光谱CT联合DWI参数在肝细胞癌TACE疗效及预后转归中的评估价值

Evaluation value of spectral CT combined with DWI parameters in the efficacy and prognostic regression of transcatheter arterial embolization for hepatocellular carcinoma

目的探究光谱CT联合磁共振弥散加权成像(DWI)参数对肝细胞癌经导管动脉栓塞(TACE)的疗效及预后转归的评估价值。方法前瞻性选取2022年6月至2024年2月拟于平煤神马集团总医院行TACE的128例肝细胞癌患者作为研究对象,治疗4周后根据疗效分为有效组(n=81)和无效组(n=47)。比较两组患者的基线资料、光谱CT、DWI定量参数,采用多因素Logistic回归分析法分析影响肝细胞癌TACE疗效的相关因素,采用Spearman相关性分析光谱CT、DWI定量参数与肝细胞癌TACE疗效的相关性,比较不同预后转归患者的光谱CT、DWI定量参数,采用受试者工作特征(ROC)曲线分析光谱CT、DWI定量参数对肝细胞癌TACE预后转归的预测价值。结果有效组和无效组患者的肿瘤分期、甲胎蛋白、门静脉癌栓、分化程度比较差异均有统计学意义(P<0.05);治疗4周后,动脉期标准化碘浓度(AP-NIC)(0.19±0.05 vs 0.28±0.07)、静脉期标准化碘浓度(PP-NIC)(0.39±0.11 vs 0.55±0.12)、能谱曲线斜率(λHU)(1.24±0.42 vs 1.87±0.34)比较,有效组明显低于无效组,表观扩散系数(ADC)[(1.62±0.45)×10^(-3)mm^(2)/s vs(1.25±0.32)×10^(-3)mm^(2)/s]比较有效组明显高于无效组,差异均有统计学意义(P<0.05);校正前多因素Logistic回归分析结果显示,肿瘤分期、甲胎蛋白、分化程度、门静脉癌栓,治疗4周后的AP-NIC、PP-NIC、λHU及ADC均是肝细胞癌TACE疗效的影响因素(P<0.05),校正后多因素Logistic回归分析结果显示,治疗4周后的AP-NIC、PP-NIC、λHU及ADC仍是肝细胞癌TACE疗效的影响因素(P<0.05);Spearman相关性分析结果显示,治疗4周后的AP-NIC、PP-NIC、λHU与肝细胞癌TACE疗效呈正相关(r=0.797、0.779、0.794,P<0.05),治疗4周后的ADC与肝细胞癌TACE疗效呈负相关(r=-0.770,P<0.05);治疗4周后的AP-NIC(0.20±0.06)vs(0.30±0.08)、PP-NIC(0.37±0.09)vs(0.50±0.13)、λHU(1.34±0.08)vs(1.78±0.14)比较,预后良好组明显低于预后不良组,ADC[(1.55±0.24)×10^(-3)mm^(2)/s vs(1.29±0.30)×10^(-3)mm^(2)/s]比较,预后良好组明显高于预后不良组,差异均有统计学意义(P<0.05);ROC分析结果显示,治疗4周后AP-NIC、PP-NIC、λHU及ADC联合预测肝细胞癌TACE预后转归曲线下面积(AUC)为0.932,敏感度、特异度分别为91.43%、84.09%,明显大于各定量参数单独预测(P<0.05)。结论AP-NIC、PP-NIC、λHU及ADC参数与肝细胞癌TACE疗效、预后转归密切相关,AP-NIC、PP-NIC、λHU及ADC联合预测肝细胞癌TACE预后转归具有良好的参考价值。

Objective To explore the value of spectral CT combined with magnetic resonance diffusion-weighted imaging(DWI)parameters in evaluating the efficacy and prognostic regression of transcatheter arterial embolization(TACE)for hepatocellular carcinoma.Methods A prospective study was conducted on 128 patients with hepatocellular carcinoma who were scheduled to undergo TACE at Pingmei Shenma Group General Hospital from June 2022 to February 2024.After 4 weeks of treatment,the patients were divided into an effective group(n=81)and an ineffective group(n=47)based on the efficacy.Baseline data,spectral CT,and DWI quantitative parameters were compared between the two groups of patients.Multivariate logistic regression analysis was used to analyze the factors that affect the efficacy of TACE for hepatocellular carcinoma.The correlation between the quantitative parameters of spectral CT and DWI and the efficacy of TACE in HCC was analyzed using Spearman correlation analysis.The quantitative parameters of spectral CT and DWI were compared between the patients with different prognosis outcomes.The predictive value of spectral CT and DWI quantitative parameters for the prognosis of TACE in hepatocellular carcinoma was analyzed using receiver operating characteristic(ROC)curve.Results There were significant differences in tumor stage,alpha-fetoprotein,portal vein tumor thrombus,and differentiation degree between the effective and ineffective groups(P<0.05).After 4 weeks of treatment,the normalized iodine concentration in the arterial phase(AP-NIC),normalized iodine concentration in the portal venous phase(PP-NIC),and the slope rate of the spectral HU curve(λHU)of the effective group were significantly lower than those of the ineffective group:AP-NIC(0.19±0.05)vs(0.28±0.07),PP-NIC(0.39±0.11)vs(0.55±0.12),andλHU(1.24±0.42)vs(1.87±0.34);the apparent diffusion coefficient(ADC)of the effective group was significantly higher than that of the ineffective group:(1.62±0.45)×10^(-3)mm^(2)/s vs(1.25±0.32)×10^(-3)mm^(2)/s;the differences were statistically significant(P<0.05).Multivariate logistic regression analysis before correction showed that tumor stage,alpha-fetoprotein,differentiation degree,portal vein tumor thrombus,and AP-NIC,PP-NIC,λHU,and ADC after 4 weeks of treatment were all factors affecting the efficacy of TACE for hepatocellular carcinoma(P<0.05).Multi-variate logistic regression analysis after correction showed that AP-NIC,PP-NIC,λHU,and ADC after 4 weeks of treat-ment were still factors affecting the efficacy of TACE for hepatocellular carcinoma(P<0.05).Spearman correlation anal-ysis showed that AP-NIC,PP-NIC,andλHU were positively correlated with the efficacy of TACE for hepatocellular car-cinoma after 4 weeks of treatment(r=0.797,0.779,0.794,P<0.05),while ADC was negatively correlated with the effica-cy of TACE for hepatocellular carcinoma after 4 weeks of treatment(r=-0.770,P<0.05).The AP-NIC,PP-NIC,andλHU in the good prognosis group after 4 weeks of treatment were significantly lower than those in the poor prognosis group:AP-NIC(0.20±0.06)vs(0.30±0.08),PP-NIC(0.37±0.09)vs(0.50±0.13),andλHU(1.34±0.08)vs(1.78±0.14);the ADC in the good prognosis group was significantly higher than that in the poor prognosis group:(1.55±0.24)×10^(-3)mm^(2)/s vs(1.29±0.30)×10^(-3)mm^(2)/s;the differences were statistically significant(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the combined detection of AP-NIC,PP-NIC,λHU,and ADC for predicting the prognosis of TACE in hepatocellular carcinoma after 4 weeks of treatment was 0.932,with a sensitivity of 91.43%and a specificity of 84.09%,which was significantly greater than that of each parameter alone(P<0.05).Conclusion The parameters of AP-NIC,PP-NIC,λHU,and ADC are closely related to the efficacy and prognosis of TACE for hepatocellular carcino-ma.The combined detection of AP-NIC,PP-NIC,λHU,and ADC for predicting the prognosis of TACE for hepatocellu-lar carcinoma has good reference value.