Transient hepatic intensity differences: correlations with treatment outcomes and adverse events following DEB-TACE in hepatocellular carcinoma.
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BACKGROUND: Transient hepatic intensity differences (THID) on MRI are commonly observed in hepatocellular carcinoma (HCC) patients following drug-eluting bead transarterial chemoembolization (DEB-TACE). We evaluated the association between THID, treatment outcomes, and adverse events in HCC patients treated with DEB-TACE. MATERIALS AND METHODS: This retrospective analysis included data from a prospective study conducted with 102 consecutive HCC patients treated with DEB-TACE between December 2017 and December 2020. The chi-square test assessed correlations between THID and adverse events, including biliary injury, intrahepatic metastasis, and portal venous thrombosis. Kaplan-Meier method evaluated overall survival (OS) and progression-free survival (PFS), with log-rank tests comparing THID complexity (simple vs complex) and severity (mild, moderate, and severe). Logistic regression identified factors associated with THID development. RESULTS: Among the 102 HCC patients, 74 (72.5%) developed THID after DEB-TACE. Patients with THID had significantly higher rates of biliary injury (47% vs 14.3%, p = 0.002) and intrahepatic metastasis (25.7% vs 7.1%, p = 0.030). Complex THID was associated with worse PFS (p = 0.024). Moderate-to-severe THID had worse OS (p = 0.019) and PFS (p = 0.038). Factors associated with THID development included a higher tumor burden, baseline THID, and Child-Pugh class A. CONCLUSION: THID correlates with an increased risk of biliary injury and intrahepatic metastasis and is associated with worse OS and PFS in HCC patients following DEB-TACE. CRITICAL RELEVANCE STATEMENT: THID development after DEB-TACE correlates with higher incidence of biliary injury, intrahepatic metastasis, and worse OS/PFS, emphasizing its potential as a critical imaging biomarker. This study advances clinical radiology by highlighting THID as an important factor in treatment outcomes. KEY POINTS: THID after drug-eluting bead transcatheter arterial chemoembolization correlates with treatment outcomes and adverse events in HCC. THID correlates with higher biliary injury, intrahepatic metastasis, and reduced survival rates. Complex or severe THID correlates with poorer survival in HCC patients.