术前MRI四点法瘤周和最大层面瘤体ADC值预测TACE治疗肝细胞癌患者预后的临床价值OACSTPCD

Objective To investigate the clinical value of preoperative four-point peritumoral apparent diffusion coefficient(ADC)value and the largest layer of the tumor body's ADC value on MRI in predicting the prognosis of patients with hepatocellular carcinoma(HCC)treated by transarterial chemoembolization(TACE).Methods Totally 103 HCC patients who received TACE were selected for preoperative MRI examination.The largest lesion in the liver was taken as the target lesion,and the directions of 3,6,9,and 12 o'clock along the margin of the largest layer of target lesion were taken as the the region of interest(ROI),and the average value of the four regions as the four-point peritumoral ADC value.The ADC value of the largest layer of the target lesion was measured as the largest layer of the tumor body's ADC value.After 6 and 12 months of TACE treatment,enhanced CT or MRI examination was performed to evaluate the clinical efficacy according to mRECIST criteria.CR,PR and SD were defined as stable disease,and disease control rate(DCR)was calcu-lated.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of preoperative four-point peritumoral ADC value and the largest layer of the tumor body's ADC value in tumor progression at 6 and 12 months after TACE treatment.Results According to mRECIST criteria,after 6 months of TACE treatment,there were 12 cases of CR,18 cases of PR,22 cases of SD,51 cases of PD,and DCR was 50.5％(52/103).After 12 months of TACE treat-ment,there were 7 cases of CR,10 cases of PR,15 cases of SD,71 cases of PD,and DCR was 31.1％(32/103).After 6 and 12 months of TACE treatment,both the preoperative four-point peritumoral ADC values and the largest layer of the tumor body's ADC values in the progressive patients were higher than those in the stable patients(all P<0.05),while there were no significant differences in serum AFP,cholinesterase or globulin levels between the progressive patients and the stable patients(all P>0.05).The area under the curve of preoperative four-point peritumoral ADC value and the larg-est layer of the tumor body's ADC value in predicting 6-month progression of TACE treatment were 0.893 and 0.785,and the optimal cut-off values were 1.394×10-3 and 1.505×10-3 mm2/s.The sensitivities were 82.4％and 62.7％,and the specificities were 84.6％and 88.5％,respectively.The area under the curve of preoperative four-point peritumoral ADC value and the largest layer of the tumor body's ADC value in predicting 12-month progression of TACE treatment were 0.848 and 0.734,and the optimal cut-off values were 1.309×10-3 and 1.505×10-3 mm2/s,with the sensitivities of 78.9％and 49.3％,and the specificities of 84.4％and 90.6％,respectively.Conclusion Both preoperative four-point peritumoral ADC value and the largest layer of the tumor body's ADC value can predict the prognosis of HCC patients,and the predictive value of preoperative four-point peritumoral ADC value is relatively higher.