Abstract: Objective To investigate the predictive value of multiparametric magnetic resonance imaging (mpMRI) combined with CT dynamic enhancement on the efficacy of immunotherapy for patients with advanced hepatocellular carcinoma (HCC). Methods 123 patients with advanced HCC diagnosed by histopathological examination of puncture biopsy from August 2020 to August 2022 were selected for the study. All patients received MRI and CT dynamic enhancement examination before immunotherapy. They were randomly divided into a training group and a validation group, Among them, 86 cases were included in the training group and 37 cases were included in the validation group. At 8 weeks after immunotherapy, all patients in the training group were further divided into a control group (32 cases) and a progressive group (54 cases) according to the modified solid tumor efficacy evaluation criteria, and the two groups were compared for MRI parameters [i.e., enhancement rate (ER), fat fraction (FF), maximum downward slope (MSD), maximum upward slope (MSI), mean enhancement time (MET), apparent diffusion coefficient (ADC), volume conversion constant (Ktrans), rate constant (Kep), extravascular extracellular volume fraction (Ve), plasma volume fraction (Vp)] and CT dynamic Enhancement scan quantitative parameters [i.e.,perfusion value, peak enhancement (PH), ratio of mass to peak aortic enhancement (M/A) value, and time to peak mass enhancement (Tp). Spearman’s correlation coefficient was used to analyze the correlation between MRI parameters and quantitative CT dynamic enhancement scan parameters and the efficacy of immunotherapy for advanced HCC. The receiver operating characteristic (ROC) curve were plotted to assess the predictive value of MRI parameters combined with quantitative CT dynamic enhancement scan parameters on the efficacy of immunotherapy for advanced HCC, and the efficacy was validated in the validation group. Results The ER, MSI, and Ktrans in patients of the control group were greater than those in the progressive group, and the ADC and Ve were smaller than those in the progressive group, with statistically significant differences (P<0.05). The perfusion and PH value in the control group were smaller than those in the progressive group, and Tp was larger than that in the progressive group, with statistically significant difference (P<0.05). In the mpMRI parameters, ER and MSI were positively correlated with immunotherapy efficacy (r=0.326, 0.331, both P<0.05), whereas ADC, Ktrans and Ve were negatively correlated with immunotherapy efficacy (r=-0.331, -0.342, -0.350, all P<0.05). In the quantitative parameters of CT dynamic enhancement scan , the perfusion value and PH were negatively correlated with immunotherapy efficacy (r=-0.402, -0.394, both P<0.05), and Tp was positively correlated with immunotherapy efficacy (r=0.387, P<0.05). The area under the curve (AUC) of ER, MSI, ADC, Ktrans, and Ve of the MRI parameters in the training group for predicting immunotherapy efficacy was 0.742, 0.770, 0.761, 0.720, and 0.731, respectively. And the AUCs of perfusion value, PH and Tp of the CT dynamic enhancement scan quantitative parameters for predicting immunotherapy efficacy were 0.730, 0.743, and 0.699, respectively, all of which were lower than that of 0.879 as predicted by the combination of mpMRI and quantitative parameters of CT dynamic enhancement scan (all P<0.05). The joint prediction also had good diagnostic efficacy with a AUC value of 0.868 in the validation group. Conclusion The mpMRI combined with quantitative CT dynamic enhancement scan parameters have good predictive value for the efficacy of immunotherapy for advanced HCC patients.

Key words: Hepatocellular carcinoma, Immunotherapy, Multiparameter magnetic resonance imaging, CT dynamic enhancement, Efficacy, Prediction