A case of advanced hepatocellular carcinoma who died of metabolic encephalopathy early in the course of treatment with sorafenib with marked changes in imaging findings

Abstract

We encountered a patient who died of metabolic encephalopathy early in the course of oral treatment with sorafenib. In this case, we performed sonazoid-enhanced ultrasound (CE-US), and diffusion-weighted MR imaging at both baseline and one week after treatment. At one week after treatment, CE-US showed a decrease in blood flow signal of both the tumor and normal kidney parenchyma compared with baseline images. On the other hand, diffusion-weighted MR imaging showed that the apparent diffusion coefficient (ADC) value obtained at one week after treatment was decreased compared with ADC at baseline. Abrupt changes in the imaging findings, such as decreases in blood flow, are suggested as predictors of treatment response to sorafenib. Patients should therefore be followed carefully for signs of serious side effects.