Magnetic resonance imaging features predictive of an incomplete response to transarterial chemoembolization in patients with hepatocellular carcinoma A STROBE-compliant study

To identify pretreatment magnetic resonance imaging (MRI) features associated with an incomplete response (IR) to transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). The medical records of 89 patients with HCC who had undergone a first TACE were reviewed retrospectively. The size, visual attenuation in the arterial phase, signal intensity (SI) on T1-, T2-, and diffusion-weighted images, and apparent diffusion coefficient (ADC) values of each lesion were evaluated on pretreatment images. The response to TACE was routinely assessed at 4 weeks post-treatment by 4-phase computed tomography. The HCC patients were classified as complete or incomplete responders based on the arterial–phase enhancement of the target lesion. In multivariate analysis, larger lesion diameter (P = .004, OR = 1.06 per millimeter, 95% CI = 1.02–1.11), faint enhancement on arterial phase (P = .021, OR = 3.24, 95% CI = 1.22–9.14), and non-low SI on T1-weighted images (P = .016, OR = 3.36, 95% CI = 1.29–9.32) were significantly associated with increased odds of an IR to TACE in HCC patients. An iso-to-high T1-weighted SI by pretreatment MRI was an independent predictor of an incomplete response to TACE in patients with HCC, in addition to faint arterial enhancement and lesion size. Abbreviations: aFP = alpha-fetoprotein, AASLD = American Association for the Study of Liver Diseases, APASL = Asia-Pacific Association for the Study of the Liver, CI = confidence interval, EASL = European Association for the Study of the Liver, HCC = hepatocellular carcinoma, IR = incomplete response, MRI = magnetic resonance imaging, OR = odds ratio, PD = progressive disease, PR = partial response, RFA = radiofrequency ablation, SD = stable disease, SI = signal intensity, TACE = transarterial chemoembolization.