The Value Of ADC Value Combined Gd-EOB-DTPA In The Evaluation Of The Therapeutic Effect Of Liver Cancer After TACE

ObjectiveTo explore the diagnostic value of the apparent diffusion coefficient（ADC）value of diffusion weighted imaging（DWI）combined with Gd-EOB-DTPA enhanced magnetic resonance imaging in patients with hepatocellular carcinoma（HCC）after TACE.MethodsA retrospective selection of 52 patients with hepatocellular carcinoma who were treated at The Second Hospital of Dalian Medical University from January 2019 to October 2020.Fifty-two patients with HCC who met the inclusion and exclusion criteria and were treated only by interventional therapy were included,including 33 males and19 females.A total of 106 HCC lesions were detected.According to the Chinese Society of Clinical Oncology（CSCO）Guidelines for the Diagnosis and Treatment of Primary Liver Cancer（2020）and the MRECIST criteria recommended by the European Society for the Study of the Liver（EASL）and the European Organization for Research in the Treatment of Cancer（EORTC）in 2012,as the reference criteria for evaluating whether there is a residual diagnosis of cancer foci after TACE,Postoperative DSA angiography and pathological puncture results were used as the gold standard for diagnosis.Gd-EOB-DTPA,DWI and the combination of the two were used to diagnose the cancer foci after TACE,and the sensitivity,specificity and accuracy of the three were evaluated.The ROC curve was used to analyze the ADC of the effective group and the ineffective cancer foci after the operation,to explore the value of ADC value in the diagnosis of cancer after TACE.Kappa test analyzes the consistency of Gd-EOB-DTPA and the gold standard diagnosis results.Calculate the preoperative and postoperative CER and SIR of HCC lesions in the arterial phase,use paired-sample t test for the preoperative and postoperative ADC,CER,and SIR values,and use the ADC and CER values for the effective and ineffective groups Using independent sample t-test for SIR and SIR values to explore their value in evaluating the efficacy of TACE.ResultsBased on the gold standard,a total of 106 HCC cancer foci were detected in 52patients,67 necrotic cancer foci after operation,39 residual or new cancer foci after operation,and most necrotic cancer foci showed low signal on T1WI and high T2WI Signal,enhanced scan without enhancement,DWI sequence is low signal,ADC image is high signal,HBP is low signal.Residual or recurring cancer lesions are mostly manifested as low or equal low signal on T1WI,high or mixed high signal on T2WI,and rapid enhancement in the arterial phase,while the enhancement in the venous or delayed phase is reduced.The DWI sequence is high signal,the ADC image is low signal,and HBP is Obviously low signal.The ADC value of cancer foci before operation was（1.40±0.23）×10^-3mm²/s,which was lower than（1.76±0.33）×10^-3mm²/s after operation,P<0.001.The postoperative ADC value of the effective group was（1.90±0.30）×10^-3mm²/s higher than that of the invalid group（1.51±0.23）×10^-3mm²/s,the area under the ROC curve of the postoperative ADC value was 0.837,and the ADC cut-off threshold was 1.745×10^-3mm²/s.The sensitivity of Gd-EOB-DTPA and DWI in diagnosing postoperative cancer foci were both 92.31%,and the specificities were94.03%and 95.52%,respectively.The Kappa consistency test was used to calculate the Gd-EOB-DTPA and gold standard for postoperative cancer foci.According to the diagnosis result,Kappa value=0.859,P<0.001,the sensitivity and specificity of the two simultaneous use were 97.44%and 100%,respectively.The postoperative CER value of cancer lesions was 0.55±0.36,and the SIR value was 0.96±0.15,both of which were lower than preoperatively,P<0.001,and the effective group was significantly lower than the ineffective group.Conclusion1.Residual or recurring cancer foci after TACE are mostly low or equal low signal on T1WI,high or mixed high signal on T2WI,high signal on DWI sequence,low signal on ADC map,rapid enhancement in the arterial phase,but delayed in the venous phase Phase enhancement decreases,HBP is obviously low signal.2.The postoperative ADC value is of high value for evaluating the treatment effect.The Gd-E0B-DTPA diagnosis result has good consistency with the gold standard diagnosis result,but the combination of the two has a higher diagnostic value.3.The CER value and SIR value of the cancer focus after operation were lower than those before operation,and the effective group decreased more significantly than the ineffective group.