Study On Risk Factors Of Local Tumor Progression In Hepatocellular Carcinoma Treated By Microwave Ablation As Depicted On CT And MRI

Part one:Morphologic Risk Factors of Local Tumor Progression in Hepatocellular Carcinoma treated by Microwave Ablation on CT and MRIObjective:Microwave ablation(MWA)is an effective method for the treatment of liver malignant tumors.This study investigated the morphological risk factors of local tumor progression(LTP)in the follow-up of ultrasound-guided MWA in the treatment of hepatocellular carcinoma(HCC)by CT and MRI.Methods:87 patients with HCC treated by MWA in our hospital from June 2017 to June 2021 were collected retrospectively,with a total of 113 tumor lesions.Plain and enhanced CT or MRI scans of the upper abdomen were performed within 14 days before operation,and followed up with CT or MRI after operation.The first imaging examination was completed within 1 month after MWA.Enhanced CT or MRI of the liver was performed every month within the first 3 months after operation.If there were no obvious positive results,follow-up was performed every 3 months.Univariate analysis and binary Logistic regression analysis were used to evaluate the patient’s age,gender,liver cirrhosis,tumor size,tumor location and adjacent relationship,so as to explore the risk factors of LTP after ultrasound-guided MWA in the treatment of HCC.Results:113 HCC lesions were treated with MWA,at the first follow-up CT or MRI after MWA treatment,no residual signs of tumor were found at the edge of the ablated regions,but at the second and subsequent follow-up CT or MRI,tumor tissue(LTP)was found at the edge of 20 ablated regions.The incidence of liver cirrhosis,tumor close to large vessels and fuzzy tumor boundary in patients with LTP is higher than that in patients without LTP(P<0.05).There was no significant difference in age,gender,whether the tumor was close to the diaphragm or extrahepatic organs,and whether the tumor was multiple between patients with LTP and patients without LTP(P>0.05).Binary Logistic regression analysis showed that tumor proximity to intrahepatic large vessels(odds ratio=7.251,P=0.003)and fuzzy tumor boundary(odds ratio=6.110,P=0.006)were independent risk factors of LTP after MWA treatment in HCC.Conclusion:The tumor proximity to intrahepatic large vessels and fuzzy tumor boundary are the independent risk factors of LTP after MWA treatment in HCC.Part Two:CT and MRI Measurement of Ultrasound-guided Microwave Ablation Range of Hepatocellular Carcinoma and Prediction of Postoperative Local Tumor ProgressionObjective:To study the feasibility of quantitative prediction of local tumor progression(LTP)of hepatocellular carcinoma(HCC)by combining the MWA range measured by the first imaging examination after ultrasound-guided microwave ablation(MWA)and the tumor range measured by preoperative imaging.Methods:87 patients with HCC treated by MWA in our hospital from June 2017 to June 2021 were collected retrospectively,with a total of 113 tumor lesions.Plain and enhanced CT or MRI scans of the upper abdomen were performed within 14 days before operation,and followed up with CT or MRI after operation.The first imaging examination was completed within 1 month after MWA.Enhanced CT or MRI of the liver was performed every month within the first 3 months after operation.If there were no obvious positive results,follow-up was performed every 3 months.The axial images were examined by enhanced CT or MRI within 14 days before operation,and the related parameters of preoperative tumor size were measured,including the long diameter,short diameter and tumor area of the preoperative tumor.With reference to the preoperative images,the axial maximum slice image of the preoperative tumor range was selected for the first postoperative enhanced CT or MRI examination,and the relevant parameters were measured,including the long diameter,short diameter and ablation area of the ablation focus.The long diameter difference(long diameter of ablation focus-long diameter of tumor),short diameter difference(short diameter of ablation region-short diameter of tumor),area difference(area of ablation focus-tumor area)and area ratio(area of ablation focus/tumor area)between ablation region and tumor were calculated.Mann Whitney U test and binary Logistic regression were used to analyze the independent risk factors of LTP in the above parameters,and the receiver operating characteristic curve(ROC)was further used to evaluate the efficacy of independent risk factors in predicting LTP after MWA.Results:113 HCC lesions were treated with MWA,at the first follow-up CT or MRI after MWA treatment,no residual signs of tumor were found at the edge of the ablated lesions,but at the second and subsequent follow-up CT or MRI,tumor tissue(LTP)was found at the edge of 20 ablated regions.Mann Whitney U test showed that the long diameter difference,short diameter difference,area difference and area ratio of LTP patients after MWA were less than those without LTP(P<0.05).Binary Logistic regression analysis showed that short diameter difference was an independent risk factor for LTP in HCC after MWA(odds ratio=8.910,P=0.045).ROC analysis showed that short diameter difference could better predict the occurrence of LTP after MWA in HCC patients.The area under ROC was 0.853,the sensitivity was 0.645 and the specificity was 0.950.Conclusion:The short diameter difference between postoperative ablation region and preoperative tumor is an independent risk factor for LTP in HCC after MWA,and the short diameter difference can better predict the occurrence of LTP in HCC patients after MWA.