Application Value Of One-step Spectral And Perfusion CT Technique In Assessing The Efficacy Of DEB-TACE For Hepatocellular Carcinoma

Objective:To explore the clinical value of one-step spectral and perfusion CT scan in assessing the efficacy of drug-eluting bead transarterial chemoembolization for hepatocellular carcinoma.Materials and Methods:Between June 2018 to December 2019,patients with DSA confirmed as hepatocellular carcinoma were prospectively collected in this study.All patients underwent One-step spectral and perfusion CT scan with GE Revolution CT after 4～6 weeks treated by DEB-TACE,and received DSA examinations 1 to 5 days after the CT examination.This study included 32 patients with a total of 49 residual or recurrent lesions which were based on DSA results.After the scan,we combine the original perfusion image with the 100 kVp-like level spectrum image to reconstruct it to obtain CT perfusion images.Transfer all the images to the workstation of ADW 4.7,obtain the spectrum and perfusion parameters.Perfusion parameters:blood volume(BV),blood flow(BF),hepatic artery blood flow(a-BF),mean transit time(MTT),hepatic artery fraction(HAF),and surface permeability(PS).Spectrum parameters:iodine concentration(IC),standardized iodine concentration(NIC),standardized iodine Concentration Difference(NICD).Using the DSA angiography results as the gold standard,the differences between the parameters of the residual or recurrent lesions and the liver parenchyma were obtained,and the receiver operating characteristics(ROC)curve was obtained.Results:1.Diagnostic value of perfusion parametersThe a-BF,HAF,PS,BV,and BF of the residual or recurrent lesions of hepatocellular carcinoma after DEB-TACE were higher than those of normal liver parenchyma,and the MTT was lower than that of normal liver parenchyma,The differences between groups were statistically significant(p<0.01).The AUCs of a-BF and HAF were 0.884 and 0.831,the AUCs of the other perfusion parameters were<0.75.The sensitivity and specificity of a-BF were 87.8%and 84.4%,The sensitivity and specificity of HAF were 85.7%and 87.5%.2.Diagnostic value of spectrum parametersThe spectrum parameters of residual or recurrent lesions were higher in AP-NIC than in normal liver parenchyma,and the difference was statistically significant(p<0.001).DP-NIC was lower than normal liver parenchyma,exhibiting a significance difference(p<0.05).There was no significant difference in PP-NIC between two groups(p>0.05).The differences between PA-NICD,DP-NICD,and DA-NICD between residual or recurrent lesions and normal liver parenchyma were statistically significant(p<0.05).The AUC of AP-NIC was 0.913,and the AUCs of other energy spectrum parameters were<0.35.The sensitivity and specificity of AP-NIC were 89.8%and 87.5%,respectively.3.Diagnostic value of perfusion parameters combined with energy spectrum parametersCombination a-BF with AP-NIC with AUC assess the residual or recurrent lesions 0.987,and the sensitivity,specificity,positive predictive value,negative predictive value,accuracy were 100.0%,89.8%,86.5%,100%,93.8%,respectively.Combination HAF with AP-NIC assess the residual or recurrent lesions with AUC 0.943,and Sensitivity,specificity,positive predictive value,negative predictive value,accuracy were 84.8%,93.9%,90%,90.2%,90.1%,respectively.Combination a-BF,HAF with AP-NIC assess the residual or recurrent lesions with AUC 0.988,and the sensitivity,specificity,positive predictive value,negative predictive value,accuracy were 100.0%,89.8%,86.5%,100%,93.8%,respectively.The AUC of HAF combined with AP-NIC was smaller than the AUC of a-BF combined with AP-NIC,and also smaller than the AUC of a-BF,HAF combined with AP-NIC,and the difference was statistically significan(p<0.05).There was no significant difference in AUC between the combination of a-BF,AP-NIC and the combination of a-BF,HAF,AP-NIC(p>0.05).Conclusions:The a-BF,HAF,AP-NIC have high diagnostic value for HCC after DEB-TACE,the combination of energy spectroscopy and perfusion parameters could improve the sensitivity and specificity,one-stop spectral and perfusion CT scan has higher clinical application value than perfusion imaging or spectral imaging.