| Objective:Intranetvoxel incoherent motion diffusion weighted imaging?IVIM-DWI?and magnetic resonance imaging?MRI?enhancement and were performed before and after transcatheter arterial chemoembolization?TACE?for hepatocellular carcinoma?HCC?,and the parameters of IVIM-DWI double index model and stretched-exponential model were quantitatively analyzed.We aim to evaluate the value of IVIM-DWI in predicting and evaluating the efficacy of TACE for HCC.Materials and Methods:Forty-six patients with HCC confirmed by clinical or pathological diagnosis from February 2017 to June 2018 who were scheduled to undergo the first TACE treatment were collected retrospectively.All patients were examined by abdominal MRI enhanced scan and IVIM within one week before the first TACE treatment and after one month after the treatment.The perfusion coefficient?D*?,perfusion fraction?f?,diffusion coefficient?D?value of IVIM double exponential model,the distribution diffusion coefficient?DDC?,stretch factor???of stretched-exponential model and tumor maximum diameter?MTD?were measured.All cases were divided into progressive group and stable group according to the response evaluation criteria in solid tumors?RECIST??Version 1.1?.The stable group included complete remission?CR?,partial remission?PR?,progression group including stable disease?SD?and progression disease?PD?.The differences of IVIM parameters D,D*,f,DDC,?and MTD before and after TACE treatment were compared by paired t-test.Independent sample t-test was used to compare the values of D,D*,f,DDC,?,MTD and the changes of?D,?D*,?f,?DDC,??,?MTD in different curative effect groups before and after TACE treatment.ROC curve was used to analyze the statistically significant parameters to evaluate the efficacy of TACE treatment in the HCCs.Results:1.A total of 46 lesions were found in 46 patients with HCCs,of which 22 were located in the left hepatic lobe,18 in the right hepatic lobe and 6 in the junction of the right hepatic lobe and the left hepatic lobe.The maximal tumor diameter ranges from2.2 to 13.5 cm,with the median of 5.2cm.2.The D values of forty-six patients before and after TACE treatment were?0.72±0.18?×10-3mm2/s and?0.98±0.27?×10-33 mm2/s,respectively;the D*values were?21.61±8.68?×10-3mm2/s and?14.81±5.52?×10-3mm2/s,respectively;the DDC values were?1.33±0.17?×10-3mm2/s and?1.52±0.17?×10-3mm2/s,the?values were?0.83±0.11?×10-3mm2/s and?0.91±0.19?×10-3mm2/s,and the MTD values were?6.09±3.17?cm and?5.07±3.10?cm,respectively.After TACE treatment,the values of D,DDC and?were higher than those before treatment,MTD,D*.The value was lower than before treatment,and the difference was statistically meaningful?P<0.05?.3.Before TACE treatment,the D values of the stable group and the progressive group were?0.78±0.16?×10-3mm2/s and?0.64±0.17?×10-3mm2/s,respectively,and the DDC values were?1.40±0.13?×10-3mm2/s and?1.23±0.17?×10-3mm2/s,respectively;and the values of?were 0.87±0.11,0.76±0.08,respectively;the values of MTD were?5.18±2.43?cm and?7.28±3.67?cm,respectively.The values of D,DDC and?in the stable group were higher than those in the progressive group,and the difference was statistically significant?P<0.05?.4.After TACE treatment,the D values of stable group and progressive group were?1.09±0.28?×10-3mm2/s and?0.84±0.26?×10-3mm2/s respectively,and the MTD values of stable group and progressive group were?3.95±2.40?cm,and?6.52±3.36?cm,respectively,which were higher than those of progressive group.MTD in stable group was lower than that in progressive group,and the difference was statistically significant?P<0.05?.5.The?D values of stable group and progressive group were?0.30±0.13?×10-3mm2/s and?0.20±0.10?×10-3mm2/s,respectively.The?D value of stable group was higher than that of progressive group?P<0.05?.6.Prediction of D,DDC,?values before TACE treatment,dynamic changes of D value after treatment and dynamic changes of D value after treatment the area under the ROC curve for evaluating the efficacy of TACE in the treatment of liver cancer was0.712,0.740,0.754,0.729 and 0.777,respectively.The sensitivity and specificity were in the order of 69.2%and 70%,76.9%and 70%,69.2%and 70.6%,73.1%and 70%,and 61.5%and 80%,respectively.The AUC value of parameter D was the most valuable,and the best diagnostic threshold value was 0.290×10-3mm2/s.Conclusion:1.The values of D,DDC,?before treatment,D value after treatment and dynamic changes of D value after treatment of IVIM could be valuable in predicting and evaluating the efficiency of TACE in the treatment of HCCs.The prediction and evaluation of dynamic changes of D value after treatment were better than those of D,DDC,?value before the treatment and D value after the treatment.2.IVIM parameters can reflect the change of tissue structure before and after TACE treatment and IVIM-DWI is expected to be a non-invasive imaging technology to evaluate and predict the curative effect of TACE in hepatocellular carcinomas. |
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