Dynamic Contrast-Enhanced MRI Kinetic Parameters as Prognostic Biomarkers for Prediction of Survival of Patient with Advanced Hepatocellular Carcinoma: A Pilot Comparative Study

Rationale and Objectives: Tracer kinetic model selection for dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) data analysis influences its use as a prognostic biomarker. Our aim was to find DCE-MRI parameters that predict 1-year survival (1 YS) and overall survival (OS) among patients with advanced hepatocellular carcinoma (HOC) treated with antiangiogenic monotherapy by conducting a proof-of-concept comparative study of five different kinetic models. Materials and Methods: Twenty patients with advanced HOC underwent DCE-MRI and subsequently received sunitinib. Pretreatment DCE-MRI data were analyzed retrospectively by using the Tofts-Kety (TK), extended TK, two compartment exchange, adiabatic approximation to the tissue homogeneity (AATH), and distributed parameter (DP) models. Arterial flow fraction (7), arterial blood flow (BFA,), permeability-surface area product (PS), fractional interstitial volume (v(1)), and other five parameters were calculated for each model. Individual parameters were evaluated for 1YS prediction using cross-validated Kaplan-Meier analysis, and for association with OS using univariate Cox regression analysis, with additional permutation testing. Results: For 1YS prediction, the TK model-derived 7 (P =.007) and vi (P =.029) and the AATH model-derived PS (P =.005) were significant; all these parameters were lower in the high-risk group. Increase in the AATH model-derived PS and the DP model-derived BFA was associated with significant increase in OS with hazard ratios of 0.766 (P =.023) and 0.809 (P =.025), respectively. Conclusions: The AATH model-derived PS was an effective prognostic biomarker for both 1 YS and OS.