DCE-MRI定量灌注参数联合MRI图像纹理参数与原发性肝癌TACE疗效关系

摘要/Abstract

摘要： 目的分析动态对比增强磁共振成像(DCE-MRI)定量灌注参数联合MRI图像纹理参数与原发性肝癌经导管动脉化疗栓塞(TACE)疗效关系。方法回顾性分析2022年3月至2023年5月海安市中医院101例行TACE治疗的原发性肝癌患者的病历资料,根据治疗效果分为无效组[疾病进展(PD)+疾病稳定(SD)]与有效组[部分缓解(PR)+全部缓解(CR)]。对比2组DCE-MRI定量灌注参数、MRI图像纹理参数及临床资料,分析原发性肝癌TACE治疗无效的影响因素,分析DCE-MRI定量灌注参数联合MRI图像纹理参数对原发性肝癌TACE治疗无效的预测价值。结果治疗3个月后,101例原发性肝癌患者中CR2例,PR54例,SD32例、PD13例;有效组56例,无效组45例。无效组组织间隙-血浆速率常数(K_ep)与容积转移常数(K^trans)低于有效组(P<0.05),2组血管外细胞外间隙容积分数(V_e)、血浆容积分数(V_p)对比差异无统计学意义(P>0.05)。无效组标准差比有效组高(P<0.05),无效组惰性比有效组低(P<0.05),2组熵、偏度、均匀度、平均值对比差异无统计学意义(P>0.05)。无效组糖类抗原199、肿瘤直径高于有效组(P<0.05)。K^trans、K_ep、惰性、标准差、肿瘤直径为原发性肝癌TACE治疗无效的影响因素(P<0.05)。K^trans、K_ep、标准差、惰性单独预测及四者联合预测原发性肝癌TACE治疗无效的曲线下面积(AUC)值分别为0.803、0.795、0.824、0.816、0.903(P<0.05),且四者联合的AUC值高于单独指标预测的AUC值(P<0.05)。结论 K^trans、K_ep、惰性、标准差在预测原发性肝癌TACE疗效中具有重要价值,且四者联合的预测价值更高。

关键词: 动态对比增强磁共振成像, 灌注参数, 磁共振成像, 纹理参数, 原发性肝癌, 经导管动脉化疗栓塞, 疗效, 预测价值

Abstract: Objective To analyze the relationship between dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) quantitative perfusion parameters and MRI image texture parameters and the therapeutic effect of transcatheter arterial chemoembolization (TACE) for primary liver cancer. Methods The medical records of 101 patients with primary liver cancer treated with TACE from March 2022 to May 2023 were retrospectively analyzed. All patients received TACE treatment and were divided into ineffective group [disease progression (PD) + stable disease (SD)] and effective group [partial response (PR) + total response (CR)] according to the treatment effect. The DCE-MRI quantitative perfusion parameters, MRI image texture parameters and clinical data of the two groups were compared to analyze the influencing factors of the ineffective TACE treatment for primary liver cancer, and analyze the predictive value of DCE-MRI quantitative perfusion parameters combined with MRI image texture parameters for the ineffective TACE treatment for primary liver cancer. Results After a three-month treatment, among 101 patients with primary liver cancer, there were 2 cases of CRs, 54 cases of PRs, 32 cases of SDs, 13 cases of PDs, 56 cases of effective group, and 45 cases of ineffective group. The interstitial plasma rate constant (K_ep) and volume transfer constant (K^trans) of the ineffective group were lower than those of the effective group (P<0.05), and there was no difference in extracellular space volume fraction (V_e) and plasma volume fraction (V_p) between the two groups (P>0.05). The standard deviation of invalid value was higher than that of effective group (P<0.05), and the inertness of invalid group was lower than that of effective group (P<0.05). There were no significant differences in entropy, skewness, evenness and mean value in 2 groups (P>0.05). The carbohydrate antigen 199 and tumor diameterin the ineffective group were higher than effective group (P<0.05). K^trans, K_ep, inertia, standard deviation and tumor diameter were the influential factors of TACE treatment for primary liver cancer (P<0.05). The area under the curve (AUC) values of K^trans, K_ep, standard deviation, inertia and the four combined predicted the failure of TACE treatment for primary liver cancer were 0.803, 0.795, 0.824, 0.816, 0.903 (P<0.05), respectively. The combined AUC value of the four indexes was higher than predicted by the single index (P<0.05). Conclusion K^trans, K_ep, inertia and standard deviation have important value in predicting TACE efficacy of primary liver cancer, and the joint model of the four indicators has higher predictive value.

Key words: Dynamic contrast enhanced magnetic resonance imaging, Perfusion parameters, Magnetic resonance imaging, Texture parameters, Primary liver cancer, Transcatheter arterial chemoembolization, Curative effect, Predictive value

张海军, 骆科纯, 包军军. DCE-MRI定量灌注参数联合MRI图像纹理参数与原发性肝癌TACE疗效关系[J]. 肝脏, 2025, 30(10): 1354-1359.

ZHANG Hai-jun, LUO Ke-chun, BAO Jun-jun. Relationship between DCE-MRI quantitative perfusion parameters and MRI image texture parameters and TACE efficacy in primary liver cancer[J]. Chinese Hepatolgy, 2025, 30(10): 1354-1359.

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