Abstract: Objective To analyze the value of hepatic CT perfusion imaging parameters in evaluating residual lesions after transcatheter arterial chemoembolization (TACE) in patients with primary liver cancer (PLC). Methods The clinical data of 95 PLC patients admitted to the Interventional Departments of Dongtai Traditional Chinese Medicine Hospital and Nanjing Zhongda Hospital between October 2021 and September 2024 were retrospectively analyzed. This study compared the changes in CT perfusion imaging parameters between completely perfused lesions and residual lesions before and after TACE treatment, and further evaluated their capability in assessing residual lesions. Results Among the 95 patients, 30 cases (31.6%) achieved complete remission. Compared with pre-TACE values, completely embolized lesions showed significant post-TACE decreases in blood volume of the region of interest, embolized area blood volume, hepatic arterial perfusion, and hepatic perfusion index (P<0.05), while time to peak and portal venous perfusion increased significantly (P<0.05). In contrast, residual lesions exhibited significant reductions in portal venous perfusion (P<0.05) but increases in hepatic arterial perfusion and hepatic perfusion index (P<0.05) after TACE, with no significant difference in blood volume of the region of interest, embolized area blood volume, or time to peak before and after treatment (P>0.05). A multi-parameter diagnostic model combining CT perfusion imaging parameters was constructed to predict residual lesions (binary outcome) after TACE. ROC curve analysis confirmed that the area under the curve (AUC), sensitivity, and specificity of this multi-parameter diagnostic model were 0.93, 87.7% (57/65), and 90.0% (27/30), respectively. These values were significantly outperforming the individual parameters (AUC range: 0.72~0.84; Delong test, P<0.05), indicating complementary diagnostic information among parameters. Conclusion CT perfusion imaging parameters sensitively reflect hemodynamic changes in PLC lesions after TACE. The multi-parameter diagnostic model exhibits high efficacy for postoperative evaluation, demonstrating promising clinical utility.

Key words: Primary liver cancer, Transcatheter arterial chemoembolization, CT perfusion imaging