Comparison Of Dual-energy Iodiogram And Diffusion-weighted Magnetic Resonance Imaging In The Evaluation Of Efficacy After TACE Surgery For Hepatocellular Carcinoma

Objective:To compare the value of dual-energy iodiogram and diffusion weighted magnetic resonance imaging in the evaluation of the efficacy of hepatocellular carcinoma after TACE surgery.Methods:Thirty-five patients with hepatocellular carcinoma who came to Handan Central Hospital from September 2021 to December 2022 were selected,all of whom had received one or more TACE treatments,including26 males and 9 females,aged 37-77(64±9)years.The 100 Kv and Sn150 Kv images obtained after dual-source CT scanning of all patients were imported into Siemens Syngo via workstation,and the iodine map was reconstructed using liver VNC post-processing software.The image quality of conventional CT images and dual-energy iodide images were evaluated subjectively from three aspects: the display degree of the lesion defect area after iodized oil embolization,the absence of artifacts around the lesion,and whether the enhancement can be accurately judged.With the results of postoperative DSA as the gold standard,iodine map and DWI were used to make qualitative diagnosis of the cancer foci after TACE surgery,and their sensitivity,specificity,accuracy,positive predictive value and negative predictive value were evaluated.The concentrations of AP and PP iodine in normal liver tissue,ADC values and AP and PP iodine in relapsed residual tissue and necrotic tissue were measured on the post-processing software.The standardized iodine concentration(NIC)was calculated.When the data were in line with the normal distribution,the independent sample T-test(T-value)was used to compare the differences between the two groups;otherwise,the Mann-Whitney U test(Z-value)was used.The receiver operating characteristic curve(ROC)was drawn to analyze the efficacy of multiple parameters in diagnosing different tissues after TACE.Results:The iodide deposits were bright yellow on the iodide chart;the newly developed and residual active HCC lesions after TACE surgery were enhanced on the arterial stage iodide chart,showing orange red;the necrotic HCC lesions were not enhanced on the arterial stage iodide chart,showing black.The regional score and the peripheral score of the 35 HCC patients were higher than those of conventional CT images,and the differences were statistically significant(P<0.05).Using DSA as the gold standard,a total of 73 lesions were detected,including 42 recurrent and residual lesions and 31 necrotic lesions.Comparing the detection of the 73 lesions after TACE by the two methods,the specificity and positive predictive value of the lesions detected by dual-energy iodine graph were higher than that of DWI,which were 90.32% and 92.31%,respectively.The sensitivity,accuracy and negative predictive value were lower than those of DWI,which were 85.71%,87.67%and 82.35%,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the combined diagnosis of HCC lesions after TACE operation were 95.23%,96.77%,95.89%,97.56%and 93.75%,respectively.Compared with normal liver tissue and necrotic tissue,NIC of recurrent and residual tissue in arterial period showed statistically significant differences(P<0.05).There was no significant difference between the NIC of necrotic tissue and that of normal liver tissue(P>0.05).The differences in NIC in recurrent and residual tissues during portal pulse stage were statistically significant compared with those in necrotic tissues,but not statistically significant compared with those in normal tissues.The NIC of necrotic tissue was statistically different from that of normal tissue(P<0.05).ADC value of necrotic tissue was higher than that of relapsed and residual tissue,and the difference was statistically significant(P<0.05).In the differentiation of relapsed,residual and necrotic tissues,the area under the NIC ROC curve of portal phase was the largest(0.951),and the sensitivity and specificity of lesion diagnosis were also high(88.10% and96.80%,respectively).Conclusions:(1)Dual-energy iodiogram was better than conventional CT image in showing the enhancement ability of the poorly embolized area and surrounding tissue after TACE.(2)The specificity and positive predictive value of dual-energy iodiogram for lesion detection were higher than those of Mr Diffusion weighted imaging,but its sensitivity,accuracy and negative predictive value were lower than those of Mr Diffusion weighted imaging.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the two methods combined in the diagnosis of HCC lesions after TACE were higher than those using only one test method.(3)PP NIC was the most effective in differentiating recurrent,residual and necrotic tissues.