Pre-TACE kurtosis of ADCtotal derived from histogram analysis for diffusion-weighted imaging is the best independent predictor of prognosis in hepatocellular carcinoma

PurposeTo determine the feasibility of pre-TACE IVIM imaging based on histogram analysis for predicting prognosis in the treatment of unresectable hepatocellular carcinoma (HCC).Materials and methodsFifty-five patients prospectively underwent 1.5T MRI 1 week before TACE. Histogram metrics for IVIM parameters and ADCs maps between responders and non-responders with mRECIST assessment were compared. Kaplan-Meier, log-rank tests and Cox proportional hazard regression model were used to correlate variables with time to progression (TTP).ResultsMean (p = 0.022), median (p = 0.043), and 25(th) percentile (p < 0.001) of perfusion fraction (PF), mean (p < 0.001), median (p < 0.001), 25(th) percentile (p < 0.001) and 75(th) percentile (p = 0.001) of ADC((0,500)), mean (p = 0.005), median (p = 0.008) and 25(th) percentile (p = 0.039) of ADC(total) were higher, while skewness and kurtosis of PF (p = 0.001, p = 0.005, respectively), kurtosis of ADC((0,500)) and ADC(total) (p = 0.005, p = 0.001, respectively) were lower in responders compared to non-responders. Multivariable analysis demonstrated that mRECIST was associated with TTP independently, and kurtosis of ADC(total) had the best predictive performance for disease progression.ConclusionPre-TACE kurtosis of ADC(total) is the best independent predictor for TTP.Key Points center dot mRECIST was associated with TTP independently.center dot Lower kurtosis and higher mean for ADCs tend to have good response.center dot Pre-TACE kurtosis of ADC(total)is the best independent predictor for TTP.