DSA半定量灌注参数评价进展期原发性肝细胞癌TACE短期疗效的能力

Semi-quantitative hemodynamic parameters obtained from perfusion DSA in assessment of short-term efficacy of TACE for advanced hepatocellular carcinoma

摘要:

目的  评价通过数字减影血管造影（DSA）获取的半定量血流灌注参数评估进展期原发性肝细胞癌肝动脉化疗栓塞（TACE）短期疗效的能力。方法  34例经实验室和影像学资料证实的进展期肝细胞癌患者共53个病灶进行TACE，TACE前经肝固有动脉行DSA灌注成像，获得医学数字成像和通信标准（DICOM）原始图像后，导入自主研发的后处理软件Analysis 1.0进行后处理，生成各区域感兴趣区（ROI）的时间－密度曲线（TDC）并获取瘤灶DSA灌注半定量参数包括视频密度增量峰值（△PV）、达峰时间（TP）、显影持续时间（TD）、TDC升支（KmaxU）及降支最大斜率（KmaxU）。对比患者术前及术后3～5个月的CT资料，根据实体肿瘤RESIST标准将肿瘤分为治疗反应组和无反应组，采用t检验对比两组患者间DSA血流动力学灌注参数的差异。对有统计学意义的值进行受试者工作特征曲线（ROC）分析。结果  反应组的TD明显高于无反应组（均数分别为12.26和9.86；P =0.002）。根据TD绘制ROC曲线，曲线下面积（AUC）为0.728。当临界值TD=11 s时，TD预测判断TACE治疗反应的敏感性为63.9%，特异性为82.4%。TD阳性预测值为88.5%，阴性预测值为51.9%。结论  半定量DSA灌注成像可用于预测进展期肝细胞癌TACE短期治疗疗效。治疗前较高的TD值提示TACE治疗短期疗效较好。

Abstract:

Objective To evaluate the ability of semi-quantitative hemodynamic parameters of advanced hepatocellular carcinomas (HCCs) by perfusion digital subtraction angiography (DSA) in assessing short-term effect of transcatheter arterial chemoembolization (TACE). Methods The study was approved by the local research and ethics committee, and patient informed consent was obtained. Thirty-four patients with fifty-three tumors proved by imaging and laboratory data underwent DSA perfusion through proper hepatic artery before TACE. Regions of interest were drawn around tumor staining area. The original DICOM images were imported to self-developed software analysis 1.0. Semi-quantitative hemodynamic parameters including peak increment of density value (△PV), time to reach the peak (TP), time of developing duration (TD), maximum slope of the upslope (KmaxU) and maximum slope of the descent (KmaxD) were obtained. Treatment response was defined according to RESIST of solid tumors after comparing pretreatment images with the images 3-5 months after treatment. The pretreatment values of the responders and the nonresponders were compared using T test. A two-tailed P value of 0.05 or less was considered to indicate a significant difference. Receiver operating charac-teristic (ROC) curve analysis was performed on the parameters. Results The TD value of the responders was significantly higher than that of the nonresponders (median tumor TD value, 12.26 vs 9.86; P = 0.002). The area under the curve (AUC) of ROC for TD was 0.728. When the cufoff was 11 s, the sensitivity and specificity of TD in prediction of the response to TACE were 63.9% and 82.4% respectively; the positive predictive value and negative predictive value were 88.5% and 51.9% respectively. Conclusions Semi-quantitative hemodynamic perfusion DSA may be used to predict the short-term therapeutic effect of TACE in patients with advanced HCCs. A higher pretreatment TD value is associated with a better response to TACE treatment.