Published online Oct 27, 2022. doi: 10.4240/wjgs.v14.i10.1150
Peer-review started: April 18, 2022
First decision: July 14, 2022
Revised: July 29, 2022
Accepted: September 21, 2022
Article in press: September 21, 2022
Published online: October 27, 2022
Processing time: 190 Days and 2.4 Hours
Transcatheter arterial chemoembolization (TACE) has been used to treat patients with hepatocellular carcinoma (HCC) as a palliative therapy. Nevertheless, HCC is prone to recur after TACE. Traditional anatomical MRI has certain limitations in assessing recurrence. Diffusion kurtosis imaging (DKI) provides a detailed depiction of the microstructural environment. Whether DKI-derived metrics can provide clinical feasibility in predicting HCC recurrence and cellular invasion of the peritumoral liver zone after TACE remains to be a concern.
To investigate the clinical use of DKI in predicting recurrence and cellular invasion of HCC in the peritumoral liver zone after TACE.
In this study, 76 patients with 82 hepatic cancer nodules were enrolled and underwent DKI after TACE. Forty-eight and 34 nodules were divided into two groups: True progression and pseudo-progression, respectively.
DKI-derived metric maps were used to assess the TACE-treated area, peritumoral liver zone, and far-tumoral zone. To compare the prediction performance of each DKI metric between the true progression and pseudo-progression groups, the non-parametric U test and receiver operating characteristic curve (ROC) analysis were performed. The independent t-test was utilized to compare each DKI metric between the peritumoral and far-tumoral zones in the true progression group.
DKI metrics, including mean diffusivity (MD), axial diffusivity (DA), radial diffusivity (DR), axial kurtosis (KA), and anisotropy fraction of kurtosis (Fak), exhibited significantly different values between the true progression and pseudo-progression groups, respectively (P < 0.05). Furthermore, the peritumoral zone had substantially different DA, DR, KA, and FAk values than the far-tumoral zone in the true progression group. Additionally, MD values of the liver parenchyma (peritumoral and far-tumoral zones) were substantially lower in the true progression group compared to the pseudo-progression group (P < 0.05).
DKI has been shown to predict the therapeutic response of HCC to TACE with high accuracy. Furthermore, DKI may indicate cellular invasion of the peritumoral zone by molecular diffusion-restricted change.
This study systematically investigated the clinical feasibility of all DKI-derived metrics in predicting recurrence and cellular invasion of the peritumoral liver zone of HCC after TACE, providing an accurate evaluation method to help guide subsequent therapeutic planning in clinical practice for patients with HCC after TACE.