Evaluation of Hypoxia in Hepatocellular Carcinoma Using Quantitative MRI: Significances, Challenges, and Advances

• Published in: Journal of magnetic resonance imaging Vol. 58; no. 1; pp. 12 - 25
• Main Authors: Chen, Meicheng, Zhou, Xiaoqi, Cai, Huasong, Li, Di, Song, Chenyu, You, Huayu, Ma, Ruixia, Dong, Zhi, Peng, Zhenpeng, Feng, Shi‐Ting
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-07-2023; Wiley Subscription Services, Inc
• Subjects: Carcinoma, Hepatocellular - pathology; Chemotherapy; Diffusion Magnetic Resonance Imaging; Emission analysis; Evaluation; Hepatocellular carcinoma; Humans; Hypoxia; Hypoxia - diagnostic imaging; In vivo methods and tests; Invasiveness; Liver cancer; Liver Neoplasms - pathology; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Medical imaging; Metabolism; Metastases; Microenvironments; MRI; Oxygenation; Positron emission; Positron emission tomography; Prognosis; Radiation; Radiation effects; Radiation therapy; Spectroscopy; Substrates; Tumor Microenvironment; Tumors; hypoxia; tumor microenvironment; MRI; hepatocellular carcinoma
• ISSN: 1053-1807; 1522-2586
• DOI: 10.1002/jmri.28694

This review aimed to perform a scoping review of promising MRI methods in assessing tumor hypoxia in hepatocellular carcinoma (HCC). The hypoxic microenvironment and upregulated hypoxic metabolism in HCC are determining factors of poor prognosis, increased metastatic potential, and resistance to chemotherapy and radiotherapy. Assessing hypoxia in HCC is essential for personalized therapy and predicting prognoses. Oxygen electrodes, protein markers, optical imaging, and positron emission tomography can evaluate tumor hypoxia. These methods lack clinical applicability because of invasiveness, tissue depth, and radiation exposure. MRI methods, including blood oxygenation level‐dependent, dynamic contrast‐enhanced MRI, diffusion‐weighted imaging, MRI spectroscopy, chemical exchange saturation transfer MRI, and multinuclear MRI, are promising noninvasive methods that evaluate the hypoxic microenvironment by observing biochemical processes in vivo, which may inform on therapeutic options. This review summarizes the recent challenges and advances in MRI techniques for assessing hypoxia in HCC and highlights the potential of MRI methods for examining the hypoxic microenvironment via specific metabolic substrates and pathways. Although the utilization of MRI methods for evaluating hypoxia in patients with HCC is increasing, rigorous validation is needed in order to translate these MRI methods into clinical use. Due to the limited sensitivity and specificity of current quantitative MRI methods, their acquisition and analysis protocols require further improvement.
Evidence Level
3.
Technical Efficacy
Stage 4.