CardioVascular and Interventional Radiology

, Volume 41, Issue 11, pp 1716–1726 | Cite as

Transarterial Radioembolization Following Chemoembolization for Unresectable Hepatocellular Carcinoma: Response Based on Apparent Diffusion Coefficient Change is an Independent Predictor for Survival

  • Elisabeth G. Klompenhouwer
  • Raphaëla C. Dresen
  • Chris Verslype
  • Annouschka Laenen
  • Lawrence Bonne
  • Vincent Vandecaveye
  • Geert MaleuxEmail author
Clinical Investigation
Part of the following topical collections:
  1. Interventional Oncology



To evaluate whether response based on contrast-enhanced magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) change at diffusion-weighted MRI after transarterial radioembolization (TARE) can predict survival, in patients with prior transarterial chemoembolization with drug-eluting beads (DEB-TACE) for hepatocellular carcinoma (HCC).


We identified all patients who received DEB-TACE prior to TARE for HCC between 2007 and 2016. Response on MRI was determined by modified RECIST (mRECIST) and ADC change relative to pre-TARE imaging (ADCratio). Kaplan–Meier and log-rank tests were used to correlate the response/disease and treatment variables to overall survival. Multivariable Cox regression models were used to correct for confounders.


A total of 29 consecutive patients were included. Univariable analysis showed that response determined by mRECIST was a nonsignificant predictor of survival (p = 0.057), and response determined by ADCratio was a significant predictor of survival (p = 0.011). Number of prior DEB-TACE procedures (p = 0.037), female gender (p < 0.001) and BCLC C (p = 0.03) were related to worse survival. The number of prior DEB-TACE procedure was significantly higher in non-responders determined by ADCratio (p = 0.028). Multivariable analyses showed that response based on ADCratio was an independent predictor of survival (p = 0.041).


ADCratio following TARE is an independent predictor for survival in patients who previously underwent DEB-TACE for HCC.


Radioembolization Chemoembolization Magnetic resonance imaging Diffusion-weighted imaging Survival analysis Follow-up studies 



This study received no funding.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Consent for Publication

For this type of study consent for publication is not required.

Ethical Approval Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study (retrospective) formal consent is not required.

Informed Consent

This is a retrospective study.


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© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of RadiologyUniversity Hospitals LeuvenLouvainBelgium
  2. 2.Department of RadiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  3. 3.Department of Digestive OncologyUniversity Hospitals LeuvenLouvainBelgium
  4. 4.Department of Biostatistics and Statistical BioinformaticsKU Leuven Universiteit HasseltLouvainBelgium

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