钆塞酸二钠增强MRI的影像特征和肝胆期直方图参数对肝细胞癌经动脉化疗栓塞术应答反应的预测价值

Predictive value of Gd-EOB-DTPA enhanced MRI features and hepatobiliary phase histogram parameters in response to transarterial chemoembolization for hepatocellular carcinoma

目的 探讨钆塞酸二钠(gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid, Gd-EOB-DTPA)增强MRI的影像特征和肝胆期直方图参数对肝细胞癌(hepatocellular carcinoma, HCC)患者经动脉化疗栓塞术(transarterial chemonembolization, TACE)治疗应答反应的预测价值。材料与方法 前瞻性招募2020年6月至2021年6月在新乡医学院第一附属医院初诊的54例HCC患者,评估病灶的影像学特征,并提取肝胆期病灶的直方图均值、变异度、峰度、偏度、第10百分位、第90百分位、熵、最大值、最小值及中值等参数。根据改良实体瘤疗效评价标准(modified Response Evaluation Criteria in Solid Tumors, mRECIST),分析影像学特征和肝胆期直方图参数在TACE术后不同应答组中的差异,应用logistic回归分析和受试者工作特征(receive operating characteristic, ROC)曲线分析有统计学意义的参数对应答反应的预测价值。结果 应答组28例,非应答组26例。不完整的包膜、动脉期瘤周强化、肝胆期瘤周低信号的发生率在非应答组明显高于应答组(P均<0.05)。均值、变异度、第10百分位、中值非应答组明显高于应答组(P<0.05)。Logistic回归分析显示,动脉期瘤周强化、肝胆期瘤周低信号和变异度是应答反应独立影响因素(P均<0.05)。ROC曲线分析显示,综合参数预测应答反应的曲线下面积、敏感度、特异度分别为0.904(95%CI:0.816~0.992)、80.8%、96.4%。结论 动脉期瘤周强化、肝胆期瘤周低信号和变异度是TACE术后应答反应的独立预测因素,且定性指标与定量参数综合的预测模型有好的预测效能,为HCC患者的精准治疗提供帮助。

Objective: To evaluate the value of Gd-EOB-DTPA enhanced MRI and hepatobiliary tumor histogram parameters in predicting the response to transarterial chemoembolization(TACE) in patients with hepatocellular carcinoma. Materials and Methods: Fifty-four patients with newly diagnosed HCC treated in the First Affiliated Hospital of Xinxiang Medical College from June 2020 to June 2021 were collected. The imaging features of the lesions were evaluated, and the histogram mean, variation, kurtosis, skewness, 10th percentile(Perc10%), 90th percentile(Perc90%), entropy, maximum, minimum and median values of hepatobiliary lesions were extracted.According to modified Response Evaluation Criteria in Solid Tumors(mRECIST), the differences of imaging features and histogram parameters in different response groups after TACE were analyzed. Logistic regression and receiver operating characteristic(ROC)curves were used to analyze the predictive value of meaningful parameters for response. Results: There were 28 cases in response group and 26 cases in non-response group. The incidences of incomplete capsule, arterial phase peritumoral enhancement and hepatobiliary peritumoral hypointensity in the non-response group were significantly higher than those in the response group(P<0.05). The mean value, degree of variability, Perc10% and median response group were significantly higher than those in the non-response group. Logistic regression analysis showed that peritumoral enhancement in arterial phase, low signal intensity and degree of variation in hepatobiliary phase were independent influencing factors of response(P<0.05). The area under the ROC curve, sensitivity and specificity of the combined parameters were 0.904(95% CI: 0.816-0.992), 80.8% and 96.4%, respectively. Conclusions: Periarterial tumor enhancement,perihepatobiliary tumor hypointense and variation are independent predictors of response after TACE, and the predictive model combining qualitative indicators and quantitative parameters has good predictive efficacy, which helps in the precision treatment of HCC patients.