多参数磁共振成像联合CT动态增强对晚期肝细胞癌免疫治疗疗效的预测价值  

The predictive value of multiparametric magnetic resonance imaging combined with CT dynamic enhancement on the efficacy of immunotherapy for patients with advanced hepatocellular carcinoma

作　　者：朱继兰 赵霞 王市伟 杨蕾 ZHU Ji-lan;ZHAO Xia;WANG Shi-wei;YANG Lei(Department of Radiology,Qingdao Central Hospital Affiliated to University of Health and Rehabilitation Sciences,Shandong 266042,China)

机构地区：[1]康复大学附属青岛中心医院放射科,山东266042

出　　处：《肝脏》2024年第9期1040-1046,共7页Chinese Hepatology

摘　　要：目的 探讨多参数磁共振成像(Nuclear magnetic resonance imaging, MRI)联合CT动态增强对晚期肝细胞癌(Hepatocellular carcinoma, HCC)免疫治疗疗效的预测价值。方法 选取2020年8月—2022年8月在青岛大学附属青岛市中心医院经穿刺活检组织病理学检查确诊的晚期HCC患者123例为研究对象,均于免疫治疗前接受MRI及CT动态增强检查。随机分为训练组和验证组,86例纳入训练组,37例纳入验证组。训练组免疫治疗8周后,根据改良实体瘤疗效评价标准将所有患者分为控制组(32例)和进展组(54例),比较两组MRI参数[增强率(Enhanced response, ER)、脂肪分数(Full fat, FF)、最大下降斜率(Mean squared deviation, MSD)、最大上升斜率(Modified surface index, MSI)、平均强化时间(Mean exit time, MET)、表观扩散系数(Apparent diffusion coefficient, ADC)、容积转换常数(Ktrans)、速率常数(Kep)、血管外细胞外容积分数(Ve)、血浆容积分数(Vp)]和CT动态增强扫描定量参数[灌注值、强化峰值(Potential of hydrogen, PH)、肿块与主动脉强化峰值之比(M/A)值、肿块强化达到峰值时间(Time-to-peak tension, Tp)]。采用Spearman相关系数分析MRI参数和CT动态增强扫描定量参数与晚期HCC免疫治疗疗效的相关性,绘制受试者工作特征(ROC)曲线评估MRI参数联合CT动态增强扫描定量参数对晚期HCC免疫治疗疗效的预测价值,并在验证组中加以验证。结果 控制组ER、MSI均大于进展组,ADC、Ktrans、Ve均小于进展组(P<0.05)。控制组灌注值、PH值均小于进展组,Tp大于进展组(P<0.05)。MRI参数ER、MSI与免疫治疗疗效呈正相关性(r=0.326、0.331,均P<0.05),ADC、Ktrans、Ve与免疫治疗疗效呈负相关性(r=-0.331、-0.342、-0.350,均P<0.05);CT动态增强扫描定量参数灌注值、PH与免疫治疗疗效呈负相关性(r=-0.402、-0.394,均P<0.05),Tp与免疫治疗疗效呈正相关性(r=0.387,P<0.05)。训练组MRI参数ER、MSI、ADC、Ktrans、Ve预测免�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 progre

关 键 词：肝细胞癌 免疫治疗 多参数磁共振成像 CT动态增强 疗效 预测 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]