Figure 4.
Evolution of multimodal multiparametric imaging biomarkers in liver cancer after cTACE. A, The figure illustrates representative changes of liver tumors on mpMRI and CT induced by cTACE. In the vertical direction, the imaging scans are arranged according to the time of acquisition. In the horizontal, images are arranged according to the modality including precontrast T1-weighted (T1w) images, DCE images in the arterial phase (15–20 seconds after contrast bolus injection), and ADC maps, all in axial plane, and axial as well as coronal CT images with (baseline) and without (post-cTACE) contrast administration. Untreated tumors demonstrated rim hyperenhancement on contrast-enhanced MRI and CT and a viable tumor rim (low ADC) and necrotic core (high ADC). Corresponding histology from the tumor rim revealed strong ubiquitous staining with the proliferation marker PCNA and low signal from TUNEL staining of cell death. Treatment with cTACE achieved durable devascularization and onset of necrosis as early as 1 day post-cTACE and sustained lipiodol deposition at all time points. These findings were histologically confirmed by disappearance of PCNA signal and high TUNEL signal in tumors post-cTACE. B, Box plots from volumetric quantification of arterial tumor enhancement (DCE), tumor cellularity (ADC), and lipiodol coverage (CT) of the tumor illustrate the longitudinal cTACE effects. Significant differences are indicated by * compared with baseline (**, P < 0.01;***, P < 0.001) and by # for comparison of incomplete cTACE with complete cTACE both at 2 weeks after treatment (#, P < 0.05; ##, P < 0.01).