الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC) is a primary liver malignancy associated with significant morbidity and mortality worldwide. Transarterial chemoembolization (TACE) has emerged as a widely utilized therapeutic modality for managing unresectable HCC, providing local control and improving patient survival. Assessment of tumor response following TACE is crucial for determining treatment efficacy and guiding subsequent therapeutic decisions. TACE is one of the minimally invasive locoregional therapies for HCC, which is considered as the gold standard treatment of unresectable large or multinodular HCC in preserved liver function patients without extrahepatic spread. TACE provides both arterial blockage ( embolization mainly by lipiodol injection in the tumor-supplying artery) and local chemotherapy (with chemotherapeutic agent ). Imaging plays a pivotal role in evaluating post-TACE tumor response, with both triphasic computed tomography (CT) and dynamic magnetic resonance imaging (MRI) being commonly employed modalities. Triphasic CT involves the acquisition of pre-contrast, arterial, and delayed-phase images, allowing for the assessment of tumor vascularity and enhancement patterns. Dynamic MRI, on the other hand, provides high soft tissue contrast and dynamic imaging capabilities, offering insights into vascular changes and tissue perfusion. Despite the established roles of triphasic CT and dynamic MRI, there remains a need for a comprehensive comparison of these imaging modalities in the context of assessing tumor response after TACE in HCC patients. Understanding the relative strengths and limitations of each technique is vital for optimizing post-treatment monitoring and enhancing the precision of therapeutic strategies. The purpose of this study is to compare the ability of Triphasic MDCT and Dynamic MRI to evaluate HCC response after TACE with respect to the extent of tumor necrosis and viable tumor tissue, a special focus on the influence of Lipiodol on assessment of tumor necrosis in patients with HCC. This prospective study was carried out on selected group of 60 patients referred to Radio diagnosis and medical imaging department at Tanta University Hospital and to Liver Al-mahala Educational Institute. It was conducted from January 2022 to september 2023. They were examined with tri-phasic CT and dynamic MRI after TACE. They were 50 (83.3%) males and 10 (16.7%) females with age range from 46 -70 years old. All patients subjected to full history taking and clinical assessment. Triphasic-CT for follow up after TACE was done. Also, dynamic MRI for follow up after TACE was done. The main results of the study revealed that: All cases exihbeted hepatocellular carcinoma in the context of cirrhosis. TACE procedures were frequently administered, with 90% of cases undergoing multiple interventions, while 10% received TACE only once. The median AFP level was 231 ng/dL, with 70% of cases displaying elevated AFP levels. In triphasic CT about 48 cases(80.0%) showed well ablated lesion with no enhancement residual while in MRI about 18 cases(30.0%) showed well ablated lesion with no enhancement residual. In triphasic CT about 12 cases (20.0%) showed residual enhancing lesion while in MRI about 42 cases (70.0%) showed residual enhancing lesion. In triphasic CT 2 (3.3%) newly developed lesion while in MRI 3 cases (5.0%) newely developed lesion . Triphasic CT and Dynamic MRI assessments revealed differences in imaging features, with varying patterns of enhancement and washout observed. Diffusion restriction patterns varied among cases. The response evaluation between triphasic CT results and dynamic MRI as fellow: Agreenment between triphasic CT results and dynamic MRI results was observed in only 30 patients : 12 cases showed residual enhancing by triphasic CT & dynamic MRI , 18 cases showed well ablated lesion by triphasic CT & dynamic MRI Disagreenment between Triphasic CT & MRI were observed in 30 cases showed residual activity by mri while in CT showed well ablated lesion . Lipiodol artifacts and contrast enhancement displayed significant differences between Triphasic CT and Dynamic MRI scans. Kappa statistics indicated poor agreement between the two modalities, particularly in the arterial phase. Contrast washout also exhibited substantial differences between Triphasic CT and Dynamic MRI scans, further emphasizing the discordance between these imaging techniques. Receiver operating characteristic (ROC) analysis demonstrated that Dynamic MRI outperformed Triphasic CT in assessing tumor response after TACE, with higher sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) values, signifying its superior diagnostic performance.