWI to comprehensively evaluate the efficacy of interventional therapy for liver cancer.
The area under the ROC curve (AUC) was 0.953, and the 95%CI: 0.898-0.983 (P < 0.001) when the ADC difference was greater than 0.380 × 10-3 mm2/second. The ROC AUC was 0.933 (95%CI: 0.872-0.970, P < 0.001) when the Ktrans difference exceeded 0.250 minute-1. In predicting the curative impact of interventional hepatocellular cancer, the ADC and Ktrans differences had sensitivities and specificities of 91.84% and 89.80%, respectively, and 91.55% and 88.73%, respectively (P < 0.05; Table 4).
| Index | Cutoff | Area under the receiver operating characteristic curve | 95%CI | Youden index | Sensitivity (%) | Specificity (%) | P value |
| Apparent diffusion coefficient difference | > 0.380 × 10-3 mm2/second | 0.953 | 0.898-0.983 | 0.835 | 91.84 | 91.55 | < 0.001 |
| Transport constant difference | > 0.250 minute-1 | 0.933 | 0.872-0.970 | 0.785 | 89.80 | 88.73 | < 0.001 |
The analysis of the changes in imaging parameters confirmed that the changes in the ADC and the Ktrans of DCE-MRI after interventional therapy for HCC have important predictive value for the therapeutic effect. The degree of increase in the ADC value and the degree of decrease in the Ktrans value after treatment can effectively distinguish between patients with effective treatment and those with ineffective treatment. Among them, those with a greater increase in the ADC value and a greater decrease in the Ktrans value are more likely to belong to the effective treatment group. ROC curve analysis indicated that the change in the ADC, as a single predictive indicator, could achieve excellent discriminative efficacy, and its accuracy in distinguishing the success or failure of treatment was extremely high. Similarly, the change in Ktrans, an independent predictor, also demonstrated outstanding discriminatory ability. The prediction performance of the changes in these two parameters is significantly better than that of the other imaging indicators. The combined application of ADC and Ktrans changes can further optimize the prediction model. The synergistic effects of these compounds can more comprehensively and accurately capture the response characteristics of the tumor microenvironment (e.g., changes in cell density and vascular function) to treatment. This discovery demonstrated that the quantitative changes in the ADC and Ktrans after interventional therapy provide sensitive and reliable imaging biomarkers for early noninvasive efficacy prediction.
Patients whose advanced liver cancer cannot be removed and who relapse following surgery are eligible for interventional therapy for liver cancer[12]. Through drug perfusion and tumor blood vessel embolization, the tumor cells’ blood supply is cut off, causing them to become necrotic and shrink. After interventional therapy, the stage of liver cancer in certain patients can be reversed, and incurable lesions can become resectable[13-15].
Thus, it is crucial to assess the early curative efficacy of interventional surgery for HCC to increase patients’ quality of life. There is not yet a single, accepted way to assess the curative effect of an interventional procedure.
The three primary techniques are imaging examination, survival analysis, and alpha-fetoprotein reexamination. The long survival periods and sizable sample sizes make survival analysis appropriate for case studies. Alpha-fetoprotein is a frequently used laboratory reference measure that has low accuracy and several affecting factors[16-18]. Clinical practice makes extensive use of imaging tests such as MRI, computed tomography, digital subtraction angiography, and ultrasound[19]. The modified Response Evaluation Criteria in Solid Tumors and European Association for the Study of the Liver criteria for solid tumors are frequently used to assess the clinical effectiveness of HCC following interventional intervention, and imaging tests can provide more precise estimates of the size of tumor lesions[20-24]. DWI makes use of MRI sensitivity to show that when the magnetic field gradient is enhanced, water molecules diffuse and cause the transverse magnetization vector to leave the phase, producing a low-signal image[25-28].
DWI may be utilized to investigate the pathophysiological status of diseases at the cellular and molecular levels and is currently the only technique available for measuring the dispersion of water molecules in vivo[29-31].
Compared with computed tomography and ultrasound, DWI has the advantages of objectivity and not requiring radiation, and it can assess the effectiveness of interventions for HCC both subjectively and quantitatively[32-35].
In this investigation, the ADC, Ktrans, Kep, and Ve were greater in the effective treatment group than in the ineffective group. The differences in the ADC, Ktrans, Kep, and Ve were positively correlated with the difference in tumor volume before and after intervention. These findings suggest that the more pronounced the changes in ADC, Ktrans, Kep, and Ve before and after treatment are, the greater the change in tumor volume.
The better the reaction to therapy. The ADC value is useful for assessing early curative effects following HCC intervention and can quantitatively reflect the extent of tumor tissue necrosis. The elevated ADC value following interventional surgery in this study suggested that blood supply obstruction, which decreased the binding of intracellular water molecules, was the cause of tumor tissue necrosis. The quantitative markers of DCE-MRI, Ktrans, Kep, and Ve, show the permeability of the vascular wall and the blood flow at the lesion.
Prior to interventional therapy, tumor cells proliferate quickly, increasing the permeability of newly formed blood vessels in the lesion and allowing contrast chemicals to enter the tumor tissue more quickly. As a result, the DCE-MRI values for Ktrans, Kep, and Ve are high. The acquired results are lower during interventional therapy because the tumor cells are necrotic, the lesion’s vascular density is lower, and the vascular permeability is lower. Following interventional surgery, the study revealed that the Ktrans, Kep, and Ve values decreased. These findings suggest that the necrosis of tumor cells following interventional surgery may be reflected in these values.
The ROC curve may clearly show the relationship between the diagnostic method’s sensitivity and specificity, assess accuracy using the diagnostic limit value, and directly represent the disease’s diagnostic efficiency[36-38]. The diagnostic accuracy increases with increasing AUC. The sensitivity and specificity of this investigation were greater than 86%, and the ADC and Ktrans difference AUC values for predicting the curative impact were 0.953 and 0.933, respectively. The use of differences in the ADC and Ktrans values was very successful in predicting the curative impact following interventional HCC surgery[39].
These findings suggest that DCE-MRI in conjunction with DWI can increase the precision of efficacy assessment following a series of liver cancer diagnostic procedures. The variations in the ADC and Ktrans before and after in
Consequently, DWI in conjunction with DCE-MRI is very useful for assessing the postoperative curative impact of liver cancer treatment.
With respect to assessing the therapeutic response of patients following interventional liver cancer surgery, DCE-MRI in conjunction with DWI has significant clinical value. The parameter changes that occur before and after interventional surgery can effectively guide the development of additional treatment plans for patients with liver cancer, provide objective imaging data for the evaluation of the curative effect, and directly reflect the curative effect.
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