Comparison between subtraction and dynamic MRI in assessing treatment response following radiofrequency ablation in patients with hepatocellular carcinoma

Abstract Background Hepatocellular carcinoma (HCC) is one of the most prevalent cancers worldwide, and if left untreated, one of the most lethal. Ablative therapies including radiofrequency ablation (RFA) play increasingly important role for patients with liver tumors who are not surgical candidates...

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Autores principales:	Ahmed Elshenawy Gabr, Hisham S. Wahba Mikhael, Samar M. El-Maadawy
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Subtraction MRI Dynamic MRI Hepatocellular carcinoma Radiofrequency ablation Medical physics. Medical radiology. Nuclear medicine R895-920
Acceso en línea:	https://doaj.org/article/8ffb0305e96f44e3b328726d2b3294e9
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spelling	oai:doaj.org-article:8ffb0305e96f44e3b328726d2b3294e92021-11-28T12:23:22ZComparison between subtraction and dynamic MRI in assessing treatment response following radiofrequency ablation in patients with hepatocellular carcinoma10.1186/s43055-021-00669-w2090-4762https://doaj.org/article/8ffb0305e96f44e3b328726d2b3294e92021-11-01T00:00:00Zhttps://doi.org/10.1186/s43055-021-00669-whttps://doaj.org/toc/2090-4762Abstract Background Hepatocellular carcinoma (HCC) is one of the most prevalent cancers worldwide, and if left untreated, one of the most lethal. Ablative therapies including radiofrequency ablation (RFA) play increasingly important role for patients with liver tumors who are not surgical candidates. Monitoring treatment response following ablation is crucial in oncologic imaging. Dynamic contrast-enhanced MRI can assess changes in tumor vascularity and perfusion while subtraction imaging is useful in differentiating residual tumor from post-ablation parenchymal changes. The aim of this study is to compare the role of subtraction MRI and conventional dynamic MRI in assessing treatment response following RFA in patients with HCC. Results The study included 48 patients with 62 HCC lesions who underwent RFA from May to October 2020, followed by MRI evaluation with 1-month interval. Two readers with experience in hepatic imaging interpreted the dynamic and subtraction dynamic MRI. The hepatic focal lesions were classified into “well-ablated” and “residual” groups according to MRI findings, and the agreement between the two readers was evaluated. Using dynamic MRI, the first reader reported 38 well-ablated lesions, and the second reader agreed in 34 of them (89.5%). Residual disease was reported by the first reader in 22 lesions and the second reader disagreed in 10 of them (45.5%) where complete ablation was reported. Thirty-eight out 44 well-ablated lesions (86.4%) showed high signal intensity on non-enhanced T1 images, and 28 lesion (63.6%) showed intermediate T2 signal. All the mis-matched readings occurred in lesions with a high signal intensity in pre-contrast T1 images. Moderate agreement between the two readers was found with Kappa value of 0.467. Significant additive value of subtraction technique to dynamic MRI was detected with a P value of 0.009. No major complications recorded except for a single case of major portal vein branch occlusion. Conclusion MRI is a powerful imaging tool in assessing tumor viability and complications after RFA in patients with HCC. Dynamic MRI study is the gold standard in detecting recurrent lesions while subtraction technique is crucial in differentiating between arterial enhancement due to residual disease and normal hyperintense T1 signal of the ablation zone.Ahmed Elshenawy GabrHisham S. Wahba MikhaelSamar M. El-MaadawySpringerOpenarticleSubtraction MRIDynamic MRIHepatocellular carcinomaRadiofrequency ablationMedical physics. Medical radiology. Nuclear medicineR895-920ENThe Egyptian Journal of Radiology and Nuclear Medicine, Vol 52, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Subtraction MRI Dynamic MRI Hepatocellular carcinoma Radiofrequency ablation Medical physics. Medical radiology. Nuclear medicine R895-920
spellingShingle	Subtraction MRI Dynamic MRI Hepatocellular carcinoma Radiofrequency ablation Medical physics. Medical radiology. Nuclear medicine R895-920 Ahmed Elshenawy Gabr Hisham S. Wahba Mikhael Samar M. El-Maadawy Comparison between subtraction and dynamic MRI in assessing treatment response following radiofrequency ablation in patients with hepatocellular carcinoma
