Objective: To evaluate the perfusion changes in advanced hepatocellular carcinoma (HCC) treated with radio therapy,usingi contrast-enhanced dynamic magnetic resonance imaging (MRI).Subjects and Methods: Dynamic contrast-enhanced MRI(DCE-MRI) was performed before, during and after radiotherapy (5000cGy in 25 fractions) in ten patients with advanced unresectable HCC that had failed to prior local therapy. A Turbo Fast Low-Anagle Shot (FLASH) sequencewas performed in a 1.5 Tesla MR scanner. An operator defined region of interest (ROI) was placed in the maximal enhancement region of the tumor site and adjacent tumor free parenchyma of all patients. A time-intensity curve (TIC)was plotted and analyzed. The initial enhancement slope from the first pass of the time-intensity curve was measured.The above perfusion parameter was estimated and correlated with clinical outcome.Results: Eight of the ten patients had stable to decreased enhancement slopes of tumors two weeks after the start of radiotherapy. The difference persisted one month after completion of radiotherapy. Comparing with clinical outcomes, stable to decrease of initial enhancement slope of tumors is associated with stable to partial response to radio therapy. When comparing the enhancement slope of parenchymal liver receiving less than 30% of radiation dosage before and during treatment, five patients had increased enhancement slope. The difference recovered one month after radiation completed. The transient increase of enhancement slope, considering hyperemia, in parenchymalliver during radiotherapy is associated with disease progression either locally or distantly in all five patients. Noneof the other five patients with stable to decreased enhancement slope of parenchymal liver progressed by 3months after radiation completed.Conclusion: The initial enhancement slope of dynamic MRI correlates with clinical outcome of patients with advanced hepatocellular carcinoma receiving radical radiotherapy.
Date:
2004-10
Relation:
Radiotherapy and Oncology. 2004 Oct;73(Suppl. 1):S281.
