| Purpose To investigate whether changes in 3-phase perfusion computed tomography(CT)parameters may aid assessment for pathologic response to transcatheter arterial chemoembolization(TACE)in advanced hepatocellular carcinoma(HCC)and to analyze the correlation between the perfusion parameters and alpha fetal protein(AFP)so that to find the best imaging biomarker for evaluating the early curative effect of patients with hepatocellular carcinoma who were underwent transcatheter arterial chemoembolization.Methods Institutional Review Board approval was secured for the collection and analysis of this retrospective study with a waiver of informed consent.30 patients with pathologically determined HCC who underwent TACE in intervention department of our hospital between January2012 and December 2014 were collected.3-phase perfusion CT were performed before,at early-treatment(one month after the first TACE)and three month after first TACE.According to Response Evaluation Criteria in Solid Tumors(m RECIST)grading from the third CT imaging and clinical situation,all patients were divided into two groups: good response to TACE(CR: complete response and PR: partial response)and non-response patients(PD: progressive disease and SD: stable disease).The quantitative perfusion parameters including hepatic artery perfusion(HAP),portal vein perfusion(PVP),hepatic perfusion index(HPI),and Arterial Enhancement Fraction(AEF)were measured with CT-Kinetics software(GE Healthcare).All patients were followed up for 3 years to calculate their survival time.The quantitative parameters of two groups were compared by using the independent-sample t test and receiver operating characteristic curve(ROC)analysis.The correlation of the change of parameters and AFP was analyzed by using Pearson correlation test.Kaplan-Meier survival curve was used toanalyze the relationship between perfusion parameters and survival time.Results 1.17 patients with good response to TACE and 13 non-response patients.our research demonstrated that AEF decreased and the PVP increased after TACE,the post-AEF,post-PVP,the percentage change of AEF and PVP before and one month after TACE had a significant difference between the two groups.But there were no significant differences between the two groups for HAP and HPI.2.The post-AEF were(0.351±0.09),(0.438±0.05)and the change of AEF were(0.313±0.170),(0.076±0.127)in good response and non-response respectively(P<0.05).The p value was 0.392 to predict the early treatment response to TACE,the diagnostic sensitivity and specificity were 86.7%,73.2% and the area under the curve of 0.876 for the post-AEF(P<0.001),the p value was 0.127 to predict the early treatment response to TACE,the diagnostic sensitivity and specificity were 93.3%,75.4% and the area under the curve of 0.886 for the percentage change of AEF(P<0.001).3.The post-PVP were(0.259±0.126),(0.159±0.086)and the change of PVP were(0.342±0.135),(0.088±0.027)in good response and non-response respectively(P<0.05).The p value was 0.152 to predict the early treatment response to TACE,the diagnostic sensitivity and specificity were 86.7%,73.2% and the area under the curve of0.763 for the post-PVP(P<0.001),the p value was 0.211 to predict the early treatment response to TACE,the diagnostic sensitivity and specificity were 78.1%,70.9%and the area under the curve of 0.823 for the percentage change of PVP(P<0.001).4.In addition we found that the perfusion parameters were correlated with the percentage change of AFP(AEF,rho=0.515,P=0.004;PVP,rho=-0.402,P=0.03).5.After treatment,the critical value of AEF was divided into two groups,AEF < 0.392 and AEF ≥ 0.392,which were analyzed by Kaplan-Meier survival curve,and the survival time of the two groups was statistically different.(χ2 = 5.127,P = 0.024).Conclusion Among the changes in quantitative perfusion parameters deriving from conventional 3-phase CT,AEF and PVP may become a biomarker in predicting the early treatment response to TACE with HCC without increasing the extra radiation dose. |
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