The Role of Diffusion-Weighted Imaging (DWI) in Locoregional Therapy Outcome Prediction and Response Assessment for Hepatocellular Carcinoma (HCC): The New Era of Functional Imaging Biomarkers.

• Type of Material: Article
• Authors: Johannes M. Ludwig, Yale University; Juan Camacho, Emory University; Nima Kokabi, Emory University; Minzhi Xing, Yale University; Hyun S. Kim, Yale University
• Language: English
• Date: 2015-11-30
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2015 by the authors; licensee MDPI, Basel, Switzerland.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/diagnostics5040546
• Title of Journal or Parent Work: Diagnostics
• ISSN: 2075-4418
• Volume: 5
• Issue: 4
• Start Page: 546
• End Page: 563
• Keywords: imaging biomarker; diffusion-weighted MRI (magnetic resonance imaging); hepatocellular carcinoma; locoregional therapies; therapy outcome
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Oncology; Health Sciences, Radiology

Abstract

Reliable response criteria are critical for the evaluation of therapeutic response in hepatocellular carcinoma (HCC). Current response assessment is mainly based on: (1) changes in size, which is at times unreliable and lag behind the result of therapy; and (2) contrast enhancement, which can be difficult to quantify in the presence of benign post-procedural changes and in tumors presenting with a heterogeneous pattern of enhancement. Given these challenges, functional magnetic resonance imaging (MRI) techniques, such as diffusion-weighted imaging (DWI) have been recently investigated, aiding specificity to locoregional therapy response assessment and outcome prediction. Briefly, DWI quantifies diffusion of water occurring naturally at a cellular level (Brownian movement), which is restricted in multiple neoplasms because of high cellularity. Disruption of cellular integrity secondary to therapy results in increased water diffusion across the injured membranes. This review will provide an overview of the current literature on DWI therapy response assessment and outcome prediction in HCC following treatment with locoregional therapies.