description	Abstract Background Hepatocellular carcinoma (HCC) is one of the most prevalent cancers worldwide, and if left untreated, one of the most lethal. Ablative therapies including radiofrequency ablation (RFA) play increasingly important role for patients with liver tumors who are not surgical candidates. Monitoring treatment response following ablation is crucial in oncologic imaging. Dynamic contrast-enhanced MRI can assess changes in tumor vascularity and perfusion while subtraction imaging is useful in differentiating residual tumor from post-ablation parenchymal changes. The aim of this study is to compare the role of subtraction MRI and conventional dynamic MRI in assessing treatment response following RFA in patients with HCC. Results The study included 48 patients with 62 HCC lesions who underwent RFA from May to October 2020, followed by MRI evaluation with 1-month interval. Two readers with experience in hepatic imaging interpreted the dynamic and subtraction dynamic MRI. The hepatic focal lesions were classified into “well-ablated” and “residual” groups according to MRI findings, and the agreement between the two readers was evaluated. Using dynamic MRI, the first reader reported 38 well-ablated lesions, and the second reader agreed in 34 of them (89.5%). Residual disease was reported by the first reader in 22 lesions and the second reader disagreed in 10 of them (45.5%) where complete ablation was reported. Thirty-eight out 44 well-ablated lesions (86.4%) showed high signal intensity on non-enhanced T1 images, and 28 lesion (63.6%) showed intermediate T2 signal. All the mis-matched readings occurred in lesions with a high signal intensity in pre-contrast T1 images. Moderate agreement between the two readers was found with Kappa value of 0.467. Significant additive value of subtraction technique to dynamic MRI was detected with a P value of 0.009. No major complications recorded except for a single case of major portal vein branch occlusion. Conclusion MRI is a powerful imaging tool in assessing tumor viability and complications after RFA in patients with HCC. Dynamic MRI study is the gold standard in detecting recurrent lesions while subtraction technique is crucial in differentiating between arterial enhancement due to residual disease and normal hyperintense T1 signal of the ablation zone.
format	article
author	Ahmed Elshenawy Gabr Hisham S. Wahba Mikhael Samar M. El-Maadawy
author_facet	Ahmed Elshenawy Gabr Hisham S. Wahba Mikhael Samar M. El-Maadawy
author_sort	Ahmed Elshenawy Gabr
title	Comparison between subtraction and dynamic MRI in assessing treatment response following radiofrequency ablation in patients with hepatocellular carcinoma
title_short	Comparison between subtraction and dynamic MRI in assessing treatment response following radiofrequency ablation in patients with hepatocellular carcinoma
title_full	Comparison between subtraction and dynamic MRI in assessing treatment response following radiofrequency ablation in patients with hepatocellular carcinoma
title_fullStr	Comparison between subtraction and dynamic MRI in assessing treatment response following radiofrequency ablation in patients with hepatocellular carcinoma
title_full_unstemmed	Comparison between subtraction and dynamic MRI in assessing treatment response following radiofrequency ablation in patients with hepatocellular carcinoma
title_sort	comparison between subtraction and dynamic mri in assessing treatment response following radiofrequency ablation in patients with hepatocellular carcinoma
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/8ffb0305e96f44e3b328726d2b3294e9
work_keys_str_mv	AT ahmedelshenawygabr comparisonbetweensubtractionanddynamicmriinassessingtreatmentresponsefollowingradiofrequencyablationinpatientswithhepatocellularcarcinoma AT hishamswahbamikhael comparisonbetweensubtractionanddynamicmriinassessingtreatmentresponsefollowingradiofrequencyablationinpatientswithhepatocellularcarcinoma AT samarmelmaadawy comparisonbetweensubtractionanddynamicmriinassessingtreatmentresponsefollowingradiofrequencyablationinpatientswithhepatocellularcarcinoma
_version_	1718408028354510848

Comparison between subtraction and dynamic MRI in assessing treatment response following radiofrequency ablation in patients with hepatocellular carcinoma

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