Abstract: Objective The aim of this study was to investigate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) for assessing tumor viability (TV) following transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Methods 89 patients with HCC were encountered in our hospital between January 2019 and February 2025, and all underwent TACE treatment. Patients received DCE-MRI for volume transfer constant (K^trans), rate constant (K_ep) and extracellular extravascular volume fraction (V_e), and DWI for apparent diffusion coefficient (ADC) measurements. TV was evaluated bydigital subtraction angiography (DSA) after TACE. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic performance. Results DSA after TACE found 96 active tumor regions, 95 adjacent liver regions and 81 necrotic tumor regions in our series; K^trans and K_ep in active tumor regions were (1.1±0.3)min^-1 and (3.0±1.3)min^-1, both significantly higher than [(0.6±0.2)min^-1 and (1.4±0.4)min^-1, respectively, P<0.05] in adjacent liver regions or [(0.3±0.2)min^-1 and (1.0±0.6)min^-1, respectively, P<0.05] in necrotic tumor regions, while the ADC was (0.9±0.3)×10^-3mm/s², significantly lower than [(1.5±0.5)×10^-3mm/s², P<0.05] in adjacent liver regions or [(1.8±0.6)×10^-3mm/s², P<0.05] in necrotic tumor regions; ROC analysis showed that the AUC was 0.973, with sensitivity of 96.0% and specificity of 96.4%, when K^trans and K_ep were combined with ADC in judging TV after TACE treatment in patients with HCC. Conclusion DCE-MRI quantitative parameters and ADC could effectively assess TV after TACE in patients with HCC, which might help clinicians make further anti-tumor plans.

Key words: Hepatocellular carcinoma, Dynamic contrast-enhanced magnetic resonance imaging, Diffusion-weighted imaging, Transarterial chemoembolization, Tumor viability, Diagnosis