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

Purpose: To 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 Methods: Fifty-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).
Results: Mean (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.
Conclusion: Pre-TACE kurtosis of ADC _total is the best independent predictor for TTP.
Key Points: • mRECIST was associated with TTP independently. • Lower kurtosis and higher mean for ADCs tend to have good response. • Pre-TACE kurtosis of ADC _total is the best independent predictor for TTP.