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Objective:
To evaluate four-dimensional (4D) flow MRI for predicting treatment response after transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC).

Materials and Methods:
A total of 195 patients were enrolled in this study. They were classified into groups: A (cirrhotic patients without HCC, n = 30), B (cirrhotic patients with HCC before TACE, n = 75), C (cirrhotic patients with HCC showing incomplete response (IR) following TACE, n = 56), and D (cirrhotic patients with HCC achieving complete response (CR) following TACE, n = 34). All patients underwent routine laboratory tests and 4D flow MRI using a 3-T MRI system to measure the quantitative parameters in the main portal vein (PV), splenic vein (SV), and superior mesenteric vein (SMV). The clinical characteristics including standard liver volume, spleen diameter, blood cell counts, liver function, and 4D flow MR metrics were compared among the groups using one-way analysis of variance. A multivariate analysis was used to verify the association of clinical characteristics and 4D flow parameters with CR after TACE treatment.

Results:
The average through-plane velocity, peak velocity magnitude, average net flow, peak flow, and net forward volume in the PV were significantly lower in groups B and C (p < 0.05) compared to those in group A. Moreover, groups B and C showed significantly lower values of the average through-plane velocity and peak velocity magnitude in the PV than those of group D (p < 0.05). The multivariate analysis demonstrated that the average through-plane velocity (ß = 1.61, 95% CI: 0.50 – 2.72, P = 0.01) and peak velocity magnitude (ß = 2.36, 95% CI: 0.58 – 4.14, p = 0.01) were independently associated with the CR of HCC after TACE.

Conclusion:
The quantitative flow measurements using 4D flow MRI can be effectively used to predict a CR after TACE in cirrhotic patients with HCC.