Abstract: Objective To explore the value of magnetic resonance imaging (MRI) combined with dynamic contrast-enhanced MRI (DCE-MRI) perfusion quantitative parameters in evaluating the efficacy of transcatheter arterial chemoembolization(TACE) in hepatocellular carcinoma (HCC) during the hepatobiliary phase. Methods Retrospective analysis of the medical records of 86 HCC patients treated with TACE at Changzhou Third People's Hospital between January 2018 and January 2023. Record the MRI manifestations and DCE-MRI perfusion quantitative parameters of the hepatic and biliary phase donut nodules before transcatheter hepatic arterial chemoembolization treatment, including the vascular permeability constant (Kt), blood reflux constant (Kep), and percentage of extracellular space volume (Ve) at the maximum level of the lesion. After hepatic artery chemoembolization treatment, the efficacy was evaluated according to the solid tumor evaluation standard 1.1 (RECIST 1.1) and divided into stable group and progressive group. Analyze the influencing factors of the efficacy of TACE in HCC patients. Evaluate the predictive efficacy of MRI manifestations of hepatic biliary doughnut nodules and DCE-MRI perfusion quantitative parameters in predicting the efficacy of TACE in HCC patients. Results Among 86 HCC patients treated with hepatic artery chemoembolization, 46 (53.49%) progressed and 40 (46.51%) remained stable. Before undergoing hepatic arterial chemoembolization treatment, the MRI liver biliary phase scan results showed that among 86 HCC patients, 35 (40.70%) had hepatic biliary doughnut nodules, and the arterial phase showed high enhanced signal, with 45 (52.33%) showing low signal and 6 (6.98%) showing high signal. The sensitivity, specificity, positive predictive value, and negative predictive value of Pu Mei Xian's hepatic biliary phase donut nodule MRI in predicting the efficacy of TACE were 76.09%, 100.00%, 100.00%, and 78.43%, respectively. The ΔKt of patients in the progression group and stable group were (0.22 ± 0.07) and (0.31 ± 0.09), respectively, with ΔKep of (0.57 ± 0.12) and (0.39 ± 0.10). The △Kt of patients in the progressive group was lower than that in the stable group, while △Kep was higher than that in the stable group (P<0.05). There was no statistically significant difference in △Ve between the two groups (P>0.05). The total bilirubin (TBil), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels in the progressive group were higher than those in the stable group (P<0.05). TBil, ALT, AST, ΔKt, ΔKep, and the appearance of sweet doughnut nodules in the hepatobiliary phase of Pramiphene are risk factors for HCC progression (P<0.05). The MRI manifestations of the liver and gallbladder phase donut nodules in Pumeixian, as well as the AUC of single and combined prediction of HCC progression with △Kt and △Kep, were 0.880, 0.750, 0.748, and 0.887, respectively. Conclusion The MRI manifestations of Pumeixian hepatobiliary doughnut nodules and the changes in Kt and Kep during DCE-MRI perfusion are related to the treatment response of HCC patients to TACE, and can be used to predict the therapeutic effect.

Key words: Hepatocellular carcinoma, Transcatheter arterial chemoembolization, Hepatobiliary phase, Nodular signal intensity, Dynamic contrast-enhanced MRI