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Updated: Dec 11, 2025
Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma
Published on: May 24, 2024
Assessment of Hepatocellular Carcinoma Response to 90Y Radioembolization Using Dynamic Contrast Material-enhanced MRI
Stefanie J Hectors1, Sara Lewis1, Paul Kennedy1
1Biomedical Engineering and Imaging Institute (S.J.H., S.L., P.K., O.B., D.S., M. Segall, B.T.), Department of Diagnostic, Molecular and Interventional Radiology (S.J.H., S.L., P.K., O.B., D.S., M. Segall, E.K., B.T.), and Department of Liver Surgery, Recanati/Miller Transplantation Institute (M. Schwartz), Icahn School of Medicine at Mount Sinai, 1460 Madison Ave, New York, NY 10029; and Department of Radiology, Weill Cornell Medicine, New York, NY (S.J.H.).
Diffusion and perfusion MRI effectively evaluate hepatocellular carcinoma (HCC) response to yttrium 90 radioembolization. Pretreatment imaging parameters can predict treatment outcomes, aiding in patient stratification for HCC radioembolization.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Hepatocellular carcinoma (HCC) is a primary liver malignancy.
- Yttrium 90 (90Y) radioembolization is a treatment for HCC.
- Predicting treatment response in HCC is crucial for patient management.
Purpose of the Study:
- To quantify diffusion and perfusion changes in HCC after 90Y radioembolization.
- To assess the predictive value of dynamic contrast-enhanced (DCE) MRI and intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) for HCC response.
- To evaluate multiparametric MRI for predicting radioembolization treatment stratification.
Main Methods:
- Prospective study of 24 HCC patients undergoing 90Y radioembolization.
- Multiparametric MRI including IVIM DWI and DCE MRI before and after treatment.
- Analysis of histogram parameters from IVIM DWI and DCE MRI, correlated with treatment response using modified Response Evaluation Criteria in Solid Tumors.
Main Results:
- 90Y radioembolization significantly decreased HCC perfusion (DCE MRI arterial flow and IVIM pseudodiffusion coefficient).
- Combined serum α-fetoprotein and portal flow skewness predicted objective response (AUC = 0.924).
- Combined IVIM pseudodiffusion coefficient standard deviation and portal flow kurtosis predicted complete response at 6 weeks (AUC = 0.916).
- DCE MRI arterial fraction standard deviation predicted complete response at 6-12 months (AUC = 0.857).
Conclusions:
- Diffusion and perfusion MRI parameters can effectively evaluate HCC response to radioembolization.
- Pretreatment DCE MRI histogram parameters show potential for radioembolization treatment stratification.
- Multiparametric MRI offers valuable insights into HCC response prediction post-radioembolization.
