关键词: 肝细胞癌, 微血管侵犯, 肝动脉化疗栓塞, 疗效, 复发, 评估效能

Abstract: Objective To investigate the value of intravoxel incoherent motion diffusion weighted imaging (IVIEM-DWI) in evaluating the preoperative condition and postoperative recurrence of hepatocellular carcinoma (HCC) patients undergoing hepatic arterial chemoembolization (TACE) therapy.Methods A total of 92 HCC patients who underwent TACE from July 2019 to June 2021 were selected for IVIM-DWI examination at 3 days before and 1 month after the surgery. The patients were divided into a microvascular invasion (MVI) positive group (n=60 cases) and a MVI negative group (n=32 cases) according to the pathological results of liver biopsy before TACE. One month after TACE therapy, the patients were divided into a stable group (n=49 cases) and a progressive group (n=43 cases) according to the efficacy evaluation. Six patients were followed up and divided into a recurrence group (n=27 cases) and a non-recurrence group (n=65 cases) according to MRI examination and tumor serological indicators. The tumor diameter, standard apparent diffusion coefficient (ADC), true apparent diffusion coefficient (D), false apparent diffusion coefficient (D*) and perfusion coefficient (f value) were compared between the MVI positive group and the MVI negative group before surgery, and the ADC, D value, D* value and f value after TACE were compared between the stable group and the progressive group, the recurrent group and the non-recurrent group. Logistic regression analysis was performed to analyze the single factors affecting the postoperative stability and recurrence of HCC patients. Receiver operating characteristic curve (ROC) was drawn to analyze the efficacy of imaging indicators in evaluating postoperative recurrence of TACE.Results Before TACE, the tumor diameter of MVI positive group was 5.61±0.94 cm, which was higher than that of negative group (4.03±0.76 cm), ADC value and D value were 0.87±0.15 and 0.82±0.24, which were lower than that of negative group (0.98±0.19 and 0.94±0.31). The difference was statistically significant (t=5.635, 4.518, 4.964, all P<0.05). The ADC and D values of the stable group after TACE were 1.28±0.47 and 1.48±0.52, which were higher than those of the progressive group (1.07±0.39 and 1.22±0.40), and the differences were statistically significant (t=5.374, 5.038, all P<0.05). The ADC value and D value in the recurrence group after TACE were 1.02±0.35 and 1.08±0.37, which were lower than those in the group without recurrence (1.36±0.51 and 1.59±0.56), and the difference was statistically significant (t=5.384, 5.897, all P<0.05). Logistic regression analysis showed that tumor diameter was negatively correlated with postoperative stability and positively correlated with postoperative recurrence in HCC patients. Postoperative ADC value and postoperative D value were positively correlated with postoperative stability, and negatively correlated with postoperative recurrence (both P<0.05). ROC curve showed that the AUC of tumor diameter, postoperative ADC value and postoperative D value for postoperative recurrence evaluation of TACE were 0.682, 0775 and 0.849, respectively, and the sensitivity and specificity were 79.56% and 77.28%, 82.73% and 79.67%, 84.51% and 82.49%, respectively. The difference was statistically significant (all P<0.05), and the evaluation efficiency of postoperative D value was better than that of tumor diameter and postoperative ADC value.Conclusion IVIEM-MRI has a higher value in evaluating MVI before operation, short-term efficacy after operation, and the prognosis of HCC patients. It also has better efficacy in evaluating D value after operation.

Key words: Hepatocellular carcinoma, Microvascular invasion, Hepatic artery chemoembolization, Curative effect, Recurrence, Evaluation effectiveness