Predictive Factors Of Hepatocellular Carcinoma Recurrence After TACE Based On Multimodal Imaging Technology

Part1: Predictive risk factors of Hepatocellular Carcinoma recurrence after TACE based on multimodal MRIObjective Multimodal MRI was used to predict and analyze the risk factors for recurrence of hepatocellular carcinoma(HCC)patients after TACE.Methods Prospective collection of HCC patients admitted to our hospital from May2019 to June 2020 who underwent TACE treatment for the first time.They were followed up for 6 months after the TACE.According to the follow-up results,they were divided into recurrence group and non-recurrence group,and the two groups of patients were compared and analyzed the Clinical and imaging characteristics.Multivariate Logistic regression analysis was used to predict the independent risk factors for recurrence of HCC patients after TACE.Results1.During the six-month follow-up,26 patients relapsed and 22 patients did not relapse.2.Comparison of clinical data between the two groups of patients: the proportion of alpha-fetoprotein(AFP)>400μg/L,alanine transaminases(ALT)level,clinical stage,preoperative serum D-dimer of patients in the recurrence group the level and the neutrophil to lymphocyte ratio(NLR)were higher than those in the non-recurrence group(all P<0.05).The proportion of serum albumin>35g/L and lymphocyte count in the recurrence group were lower than those in the non-recurrence group(all P<0.05).3.Comparison of the imaging characteristics of the two groups of patients: the number of tumor foci and the maximum diameter of HCC were relatively higher,the proportion of DWI/T2WI mismatch and the proportion of intratumoral arteries were higher,and the types of enhancement were type 3 and Type 4.While the percentage of complete envelope and the average ADC value and minimum ADC value of the tumor were lower than those in the non-recurrence group(all P <0.05).4.Multivariate logistic analysis showed that the proportion of AFP>400μg/L(OR=7.237,P=0.026),NLR(OR=6.499,P=0.022),enhancement type(OR=14.248,P=0.031),DWI/T2WI mismatch ratio(OR=8.233,P=0.020),average tumor ADC value(OR=0.150,P=0.049),tumor minimum ADC value(OR=0.003,P=0.041)were the recurrence of HCC patients after TACE independent risk factors.Conclusion1.HCC recurrence after TACE were independently related to AFP,NLR,tumor enhancement type,DWI/T2WI mismatch,and tumor ADC value.2.Based on the advantages of multi-sequence imaging and clinical features,multimodal MRI could predict the curative effect of HCC patients after TACE and had good clinical application value.Part2: Evaluation of risk factors of lipiodol uptake for predicting the recurrence of Hepatocellular Carcinoma after TACE based on multi-slice spiral CTObjective Multi-slice spiral CT was used to evaluate the uptake and clearance of lipiodol in tumor foci,and explored its value in predicting HCC patients after TACE.Methods Thirty-nine patients were enrolled and underwent MRI examination before TACE,and CT examination of the upper abdomen one week and one to two months after TACE.They were divided into recurrence group and non-recurrence group according to the follow-up results.The type of lipiodol uptake and clearance rate of the two groups of patients were analyzed,and the independent risk factors for postoperative recurrence and lipiodol clearance were analyzed by Logistic regression equation.Results1.The type of lipiodol uptake in the non-recurrence group was mainly type I,and in the recurrence group were mainly type II,III,and IV;the clearance rate of lipiodol in the tumor foci in the recurrence group was faster,and the differences were statistically significant(all P<0.05).2.The univariate Logistic regression equation analysis showed that there were differences between the two groups of patients in the type of lipiodol deposition,lipiodol clearance rate,and T1WI signal characteristics.The multivariate Logistic regression equation showed that the lipiodol clearance rate was an independent risk factor for predicting recurrence.3.The multivariate logistic regression equation was used to show that tumor enhancement type(OR=2.237,P=0.004),T1WI signal intensity(OR=9.236,P=0.015)and the minimum ADC value(OR=0.013,P=0.014)were predictions independent risk of lipiodol clearance rate.Conclusion1.Good lipiodol deposition in the tumor was closely related to the treatment effect.CT can well show the deposition and clearance of lipiodol in the tumor.2.The multivariate Logistic regression model showed that the lipiodol clearance rate was an independent risk factor for predicting recurrence after TACE.The type of tumor enhancement,T1WI signal intensity,and the minimum ADC value of the tumor were independent risk factors for predicting the rapid clearance rate of lipiodol.