MRI Evaluation of Hepatocellular Carcinoma Post Locoregional Therapy Using Post Processing Arterial Subtraction

Abstract

Background: HCC is the most common primary liver cancer and a leading cause of cancer-related death globally. Early detection and treatment are crucial for improving outcomes. For patients who are not surgical candidates, locoregional therapies like trans-arterial chemoembolization (TACE) and radiofrequency ablation (RFA) are important palliative options. Conventional MRI techniques can have limitations in differentiating viable tumour from post-treatment changes, dynamic subtraction imaging adds significant value to conventional dynamic MRI and DWI. Aim of Study: The purpose of this research is to evaluate the utility of dynamic subtracted magnetic resonance imaging (MRI) sequences for evaluation of hepatocellular carcinoma (HCC) following locoregional therapy. Patients and Methods: a cross-sectional study involved 60 HCC patients (aged 42–73) who had hepatic MRI. The following pictures were obtained: precontrast T1, T2, and dynamic contrast enhanced sequences, diffusion-weighted. On the workstation, subtracted dynamic images and dynamic curve were produced. A radiology consultant interpreted the magnetic resonance images. For the ordinary dynamic, subtracted dynamic and diffusion images, the following metrics were determined: overall agreement, sensitivity, specificity, negative predictive value, positive predictive value Results: ordinary dynamic (Arterial T1 with fat sat) showed a sensitivity of 96.77%, specificity of 58.6%, PPV of 71.4% and NPV of 94.4%, While subtraction MRI showed a sensitivity of 100%, specificity of 100%, PPV of 100% and NPV of 100% compared to DWI showed a sensitivity of 100%, specificity 93%, PPV 93.9% and NPV 100%. So Dynamic subtraction imaging was found to have a significant additive value when compared to traditional dynamic MRI and DWI. Conclusion: With a high degree of reader agreement and much greater reader confidence levels than the dynamic and diffusion pictures, the subtraction approach is a valuable confirmatory tool for the diagnosis of hepatocellular carcinoma following locoregional therapy. It also has higher sensitivity, specificity, PPV, and NPV values.