ORIGINAL ARTICLE Perfusion parameters of dynamic contrast-enhanced magnetic resonance imaging predict outcomes of hepatocellular carcinoma receiving radiotherapy with or without thalidomide Po-Chin Liang • Hui-Ju Ch’ang • Chiun Hsu • Li-Tzong Chen • Tiffany T. F. Shih • Tsang Wu Liu Received: 5 March 2014 / Accepted: 21 June 2014 Ó Asian Pacific Association for the Study of the Liver 2014 Abstract Background To correlate between signal parameters using dynamic contrast-enhanced magnetic resonance imaging (DCEMRI) and outcomes of hepatocellular car- cinoma (HCC) receiving radiotherapy with or without concomitant thalidomide. Methods DCEMRI was performed in advanced HCC patients undergoing radiotherapy with or without concomi- tant thalidomide. Initial first-pass enhancement slopes (slope) and peak enhancement ratios (peak) were measured over an operator-defined region of interest over tumor and non-tumor liver parenchyma. The perfusion parameters were correlated with clinical outcomes. The study was registered with ClinicalTrials.gov. (identifier NCT00155272). Results Forty-three patients were evaluable. There were 18 partial responses (PRs), 5 minimal responses (MRs), 17 stable diseases (SDs), and 3 progressive diseases (PDs). Baseline perfusion parameters as well as slope at 14 days of radiotherapy were higher in patients with PR or MR com- pared to SD or PD (0.81 ± 0.29 vs. 0.49 ± 0.34, p \ 0.01; 0.39 ± 0.15 vs. 0.28 ± 0.16, p = 0.02; 0.97 ± 0.38 vs. 0.46 ± 0.26, p \ 0.01; respectively). Multivariate analysis revealed perfusion parameters over liver parenchyma, but not over tumor, and independently predicted progression- free and overall survival (182 ± 33 vs. 105 ± 26 days, p = 0.01; 397 ± 111 vs. 233 ± 19 days, p = 0.001 respectively). For 22 patients receiving concomitant thalid- omide, the perfusion parameters were not significantly dif- ferent from those receiving radiotherapy alone. Conclusions Signal parameters of DCEMRI over tumor and liver parenchyma correlated with tumor response and survival, respectively, in HCC patients receiving radiotherapy. Keywords Dynamic contrast-enhanced MRI Á Radiotherapy Á Thalidomide Á Hepatocellular carcinoma Á Antiangiogenesis Introduction Patients presenting with advanced hepatocellular carci- noma (HCC) suffer from repeated ineffective nonsurgical treatments or inherent resistance to all available chemo- therapeutic agents. Recent developments in radiotherapy (RT) have provided the potential to deliver effective and safe therapy for liver tumors. Despite the 50–70 % response rates of HCC to modern RT [1], an autopsy series revealed that HCC shows tumor regression, but not P.-C. Liang Á T. T. F. Shih Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan H.-J. Ch’ang (&) Á L.-T. Chen Á T. W. Liu National Institute of Cancer Research, National Health Research Institutes, 367 Sheng-Li Rd., Tainan 704, Taiwan e-mail: hjmc@nhri.org.tw H.-J. Ch’ang Department of Radiation Oncology, National Cheng Kung University Hospital, Tainan, Taiwan C. Hsu Á T. W. Liu Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan L.-T. Chen Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan T. T. F. Shih Department of Radiology, Medical College, National Taiwan University, Taipei, Taiwan 123 Hepatol Int DOI 10.1007/s12072-014-9557-1