Hepatocellular carcinoma after systemic chemotherapy: Gadolinium-enhanced MR measurement of necrosis by volume histogram

As a preliminary study, we measured the necrosis of advanced hepatocellular carcinoma (HCC) by volume histogram after systemic chemotherapy and correl ated it with clinical data. Five patients with advanced HCC secondary to ch ronic hepatitis and cirrhosis underwent pretreatment and posttreatment MR e xamination on a 1.5 T MR scanner following systemic chemotherapy. MR sequen ces included dynamic enhanced fast spoiled gradient echo 3D images. Clinica l response to chemo therapy, as determined by MR images, was measured as ch anges of both the total tumor volume and the percent of tumor necrosis by v olume histogram algorithm. Four of five patients had clinical improvement. Three of these patients had no or minimal change of tumor volume, however, there was an increase in tumor necrosis in followup MR image. One patient o f five with no change in tumor necrosis had no response and died at 3 month s. Serial MR images showed increased irregular necrosis of advanced HCC aft er systemic chemotherapy, but stable volume, in patients who responded clin ically to systemic chemotherapy.