Can BOLD fMRI Demonstrate Early Response to Chemoembolization in HCCs?

Liver cancer is one of the most common malignancies and is among the top three leading causes of cancer-related mortalities worldwide ( 1 Fitzmaurice C Allen C Barber RM et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol. 2017; 3: 524-548 Crossref PubMed Scopus (2679) Google Scholar ). Hepatocellular carcinoma (HCC) accounts for the majority of liver cancers and related deaths ( 2 Llovet JM Kelley RK Villanueva A et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2021; 7: 6 Crossref PubMed Scopus (1076) Google Scholar ). Chronic hepatitis B and C viral infection, excess alcohol use, aflatoxin exposure, and cirrhosis are the most common causes of HCC. In patients with unresectable HCCs but preserved liver function, transcatheter arterial chemoembolization (TACE) is a commonly used treatment ( 3 Yang JD Roberts LR. Epidemiology and management of hepatocellular carcinoma. Infect Dis Clin North America. 2010; 24 (viii): 899-919 Abstract Full Text Full Text PDF PubMed Scopus (150) Google Scholar ). In the TACE approach, the abnormal arterial blood supply to HCC lesion is selectively blocked using chemotherapeutic agent(s) and embolization material to induce hypoxia and necrosis within the tumor ( 3 Yang JD Roberts LR. Epidemiology and management of hepatocellular carcinoma. Infect Dis Clin North America. 2010; 24 (viii): 899-919 Abstract Full Text Full Text PDF PubMed Scopus (150) Google Scholar , 4 Moustafa AS Abdel Aal AK Ertel N Saad N DuBay D Saddekni S Chemoembolization of hepatocellular carcinoma with extrahepatic collateral blood supply: anatomic and technical considerations. Radiographics. 2017; 37 (Epub 2017 Mar 31. PMID: 28362557): 963-977https://doi.org/10.1148/rg.2017160122 Crossref PubMed Scopus (18) Google Scholar . Typical treatment follow-up includes conventional imaging with CT or MRI after TACE and evaluation with these routine cross-sectional imaging techniques almost always relies on morphologic assessment along with contrast enhancement patterns and diffusion-weighted imaging within the treated lesion ( 5 Lim HS Jeong YY Kang HK et al. Imaging features of hepatocellular carcinoma after transcatheter arterial chemoembolization and radiofrequency ablation. Am J Roentgenol. 2006; 187: W341-W349 Crossref PubMed Scopus (62) Google Scholar ). Although the value of CT and MRI for post-TACE follow-up have been reported ( 6 Liu HF Zou LQ Lu XR et al. Diagnostic efficacy of contrast-enhanced MRI in detecting residual or recurrent hepatocellular carcinoma after transarterial chemoembolization: a systematic review and meta-analysis. J Magn Reson Imag. 2020; 52: 1019-1028 Crossref PubMed Scopus (2) Google Scholar ), they do not provide direct feedback of treatment success and response specifically at earlier phases of the treatment.