الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma is the dominant type of primary liver cancer worldwide with high mortality rate . Cirrhosis is considered as the greatest single risk factor of occurrence of HCC whatever its etiology . In Egypt , HCV and HBV are considered major risk factors for development of cirrhosis , subsequently HCC. 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 ). The aim of this study was to predict the response of HCC to transarterial chemoembolization by assessment of radiological findings in hepatocellular carcinoma patients before and after TACE using dynamic MRI and triphasic CT. This prospective study was carried out in Radiodiagnosis and Medical Imaging Department at Tanta University Hospitals and Liver Institute at Kafr- Elsheikh. It was conducted on thirty patients with radiologically proved HCC and underwent TACE as a locoregional therapy for HCC . They were examined with triphasic CT and dynamic MRI before and after TACE . They were twenty two (73.3%) males and eight (26.7%) females with age range from 40 -77 years old. Assessment of the tumor before TACE using triphasic CT was by evaluation of the tumor size, margins, location (as regard to hepatic segments, central or peripheral , relation to vascular structures ) and detection of enhancement criteria after contrast administration, in addition to assessment of the signal intensity at the non contrast T1-weighted and T2-weighted pulse sequences and the pattern of enhancement after dynamic contrast enhanced study and assessment of tissue diffusivity of the lesion after diffusion study in MRI . After TACE ,the tumor response was defined according to m RECIST (modified Response Evaluation Criteria in Solid Tumors ) by evaluation of its pattern of enhancement and detection of any difference in its size or margins and it was classified into : - completed response (CR) ,partial response (PR) ……as responders group - progressive disease (PD) ,stable disease (SD)……..as non-responders group. Assessment of the tumor after TACE also included detection of chemoembolized material deposition inside the lesion in triphasic CT images and any difference in the signal intensity at the non contrast T1-weighted and T2-weighted pulse sequences and any difference in tissue diffusivity of the lesion after diffusion study. The main results of the study revealed that: The studied patients were classified into two groups ; responders (CR & PR) & non-responders (SD & PD) , 22 patients were responders (about 73.3 %) while 8 patients were non responders ( about 26.7% ) . There was no statistically significant difference between the studied groups as regard age , sex , risk factors, clinical presentation and level of α- fetoprotein. There was no statistically significant difference between the studied groups as regard general imaging features of the patients such as ascites , splenomegaly ,patency of the portal vein and lymphadenopathy. There was statistically significant difference between the studied groups as regard the lesion criteria such as multiplicity , size , margins , involvement of both hepatic lobes and pattern of arterial phase enhancement in both triphasic CT and dynamic MRI . There was no statistically significant difference between the studied groups as regard other lesion criteria such as location of the lesion (superficial or non-superficial) and signal intensity of the lesion in T1WI and T2WI . There was statistically significant difference between the studied groups as regard number of required TACE sessions as 40% of the studied patients needed only one session , all of them were responders while all the nonresponders needed multiple TACE sessions . There was agreement between triphasic CT results and dynamic MRI as regard the tumor response in 26 patients . Disagreement between triphasic CT results and dynamic MRI results was observed in only 4 patients ; two cases were defined as CR by triphasic CT versus PR by dynamic MRI , one case was defined as PR by triphasic CT versus SD by dynamic MRI and one case was defined as PR by triphasic CT versus PD by dynamic MRI . No cases of major complications or mortality were noted in our study. Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.