DCE-MRI in hepatocellular carcinoma-clinical and therapeutic image biomarker

Dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)enables tumor vascular physiology to be assessed.Within the tumor tissue,contrast agents(gadolinium chelates)extravasate from intravascular into the extravascular extracellular space(EES),which results in a signal increase on T1-weighted MRI.The rate of contrast agents extravasation to EES in the tumor tissue is determined by vessel leakiness and blood flow.Thus,the signal measured on DCE-MRI represents a combination of permeability and perfusion.The semi-quantitative analysis is based on the calculation of heuristic parameters that can be extracted from signal intensity-time curves.These enhancing curves can also be deconvoluted by mathematical modeling to extract quantitative parameters that may reflect tumor perfusion,vascular volume,vessel permeability and angiogenesis.Because hepatocellular carcinoma(HCC)is a hypervascular tumor,many emerging therapies focused on the inhibition of angiogenesis.DCE-MRI combined with a pharmacokinetic model allows us to produce highly reproducible and reliable parametric maps of quantitative parameters in HCC.Successful therapies change quantitative parameters of DCE-MRI,which may be used as early indicators of tumor response to anti-angiogenesis agents that modulate tumor vasculature.In the setting of clinical trials,DCE-MRI may provide relevant clinical information on the pharmacodynamic and biologic effects of novel drugs,monitor treatment response and predict survival outcome in HCC patients.