扩散峰度成像对经导管动脉化疗栓塞术后肝细胞癌肿瘤患者复发和进展的预测价值

Predictive Value of Diffusion Kurtosis Imaging for Recurrence and Progression of Hepatocellular Carcinoma Tumor Patients after Transcatheter Arterial Chemoembolization

目的 探讨扩散峰度成像(diffusion kurtosis imaging,DKI)对肝细胞癌(hepatocellular carcinoma,HCC)患者经导管动脉化疗栓塞(transcatheterarterialchemoembolization,TACE)治疗复发和进展的预测价值。方法 回顾性分析2021年1月-2022年12月在联勤保障部队第九〇九医院接受TACE治疗HCC患者临床资料。根据TACE治疗6个月时的实体瘤整体改良反应评估标准(modified responsee valuation criteria in solid tumors,mRECIST),将接受TACE治疗的HCC病灶分为进展组和未进展组。在DKI衍生的度量图上评估TACE治疗区域、肿瘤周围肝区和远处肿瘤区。收集肿瘤区域、癌旁组织DKI的主要参数,包括:平均扩散率(mean diffusion,MD)、轴向扩散率(axial diffusion,Da)、径向扩散率(radialdiffusion,Dr)、平均弥散峰度(Mean kurtosis,MK),轴向弥散峰度(Axial kurtosis,Ka),纵向弥散峰度(Radial kurtosis,Kr)和峰度各向异性分数(fractionalanisotropy of kurtosi s,FAK)。使用受试者者工作特征曲线(receiver operating characteristic curve,ROC)分析DKI主要参数对TACE治疗后进展的预测价值。结果研究共纳入81例患者,89个病灶接受了TACE治疗。根据病灶TACE治疗后6个月时是否进展,分为进展组46例患者(52个病灶)和未进展组35例患者(37个病灶)。与未进展组相比,进展组患者血清AFP水平>200ng/mL比例更高、碘油造影强化比例更高、DSA肿瘤染色比例更高(P均<0.05)。与未进展病变相比,进展组的肿瘤区MD和Dr值更低,而Ka、Kr和FAK值更高(P均<0.05);进展组癌旁组织的的Da和Dr值更低,而MD、FAK和Ka值更高。扩散峰度成像参数预测患者进展的ROC曲线可见,肿瘤组织中的MD(AUC=0.916)、Kr(AUC=0.794)、Dr(AUC=0.851)、Ka(AUC=0.841)、FAK(AUC=0.757),癌旁组织的MB(AUC=0.898)、Dr(AUC=0.752)、Ka(AUC=0.884)、FAK(AUC=0.692)和FA(AUC=0.688)值均对TACE治疗后患者进展有一定预测价值。结论 DKI的相关功能参数对TACE治疗后的HCC患者复发和进展情况具有一定预测优势,值得今后进一步研究和推广。

Objective To explore the predictive value of diffusion kurtosis imaging(DKI)in the recurrence and progression of hepatocellular carcinoma(HCC)patients treated with transcatheter arterial chemoembolization(TACE).Methods A retrospective analysis was conducted on the clinical data of HCC patients who received TACE treatment in our hospital from January 2021 to December 2022.According to the modified response evaluation criteria in solid tumors(mRECIST)at 6 months of TACE treatment,HCC lesions receiving TACE treatment were divided into progressive and non-progressive group.The TACE treatment area,surrounding liver area,and distant tumor area on the DKI derived metric map were evaluated.The main parameters for DKI in tumor areas and adjacent tissues include:mean diffusion(MD),axial diffusion(Da),radial diffusion(Dr),mean kurtosis(MK),axial kurtosis(Ka),radial kurtosis(Kr),and fractional anisotropy of kurtosis(FAK)were collected.Receiver operating characteristic curve(ROC)were used to analyze the predictive value of DKI main parameters for the progression after TACE treatment.Results A total of 81 patients and 89 lesions received TACE treatment were included in the study.According to the progression of lesions at 6 months after TACE treatment,there were 46 patients in the progression group(52 lesions)and 35 patients in the non-progression group(37 lesions).Compared with the non-progression group,patients in the progression group had a higher proportion of serum AFP levels>200 ng/mL,a higher proportion of iodine oil contrast enhancement,and a higher proportion of DSA tumor staining(all P<0.05).Compared with non-progression group,the MD and Dr values in the tumor area of the progressive group are lower,while the Ka,Kr,and FAK values are higher(P<0.05).The Da and Dr values of adjacent tissues in the progression group are lower,while the MD,FAK,and Ka values are higher.The Receiver operating characteristic of diffusion kurtosis imaging parameters predicting the patient's progress can be seen.The values of MD(AUC=0.916),Kr(AUC=0.794),Dr(AUC=0.851),Ka(AUC=0.841),FAK(AUC=0.757)in tumor tissue,MD(AUC=0.898),Dr(AUC=0.752),Ka(AUC=0.884),FAK(AUC=0.692)and FA(AUC=0.688)in adjacent tissues have certain predictive value for the patient's progress after TACE treatment.ConclusionThe relevant functional parameters of DKI have a certain predictive advantage for HCC in predicting the recurrence and progression of patients after TACE treatment,and are worthy of further research and promotion in the future.