الفهرس 
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Abstract
Background: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and has a poor prognosis unless treated. Ablative therapies are promising treatment options for patients who are not eligible for surgery.
Objectives: is to evaluate the predictive values of diffusion-weighted imaging (DWI) and Subtration MRI in evaluating the efficacy of transcatheter arterial chemoembolization (TACE) in treatment of patients with hepatocellular carcinoma (HCC).
Patients and Methods: This study was carried on 30 cases of patients having (38 HCC lesions) referred Radiology Department at Ain Shams University Hospitals and National liver institute, menofiya university from outpatient clinic of internal medicine and surgery departments who underwent transarterial hepatic chemoembolization over a period of 12 month (August 2017–August 2018) with ages ranging from 59 to 73 with the mean of age of 59.6 years. Of the 30 patients only 6 were females and 24 were males.
Results: We found that dynamic study is the gold standard in detection of recurrent lesions. Well defined nodular enhancement, thick irregular marginal enhancement or gross enlargement of the lesion with arterial phase enhancement and contrast wash out were considered positive for malignancy. Ill-defined persistent enhancement or well defined rim marginal enhancement were considered benign post ablation changes. We found that subtraction technique was essential in differentiation between the normal hyperintense T1 signal of the ablation zone and arterial enhancement of the lesion. The high signal intensity seen in T1 images post TACE was explained by haemorrhagic coagulative necrosis. Subtraction imaging is ideally suited for such a role where the unenhanced T1-weighted sequence is subtracted from the identical contrast enhanced sequence.
Conclusion: We conclude that in evaluation of HCC after TACE, ADC calculated at DWI had weaker correlation to tumor necrosis degree than did findings with subtraction contrast-enhanced MRI. However, there was no difference between both methods in diagnosis of complete tumor necrosis. We suggest that whenever possible, gadolinium contrast enhancement and subtraction imaging be used for assessment of tumor necrosis after TACE.