| Background According to the latest edition of the International Agency for Research on Cancer,GLOBOCAN2018,liver cancer has become the sixth most common malignant tumor in the world.More than 50%of new cases of liver cancer and deaths occur in China every year,including hepatocellular carcinoma caused by hepatitis B.(hepatocellular carcinoma,HCC)is predominant.Patients with advanced HCC are usually treated with transcatheter arterial chemoembolization(TACE)and radiofrequency ablation(RFA).Accurate examination and diagnosis and early postoperative evaluation of patients before and after treatment are the key to the maximum benefit of patients.There are different methods for evaluating the efficacy,which are basically morphological evaluations with low reliability and accuracy.Attravoxel incoherent motion diffusion weighted imaging(IVIM-DWI),which is considered to reflect microscopic changes in tissue,can reflect tumor residual or neovascularization before changes in tumor morphology.It can be used to evaluate the early efficacy of tumor treatment,and it is expected to improve the reliability and accuracy of TACE or RFA.Objective To evaluate the therapeutic effect of IVIM-DWI on non-surgical treatment of HCC.Materials and Methods A total of 50 patients with hepatocellular carcinoma who underwent transcatheter arterial chemoembolization(TACE)or radiofrequency ablation(RFA)were collected.Male:female = 41:9,TACE:RFA = 42:8;Routine enhanced CT or MRI was performed within 48 hours before surgery,3 months after surgery,and 3-12 months after surgery,and IVIM-DWI technique scan was performed simultaneously.Magnetic resonance is a 1.5T magnetic resonance scanner(Signa Excite,GE Medical Systems).Scanning sequences include:horizontal axis and coronal precise frequency reversal to restore T2WI sequence,horizontal axis T1WI and reverse phase,a multi-phase dynamic enhanced scan of the liver acquisition with volume acceleration-expansion volume(LAVA-XV),breathing trigger horizontal axis IVIM-DWI(b value = 0,15,30,45,70,100,150,300,500,800s/mm2);Horizontal axis position screen 3D LAVA-XV multi-phase dynamic enhanced scanning:The contrast agent diethylenetriamine pentaacetate(Gd-DTPA)was injected through the dorsal vein of the hand using a high-pressure syringe at a dose of 0.2 ml/kg with a flow rate of 2 to 2.5 mL/s,followed by injection of 20 ml of the same flow rate.The saline arterial tube was collected at 12 s,45 s,2 min and 3 min after injection of contrast agent,and images of liver arterial phase,early portal vein,late portal vein and delayed phase were collected.Patients were divided into stable group and progression group by mRECIST criteria.Measurement of two groups is using two regions of interest delineation.Statistical analysis is performed on the differences between ADC value,D*value,D value and f value in the stable group and the progression group.Results Using the maximum area measurement method,before the treatment,the average value of ADC of the stable group was 1.853±0.456×10-3mm2/s,the average value of D*was 10.617±7.997×10-3nmm2/s,and the average value of D was 1.144±0.296×10-3mm2/s.the average value of f was 0.345±0.167.The average value of ADC in the progress group was 1.140±0.287×10-3mm2/s,the average value of D*was 7.981±6.778×10-3mm2/s,and the average value of D was 0.875±0.088×10-3mm2/s.the average value of f was 0.232± 0.100;the ADC value and D value between the stable group and the progressive group were compared,and the P value was<0.05.And the ADC value and the D value were used to predict the tumor progression after non-surgical treatment.The area under the curve(AUC)is 0.952 and 0.825 respectively.Within 3 months after non-surgical treatment,the average value of ADC of the stable group was 1.593±0.433×10-3mm2/s,the average value of D*was 5.157±2.106×10-3mm2/s,and the average value of D was 1.133±0.405x10-3mm2/s.the average value of f was 0.310±0.132.The average value of ADC in the progress group was 1.395±0.480±10-3mm2/s,the average value of D*was 7.175±3.374×10-3mm2/s,and the average value of D was 0.924±0.183×10-3mm2/s.the average value of f was 0.280±0.112.The D*values between the stable group and the progressive group were compared.The P value was<0.05.The D*value for predicting tumor progression after non-surgical treatment,the AUC was 0.714.After the 3-12 months review,the average value of ADC of the stable group was 1.668±0.421 ±10-3mm2/s,the average value of D*was 1.668±0.421×10-3mm2/s,and the average value of D was 1.204±0.250×10-3mm2/s.the average value of f was 0.265±0.064.The average value of ADC in the progress group was 1.993±0.556×10-3mm2/s,the average value of D*was 8.705±8.317×10-3mm2/s,and the average value of D was 1.32410.682×10-3mm2/s.the average value of f was 0.364±0.105.The f value between the stable group and the progressive group was compared,P value<0.05;The AUC corresponding to the tumor progression after non-surgical treatment was predicted to be 0.798.Using enhanced area measurement,before the treatment,the ADC value,D value and f value between the stable group and the progressive group were compared,P value was<0.05.The ADC value,D value and f value were used to predict tumor progression after non-surgical treatment.The AUC corresponding to postoperative tumor progression were 0.911,0.857,and 0.839,respectively.The D*and f values between the stable group and the progressive group were compared within 3 months after non-surgical treatment.The P value was<0.05.The D*value and F value were used to predict the AUC of tumor progression after non-surgical treatment was 0.686,0.784.After 3-12 months postoperative examination,the ADC values between stable group and progression group were compared,P value<0.05;the ADC was used to predict the AUC of tumor progression after liver cancer operation was 0.867.Conclusion Using the maximum area measurement method,the ADC value and D value before non-surgical treatment,the D*value reviewed within 3 months after surgery,and the f value reviewed during 3-12 months after surgery,all can predict the possibility of tumor progression after surgery,and among them,the preoperative ADC value has the best diagnostic effect.Using enhanced area measurement method,ADC values,D values and f values before non-surgical treatment,D*values and f values reviewed within 3 months after surgery,and ADC values reviewed during 3-12 months after surgery can be better predict the possibility of postoperative tumor progression in patients with HCC;among them,the preoperative ADC value is the best.IVIM-DWI is a non-invasive imaging technique that can sensitively observe the changes after non-surgical treatment of hepatocellular carcinoma.It has high value in monitoring and evaluating the efficacy of non-surgical treatment of hepatocellular carcinoma patients. |
PDF Full Text Request