目的 探讨基于对比增强磁共振成像(contrast-enhanced magnetic resonance imaging,CE-MRI)图像直方图参数对肝细胞癌(hepatocellular carcinoma,HCC)经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)术后早期疗效的评估和预测价值.材料与方法 回顾性分析我院2018年6月至2021年12月经病理活检证实或临床确诊为HCC的64例患者的影像及临床资料.所有患者均在TACE治疗前1个月内、首次TACE术后4～6周内行上腹部MR常规扫描及T1WI三期对比增强序列扫描,根据修正后实体瘤疗效评价标准(modified response evaluation criteria in solid tumors,mRECIST)对治疗后肿瘤疗效情况经随访将患者分为有效组34例和无效组30例.选用轴位T1WI对比增强(动脉期、门脉期、延迟期)HCC最大层面图像,通过MaZda软件人工手动勾画ROI提取病灶的直方图特征,包括均值、方差、偏度、峰度以及1、10、50、90和99百分位数值(分别记录为Perc1、Perc10、Pere50、Perc90和Perc99)共9个特征参数.采用SPSS软件分别比较TACE治疗前后有效组、无效组之间各参数的差异.对于评估肝癌术后疗效有统计学意义的参数,采用受试者工作特征(receiver operating characteristic,ROC)曲线评价其诊断效能,确定有预测价值的参数值及阈值.结果 TACE治疗前两组间差异有统计学意义的参数包括动脉期均值、Perc50、Perc90、Perc99和静脉期Perc1、延迟期峰度值(P＜0.05);TACE治疗后两组间差异有统计学意义的参数包括延迟期均值、Perc50、Perc99值(P＜0.05);其余各参数TACE治疗前后两组间比较差异无统计学意义(P＞0.05).ROC曲线显示各参数的效能为:术前动脉期均值＞术后延迟期Perc99＞术前动脉期Perc90＞术后延迟期均值＞术前延迟期峰度＞术后延迟期Perc50＞术前延迟期Perc50＞术前动脉期Perc99,TACE术前动脉期均值的ROC曲线下面积最大[0.710(95％CI:0.583～0.817)].结论 CE-MRI图像的直方图特征能够有效评估及预测肝癌TACE术后早期疗效,有助于指导临床治疗方案.
Evaluation and prediction of therapeutic effect of hepatocellular carcinoma after TACE based on contrast enhanced MRI histogram analysis
Objective:To evaluate and predict the early curative effect of transcatheter arterial chemoembolization(TACE)for hepatocellular carcinoma based on contrast-enhanced magnetic resonance imaging(CE-MRI)histogram parameters of MRI.Materials and Methods:Sixty-four patients with hepatocellular carcinoma confirmed by pathological biopsy or clinically diagnosed from June 2018 to December 2021 were selected for study.All patients underwent routine MR scan and multi-phase dynamic enhanced T1WI contrast-enhanced scan within 1 month before TACE treatment and 4-6 weeks after the first TACE treatment.According to the modified solid tumor efficacy evaluation criteria(mRECIST),the patients were divided into effective group of 34 cases and ineffective group of 30 cases.The HCC maximum axial T1WI images(arterial phase,portal phase and delayed phase)of HCC maximum slice images were selected for all patients,and the histogram features of the lesions were manually extracted by sketching ROI with MaZda software,including mean,variance,skewness,kurtosis and the values of the 1st,10th,50th,90th and 99th percentiles(recorded as Perc1,Perc10,Pere50,Perc90 and Perc99,respectively).Statistical software was used to compare the differences of histogram parameters between effective group and ineffective group before and after TACE treatment.The parameters with statistical differences in the postoperative efficacy of HCC were evaluated by the receiver operating characteristic(ROC)curve,and the valuable parameter values and thresholds were obtained.Results:The parameters with statistically significant differences between the two groups before TACE treatment including mean value,Perc50,Perc90,Perc99 in arterial phase,Perc1 in venous phase,and peak value in delayed phase(P＜0.05);the parameters with statistically significant differences between the two groups after TACE treatment including the mean value of delay period,Perc50,Perc99(P＜0.05);there was no statistically significant difference in the other parameters between the two groups before and after TACE treatment(P＞0.05).The ROC curve results showed that the efficacy of each parameter was as follows:preTACE arterial phase mean＞postTACE delay phase Perc99＞preTACE arterial phase Perc90＞postTACE delay phase mean＞preTACE delay phase kurtosis＞postTACE delay phase Perc50＞pretTACE delay phase Perc50＞preTACE arterial phase Perc99.The area under the ROC curve of preTACE arterial phase mean was the highest,with a value of 0.710(95％CI:0.583-0.817).Conclusions:The histogram features of CE-MRI can effectively evaluate and predict the characteristics of early curative effect after TACE of hepatocellular carcinoma,which helps guide clinical treatment plans.
hepatocellular carcinomamagnetic resonance imagingcontrast enhanced magnetic resonance imaginghistogram analysistexture analysis
万方数据
维普
