Role of MRI in Assessment of Hepatocellular Carcinoma (HCC) after TACE (Trans-arterial Chemoembolization) with Persistent High Alfa Fetoprotein (AFP)

Background: evaluation of treatment success after TACE is essential for making therapeutic decisions, e.g., to repeat, interrupt or completely terminate TACE. An understanding of the various therapeutic strategies and their post therapy imaging appearance is essential for accurately assessing treatment response. Evaluation of tumor response should include not only tumor markers, but also imaging modalities. Evaluation of the therapeutic effect of HCC after TACE is primarily based on the findings of imaging studies. CT is the standard imaging technique for monitoring the effectiveness of TACE.  MRI is complementary to CT in the evaluation of the therapeutic response. To know the advantages and limitations of each imaging technique in the evaluation of the therapeutic effect of HCC is important in determining if the treated tumor is completely necrotic or requires additional treatment.Objective: the purpose of this work was to study the MRI appearance of the HCC lesion after TACE in patients with high persistent AFP in cases when hyper-attenuating iodized oil impairs the assessment of residual tumor enhancement on contrast enhanced CT.
Patients and Methods: the age of patients ranged between 50 to 73 years with a mean age 58 year.All patients were diagnosed as HCC patients on a background of liver cirrhosis. Twelve patients were positive for HCV and three patients were positive for HBV infection.
Results: our study included 15 patients, 12 males and 3 females with age 51 and 73 years with a mean age of 58years.All patients included were diagnosed with HCC by a previous triphasic CT and alfa feto protein.  The patients underwent TACE and the patient’s response to embolization was assessed by AFP and CT or MRI within 1-3 months post chemoembolization. All the selected candidates showed persistent elevation of alfa feto protein after the procedure and within the 1-3 months post TACE.  MRI was performed to these patients and their MRI results were either negative or positive explaining the persistent rise of AFP where 13 patients showed positive results and 2 patients showed negative MRI findings. The positive patients were further categorized into groups according to their posttaceMRI findings. 4 patients had de novo new lesions, 6 patients had recurrence and 3 residual tumor patients.
Conclusion: diffusion-weighted MR imaging was found to be a reliable predictor along with contrast enhanced MR imaging when CT was not conclusive.