体素内不相干运动扩散加权成像对肝细胞癌微血管侵犯预测和TACE疗效的评估价值

The value of diffusion weighted imaging of voxel incoherent motion in predicting microvascular invasion and evaluating the efficacy of TACE therapy on hepatocellular carcinoma

目的探讨体素内不相干运动扩散加权成像(IVIM-DWI)对肝细胞癌(HCC)行肝动脉化疗栓塞(TACE)术前病情和术后复发评估的价值。方法选择2019年7月至2021年6月行TACE的HCC患者92例,于术前3 d、术后1个月进行IVIM-DWI检查。术前根据病理结果将患者分成微血管侵犯(MVI)阳性组(60例)和MVI阴性组(32例),术后1个月根据疗效评定分为稳定组(49例)和进展组(43例),随访6个根据MRI和肿瘤血清学指标分为复发组(27例)和未复发组(65例);比较术前MVI阳性组和MVI阴性组的肿瘤直径、标准表观扩散系数(ADC)值、真表观扩散系数(D)值、假表观扩散系数(D*)值和灌注系数(f)值,比较稳定组和进展组、复发组和未复发组术后ADC值、D值、D*值和f值;logistic回归分析HCC患者术后病情稳定和复发的影响因素;绘制受试者工作特征曲线(ROC),分析影像学指标对TACE术后复发的评估效能。结果TACE术前MVI阳性组的肿瘤直径为(5.61±0.94)cm,高于阴性组的(4.03±0.76)cm,ADC值和D值为0.87±0.15和0.82±0.24,低于阴性组的0.98±0.19和0.94±0.31,差异有统计学意义(t=5.635,4.518,4.964,均P<0.05)。TACE术后稳定组的ADC值和D值为1.28±0.47和1.48±0.52,高于进展组的1.07±0.39和1.22±0.40,差异有统计学意义(t=5.374,5.038,均P<0.05)。TACE术后复发组的ADC值和D值为1.02±0.35和1.08±0.37,低于未复发组的1.36±0.51和1.59±0.56,差异有统计学意义(t=5.384,5.897,均P<0.05)。logistic分析显示HCC患者肿瘤直径与术后病情稳定呈负相关,与术后复发呈正相关;术后ADC值和术后D值与术后病情稳定呈正相关,与术后复发呈负相关(均P<0.05)。ROC曲线显示肿瘤直径、术后ADC值和术后D值评估TACE术后复发的AUC分别为0.682、0775和0.849,敏感度和特异度分别为79.56%和77.28%、82.73%和79.67%、84.51%和82.49%,差异均有统计学意义(均P<0.05),术后D值的评估效能优于肿瘤直径和术后ADC值。结论IVIM-MRI对HCC患者术前MVI、术后近期疗效和疾病预后的评估价值较高,术后D值的评估效能更佳。

Objective To investigate the value of intravoxel incoherent motion diffusion weighted imaging(IVIEM-DWI)in evaluating the preoperative condition and postoperative recurrence of hepatocellular carcinoma(HCC)patients undergoing hepatic arterial chemoembolization(TACE)therapy.Methods A total of 92 HCC patients who underwent TACE from July 2019 to June 2021 were selected for IVIM-DWI examination at 3 days before and 1 month after the surgery.The patients were divided into a microvascular invasion(MVI)positive group(n=60 cases)and a MVI negative group(n=32 cases)according to the pathological results of liver biopsy before TACE.One month after TACE therapy,the patients were divided into a stable group(n=49 cases)and a progressive group(n=43 cases)according to the efficacy evaluation.Six patients were followed up and divided into a recurrence group(n=27 cases)and a non-recurrence group(n=65 cases)according to MRI examination and tumor serological indicators.The tumor diameter,standard apparent diffusion coefficient(ADC),true apparent diffusion coefficient(D),false apparent diffusion coefficient(D*)and perfusion coefficient(f value)were compared between the MVI positive group and the MVI negative group before surgery,and the ADC,D value,D*value and f value after TACE were compared between the stable group and the progressive group,the recurrent group and the non-recurrent group.Logistic regression analysis was performed to analyze the single factors affecting the postoperative stability and recurrence of HCC patients.Receiver operating characteristic curve(ROC)was drawn to analyze the efficacy of imaging indicators in evaluating postoperative recurrence of TACE.Results Before TACE,the tumor diameter of MVI positive group was 5.61±0.94 cm,which was higher than that of negative group(4.03±0.76 cm),ADC value and D value were 0.87±0.15 and 0.82±0.24,which were lower than that of negative group(0.98±0.19 and 0.94±0.31).The difference was statistically significant(t=5.635,4.518,4.964,all P<0.05).The ADC and D values of the stable group after TACE were 1.28±0.47 and 1.48±0.52,which were higher than those of the progressive group(1.07±0.39 and 1.22±0.40),and the differences were statistically significant(t=5.374,5.038,all P<0.05).The ADC value and D value in the recurrence group after TACE were 1.02±0.35 and 1.08±0.37,which were lower than those in the group without recurrence(1.36±0.51 and 1.59±0.56),and the difference was statistically significant(t=5.384,5.897,all P<0.05).Logistic regression analysis showed that tumor diameter was negatively correlated with postoperative stability and positively correlated with postoperative recurrence in HCC patients.Postoperative ADC value and postoperative D value were positively correlated with postoperative stability,and negatively correlated with postoperative recurrence(both P<0.05).ROC curve showed that the AUC of tumor diameter,postoperative ADC value and postoperative D value for postoperative recurrence evaluation of TACE were 0.682,0775 and 0.849,respectively,and the sensitivity and specificity were 79.56%and 77.28%,82.73%and 79.67%,84.51%and 82.49%,respectively.The difference was statistically significant(all P<0.05),and the evaluation efficiency of postoperative D value was better than that of tumor diameter and postoperative ADC value.Conclusion IVIEM-MRI has a higher value in evaluating MVI before operation,short-term efficacy after operation,and the prognosis of HCC patients.It also has better efficacy in evaluating D value after operation.