Apparent Diffusion Coefficient as a Noninvasive Biomarker for the Early Response in Hepatocellular Carcinoma After Transcatheter Arterial Chemoembolization Using Drug-eluting Beads

Background: Prognostic evaluation for Hepatocellular Carcinoma (HCC) after Transcatheter Arterial Chemoembolization (TACE) using Drug-Eluting Beads (DEBs) is essential for guiding the personalized treatment and follow-up strategy. Apparent Diffusion Coefficient (ADC) has been reported as a biomarker in conventional TACE. Objective: This study aimed to evaluate the diagnostic value of ADC(baseline), ADC change, and ADC(ratio) in predicting the early objective response for HCC after DEB-TACE. Methods: This prospective single-center study included 32 consecutive patients undergoing dynamic contrast-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging before and 1 month after DEB-TACE. After DEB-TACE, patients were grouped based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria into responders (complete response [CR], partial response [PR]) and nonresponders (Stable Disease [SD], Progressive Disease [PD]). The Mann-Whitney U test and receiver operating characteristic (ROC) curves were performed to assess the statistical differences in ADC(baseline), ADC change, and ADC(ratio) between responders and nonresponders. Results: At post-DEB-TACE follow-up MRI, 62.5% (n = 20, 11 CRs, and 9 PRs) of patients showed objective response, and 37.5% (n = 12, 7 SDs, and 5 PDs) did not respond to chemoembolization. Nonresponders had a significantly higher ADC(baseline) value than responders (p < 0.001). The ROC for identifying the response to chemoembolization demonstrated that the threshold ADC(baseline) value of 0.920 x 10(-3) mm(2)/s had 100% sensitivity and 70% specificity. The ADC change and ADC(ratio) of responders were higher than that of nonresponders (p < 0.001). Conclusion: ADC(baseline), ADC change, and ADC(ratio) may be utilized as a noninvasive biomarker for predicting the early response of HCC to DEB-TACE.