动态增强磁共振灌注成像联合血管内皮生长因子水平对肝癌患者TACE术后复发评估

摘要/Abstract

摘要： 目的研究动态增强磁共振灌注成像(DCE-MRI)联合血管内皮生长因子(VEGF)对肝动脉介入化疗栓塞术(TACE)患者术后复发情况的评估价值。方法纳入2019年1月至2023年1月本院收治且行TACE肝癌患者141例。收集患者的一般资料和病理信息并在术前进行DCE-MRI检测,测定患者血清VEGF水平。根据术后1年随访结果,分为复发组(n=51)和未复发组(n=90),Logistic回归分析筛选术后复发风险因素,并通过ROC曲线评估DCE-MRI参数和血清VEGF水平对患者复发情况的评估价值。结果复发组患者中肿瘤低分化、存在门静脉癌栓的占比分别为66.67%和56.86%,均高于未复发组,且复发组患者术前K^trans、K_ep、V_e和VEGF水平分别为(0.59±0.25)min、(0.98±0.33)min、(0.57±0.28)%、(383.71±39.41)pg/mL,均高于未复发组,差异均有统计学意义(P＜0.05)。多因素分析结果表明,K^trans、K_ep、V_e和VEGF均是影响患者术后复发的重要因素(P＜0.05)。ROC曲线显示,DCE-MRI参数联合血清VEGF水平对患者TACE术后复发的预测准确度为96.5%。结论 DCE-MRI参数和血清VEGF水平较高的患者TACE术后复发的风险更高。

关键词: 动态增强磁共振灌注成像, 血管内皮生长因子, 原发性肝癌, 肝动脉介入化疗栓塞术

Abstract: Objective To assess the value of dynamic contrast-enhanced magnetic resonance perfusion imaging (DCE-MRI) combined with serum vascular endothelial growth factor (VEGF) levels in evaluating postoperative recurrence of hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE) therapy. Methods A total of 141 HCC patients treated between January 2019 and January 2023 were selected in this study. All patients underwent TACE. Preoperative DCE-MRI was used to measure the parameters such as the volume transfer constant (K^trans), the efflux rate constant between extravascular extracellular space and plasma (K_ep), and the volume fraction of the extravascular extracellular space (V_e). Peripheral venous blood was drawn to determine serum VEGF levels. All patients were followed up for one year post operation and categorized into recurrence (n=51) and non-recurrence groups (n=90). Logistic regression analysis was used to identify factors influencing postoperative recurrence, and the predictive value of DCE-MRI parameters and serum VEGF levels was evaluated using receiver operating characteristic (ROC) curves method. Results Patients in the recurrence group were characterized by a higher proportion of poorly differentiated tumors (66.67%) and the presence of portal vein tumor thrombus (56.86%), which were higher than those in the non-recurrence group. Additionally, preoperative levels of K^trans, K_ep, V_e, and VEGF in the recurrence group were (0.59±0.25) min, (0.98±0.33) min, (0.57±0.28) %, and (383.71±39.41) pg/mL, respectively. Multifactorial analysis indicated that K^trans, K_ep, V_e, and VEGF are important factors influencing postoperative recurrence (P<0.05). The ROC curve analysis demonstrated that the combined assessment of DCE-MRI parameters and serum VEGF levels had a predictive accuracy of 96.5% for postoperative recurrence of HCC patients after TACE therapy. Conclusion Higher preoperative DCE-MRI parameters and serum VEGF levels are associated with an increased risk of recurrence after TACE therapy in HCC patients.

Key words: Dynamic contrast-enhanced magnetic resonance perfusion imaging, Vascular endothelial growth factor, Hepatocellular carcinoma, Transarterial chemoembolization

王宝, 吉盛超, 马乐, 田芃. 动态增强磁共振灌注成像联合血管内皮生长因子水平对肝癌患者TACE术后复发评估[J]. 肝脏, 2025, 30(12): 1632-1636.

WANG Bao, JI Sheng-chao, MA Le, TIAN Peng. Evaluate the recurrence of hepatocellular carcinoma after transarterial chemoembolization therapy using dynamic contrast-enhanced magnetic resonance perfusion imaging combined with serum vascular endothelial growth factor levels[J]. Chinese Hepatolgy, 2025, 30(12): 1632-1636.

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