锥形束CT在经肝动脉化疗栓塞术治疗肝癌效果评价中的价值  

Value of cone-beam computed tomography in evaluating the response of liver cancer to transarterial chemoembolization

作　　者：李兆山 沈志桃 张显顺 陈路宁[1] LI Zhaoshan;SHEN Zhitao;ZHANG Xianshun;CHEN Luning(Department of Catheterization,The First People’s Hospital of Liangshan Yi Autonomous Prefecture,Xichang 615000 China)

机构地区：[1]四川省凉山彝族自治州第一人民医院导管室,四川西昌615000

出　　处：《中国辐射卫生》2024年第6期710-715,共6页Chinese Journal of Radiological Health

基　　金：四川省凉山彝族自治州重点研发项目(21ZDYF0072)。

摘　　要：目的 评价锥形束计算机断层扫描(CBCT)用于评估经肝动脉化疗栓塞术(TACE)治疗不可切除肝癌效果中的价值。方法 以2021年7月—2023年7月在凉山彝族自治州第一人民医院接受TACE治疗的55例不可切除肝癌患者、90个病灶为研究对象,治疗后1个月采用改良实体瘤疗效评价标准评价TACE治疗效果。绘制受试者工作特征(ROC)曲线,以ROC曲线下面积(AUC)评价CBCT图像上的病灶直径、体积和密度标用于预测TACE疗效的价值。结果 55例肝癌患者经TACE治疗后,26例获得完全缓解、17例获得部分缓解、9例获得疾病稳定、3例获得疾病进展;90个病灶中,48个获得完全缓解、20个获得部分缓解、17个获得疾病稳定、5个获得疾病进展。在CBCT图像上,完全缓解和非完全缓解病灶平均直径、体积和密度分别为(20.9±9.9) mm、(1 719.3±777.9) mm^(3)、(143.7±87.9) HU和(10.9±7.7) mm、(890.0±327.4) mm^(3)、(38.8±33.3) HU,差异均有统计学意义(t=10.6、79.8、65.5,P均<0.01)。治疗后1个月,CT扫描均未见完全缓解病灶有强化灶;非完全缓解病灶均可见强化灶,病灶平均直径和密度分别为(14.1±6.2) mm和(78.8±30.3) HU。采用CBCT图像上病灶直径、体积和密度鉴别TACE治疗后完全缓解和非完全缓解获益的AUC值分别为0.935、0.955、0.981;以82.5 HU作为密度截断值,其用于预测TACE疗效的灵敏度、特异度、阳性预测值和阴性预测值分别为95.5%、100.0%、100.0%和95.0%。结论 CBCT可有效预测TACE治疗肝癌后短期疗效。Objective To assess the value of cone-beam computed tomography(CBCT)in evaluating the response of unresectable liver cancer to transarterial chemoembolization(TACE).Methods A total of 55 unresectable liver cancer patients with 90 lesions who received TACE at the First People’s Hospital of Liangshan Yi Autonomous Prefecture between July 2021 and July 2023 were enrolled in the study.The response to TACE was evaluated using the modified Response Evaluation Criteria in Solid Tumors one month post-treatment.The value of lesion diameter,volume,and density on CBCT images in predicting the response to TACE was assessed using the area under the receiver operating characteristic curve.Results Of the 55 patients treated with TACE,26 achieved complete response,17 achieved partial response,9 showed stable disease,and 3 had progressive disease.Of the 90 lesions,48 achieved complete response,20 achieved partial response,17 showed stable disease,and 5 had progressive disease.On CBCT images,the mean diameter,volume,and density of lesions with complete and non-complete responses were(20.9±9.9)mm,(1719.3±777.9)mm^(3),and(143.7±87.9)HU,versus(10.9±7.7)mm,(890.0±327.4)mm^(3),and(38.8±33.3)HU,respectively,with significant differences between the two groups(t=10.6,79.8,and 65.5;all P<0.01).One month post-treatment,CT scans displayed no enhanced areas in lesions with complete response and visible enhanced areas in lesions with non-complete response,with mean lesion diameter and density of(14.1±6.2)mm and(78.8±30.3)HU,respectively.In addition,the areas under the receiver operating charac- teristic curves of lesion diameter, volume, and density on CBCT images were 0.935, 0.955, and 0.981, respectively, in distinguishingbetween complete and non-complete responses following TACE. Using a cut-off value of 82.5 HU for predictingresponse to TACE, the lesion density had sensitivity, specificity, positive predictive value, and negative predictive value of95.5%, 100.0%, 100.0%, and 95.0%, respectively. Conclusion CBCT is effective in pr

关 键 词：锥形束CT 经肝动脉化疗栓塞术 肝癌 效果评估 

分 类 号：R816.5[医药卫生—放射医学]