The Clinical Utility of DWI-ADC Value in Predicting the Efficacy of TACE for Hepatocellular Carcinoma

Abstract

The aim of this study was to evaluate the predictive value of pre-treatment apparent diffusion coefficient (ADC) from diffusion-weighted MRI (DWI-MRI) for short-term therapeutic efficacy following transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). We retrospectively analyzed 112 treatment-naïve HCC patients who underwent TACE. Pre-treatment mean ADC values of the largest tumour were measured. Short-term tumour response was assessed at one month using mRECIST, categorizing patients into objective response (OR) or non-response (NR) groups. ROC analysis determined the optimal ADC cutoff, and multivariate logistic regression identified independent predictors of OR. Of the 112 patients, 68 (60.7%) achieved an OR. The mean pre-TACE ADC value was significantly higher in the OR group (1.19 vs. 1.01 ´ 10^–3 mm²/s; p < 0.001). ROC analysis identified an optimal ADC cutoff of 1.10 ´ 10^–3 mm²/s (AUC = 0.81), yielding a sensitivity of 76.5% and specificity of 75.0%. Multivariate analysis identified ADC > 1.10 ´ 10^–3 mm²/s (OR = 5.42), dense lipiodol deposition (OR = 3.07), and tumour size \le 7 cm (OR = 2.38) as independent predictors of OR. The pre-treatment ADC value is a significant independent predictor of short-term TACE efficacy in HCC, with higher values strongly associated with improved tumour response. An ADC threshold of 1.10 ´ 10^–3 mm²/s is a promising imaging biomarker for patient selection and treatment planning, though further prospective validation is needed.