Abstract: Objective To explore the role of dual energy CT quantitative parameters in evaluating patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Methods A retrospective analysis was conducted on the clinical and dual energy CT imaging data of 72 HCC patients who received TACE treatment in Qingdao Third People's Hospital from June 2021 to June 2024. Digital subtraction angiography (DSA) was used as a reference standard, the arterial phase standardized iodine concentration (NICAP), portal vein phase standardized iodine concentration (NICPP), iodine concentration difference (ICD), arterial iodine fraction (AIF), and Hounsfield unit curve slope (λHu) of region of interest (ROI) measurements in tumor active areas, normal liver tissue adjacent to cancer, and tumor necrosis areas were analyzed in dual energy CT iodine maps. Receiver operating characteristic (ROC) curves were used to analyze the diagnostic efficacy of dual energy CT quantitative parameters for different tissue types. Results In a total of 72 patients, 401 ROIs were measured, including 175 in the tumor active area, 175 in the peritumor normal liver tissue, and 51 in the tumor necrosis area. The λHu, NICAP, and NICPP of the tumor active area were 3.34±0.97, (16.33±6.77)%, and (46.56±12.37)%, respectively, which were all higher than those of the peritumor normal liver tissue [0.69±0.21, (2.56±0.61)%, (39.49±9.77)%] and the tumor necrosis area [0.36±0.18, (2.40±0.61)%, (9.14±2.53)%], with statistically significant differences (P<0.05). The ICD of the tumor active area was (0.52±0.18) mg/mL, which was lower than that of the peritumor normal liver tissue (1.32±0.37) mg/mL and higher than that of the tumor necrosis area (0.31±0.12) mg/mL (P values were all <0.05). The AIF of the tumor active area was 0.97±0.26, which was higher than that of the peritumor normal liver tissue (0.13±0.03) and lower than that of the tumor necrosis area (1.08±0.35) (P values were all <0.05). Conclusion Dual energy CT quantitative parameters can effectively distinguish between tumor active areas, normal liver tissue adjacent to cancer, and tumor necrotic areas in the liver after TACE.

Key words: Hepatocellular carcinoma, Dual energy CT, Transarterial chemoembolization, Tumor imaging